Gastric Sleeve (Sleeve Gastrectomy) New Jersey
The gastric sleeve or sleeve gastrectomy procedure is a restrictive bariatric surgery, meaning that it simply restricts the amount of food a patient can eat by physically reducing the size of the stomach. In the past, it was considered the first stage of a two-part procedure – the second of which being a duodenal switch. Today, the gastric sleeve is an approved, well-tested and very popular primary bariatric procedure.
To qualify for a gastric sleeve, patients must have a BMI (Body Mass Index) of 35 or over, with one or more diseases associated with morbid obesity (co-morbidities), such as type 2 diabetes, sleep apnea, high blood pressure or high cholesterol. The sleeve may be appropriate for patients with a BMI of 40 or over regardless of their co-morbidities.
How The Gastric Sleeve Works
The gastric sleeve is most often and ideally performed in a minimally invasive manner. Four small incisions are made in the abdomen through which medical devices including a high definition camera are inserted into the abdomen. A fifth, larger incision, is made (in the navel when possible) to remove excess stomach tissue.
During the gastric sleeve procedure, the surgeon creates a small, vertically oriented, sleeve-shaped stomach pouch by creating a staple line along the greater curvature of the stomach. The result is that approximately 75-90% of the stomach is removed. The newly-created sleeve-shaped pouch holds about 90-100 cc and is not much wider than your index finger.
The gastric sleeve procedure is ideal for those patients that do not want an implanted device or intense follow up, such as with the adjustable gastric band and who do not want the bypassing of intestines (and related complications and limitations) such as with the gastric bypass. The potential risks and expected weight loss with the gastric sleeve are in between those of the adjustable gastric band and gastric bypass.
Gastric Sleeve Results
It is important to remember that results will vary between patients and multiple factors affect outcomes. While results may vary between patients, the resolution of co-morbidities (diseases associated with morbid obesity) after gastric sleeve surgery is exceptional and consistently ranks amongst the highest resolution rates of all bariatric procedures.
From an Excess Body Weight Loss (EBWL) standpoint, patients can expect to lose up to 70% of their excess body weight within several months of their surgery.
A unique and compelling result of the gastric sleeve includes the possibility of feeling fewer hunger pangs after surgery. Indeed, about half of gastric sleeve patients will feel less hungry after surgery largely because the fundus of the stomach, which produces ghrelin (a hunger hormone), is removed. While we do not know the exact mechanism, studies have shown that plasma ghrelin levels do remain low for 5 years or more after surgery
Recovery From Gastric Sleeve Surgery
Due to the minimally invasive nature of the surgery, gastric sleeve patients can expect to leave the hospital within 1 to 2 days, in most cases. Of course this all depends on the patient’s unique circumstances and how well their recovery is progressing.
The stomach area will likely remain swollen and tender for several days as the body recovers from surgery, however scarring will be minimal compared to traditional open surgery. Further, pain, blood loss and the risk of infection will be much lower when compared to a traditional open surgery.
Full recovery and return to work will depend on the patient, but usually requires 3 weeks. Strenuous activities should be avoided for at least 6 weeks. The final determination of when the patient can resume normal or strenuous activity will depend on the surgeon’s assessment at a follow-up appointment.
Benefits and Advantages of the Gastric Sleeve
The popularity of the gastric sleeve or sleeve gastrectomy among patients and surgeons alike is hard to overstate. Until recently, however, there was not enough data from long-term studies to make definitive conclusions on the effectiveness of the gastric sleeve. This is also do, in part, to the variance in how the gastric sleeve is performed as well as different patients having different levels of postoperative motivation.
- The gastric sleeve is a straightforward procedure that simply cuts away 75-90% of the existing stomach, but does not alter the intestinal tract or the digestive system. Fewer intricacies often mean fewer complications
- Improvement and resolution of the diseases associated with morbid obesity are excellent. Many studies have confirmed that the 5 year type II diabetes resolution rate rivals that of the gastric bypass in some patients
- Because the procedure is performed in a minimally invasive manner, hospital stay and recovery time as well as the risks od pain and blood loss are all reduced significantly
- Gastric sleeve patients may experience the benefits of fewer hunger pangs because the fundus, which produces the hormone ghrelin, is removed during surgery. Plasma ghrelin levels seem to remain low long after surgery
- The sleeve can be revised easily if weight loss results are not up to patient expectations. A second sleeve procedure can be performed, or the sleeve can be converted to another procedure such as the Gastric Bypass or Duodenal Switch
- Patients will not need to live with an implanted medical device like the gastric band. This benefit can also reduce the incidence of longer-term complications which are more common with an implant
- The sleeve requires fewer follow-ups than the typical gastric band surgery as there is no need for trial-and-error adjustment
- Sleeve patients will experience fewer nutritional restrictions when compared to gastric bypass – and dumping syndrome is not a significant concern. This is largely because the regular flow of food through the digestive system is not altered
- The sleeve may be most appropriate for patients with extreme BMIs that incur a relatively higher surgical risk
Of course, every procedure comes with a degree of risk – both inherent to any surgery and to the procedure itself. You can learn more about the risks of the gastric sleeve below.
Risks and Considerations of the Gastric Sleeve
Whenever we evaluate a patient for the gastric sleeve / sleeve gastrectomy, or any surgical procedure, we must ensure that the risks of surgery do not outweigh the benefits patient will enjoy as a result of the procedure. Therefore, we perform a multitude of preoperative tests, to ensure that the patient is appropriate for the surgery they wish to undergo. As with any bariatric procedure, there are the inherent risks of both surgery itself and the gastric sleeve in particular. Some of these risks are detailed below however for a full understanding of the risks of the procedure, we suggest you attend a seminar and schedule a follow-up consultation.
- The staple line created during the procedure may leak, requiring immediate attention and subsequent revisional surgery. This is a rare but serious complication. This complication usually presents itself within the first week post-operatively
- The sleeve does not provide malabsorption, which means that the rate of weight loss is slower and total potential weight loss is lower when compared to the gastric bypass
- Over time, the smaller stomach pouch can stretch, allowing for some regaining of weight over the course of five or more years. If the stomach pouch stretches sufficiently, there may be a need for an adjustment to the procedure
- Some patients may develop vitamin B-12, vitamin D, zinc, folic acid and iron deficiencies. These deficiencies are rarely serious and easily managed. As such, we prescribe multivitamins and vitamin B12 supplements for at least year or two after surgery
- Some patients may develop severe gastroesophageal reflux disease (GERD) or their existing GERD is worsened. This is a longer-term complication
- Strictures, or the narrowing of any part of the sleeve, can also occur, requiring a follow up procedure – usually a balloon dilation
- All of the complications associated with any surgical procedure, including infection and in very rare cases, death.
Some of the risks and considerations above will vary between patients – some patients may experience none, while others will experience one or more. Ultimately, together with you, our patient, our goal is to develop a surgical strategy to improve your health over the long term.
Gastric Sleeve FAQs
We know that you have questions and as such we have prepared a comprehensive set up frequently asked questions. While the answers cannot substitute for a consultation with one of our surgeons, they will offer you some additional information as you are deciding what procedure may be best for you.
Q: What is the Difference between a Gastric Sleeve and a Sleeve Gastrectomy?
A: Nothing at all – the terms are interchangeable. Some patients and physicians prefer using one term over the other.
Q: Who Is The Ideal Gastric Sleeve Patient?
A: Anyone with a BMI of 40 or over, or those with a BMI of 35 or over and have one or more obesity related diseases may qualify. Because of its excellent results and versatility, the gastric sleeve can be successful for a wide range of patients. However, a small number of patients will see their GERD or chronic acid reflux worsen. The sleeve may also be preferable to a gastric band for those who are extremely obese – with a BMI of 60 or over.
Q: What results can I expect?
A: The gastric sleeve has excellent weight loss and obesity related disease improvement potential. While individual results vary, the average patient may lose up to 70% of their excess body weight. Patients will also improve or eliminate most of their obesity related diseases, with especially high resolution rates of elevated cholesterol and blood sugar.
Q: Are All Sleeves Performed Laparoscopically?
A: Most of our gastric sleeve procedures are performed in a minimally invasive manner. However, patient specific circumstances may dictate an open procedure being safer or more effective. If patient safety is a concern, the procedure may be converted to open during surgery – this is a very rare occurrence.
Q: How Long Is The Hospital Stay After A Gastric Sleeve?
A: A typical, uneventful recovery from a laparoscopic gastric sleeve will require a 1-2 night stay in the hospital. An open procedure may require an additional day or so of observation.
Q: Is The Gastric Sleeve Reversible?
A: In short, no. Part of the stomach is removed from the abdomen during this procedure and cannot be reattached.
Q: Can You Revise A Gastric Sleeve?
A: Absolutely, yes. In fact, the gastric sleeve offers a number of revision options. The sleeve procedure can be repeated to shrink the stomach further, or the procedure can be converted to a gastric bypass or duodenal switch. Please learn more about gastric sleeve revisions.
Q: Will I Feel Hungry?
A: A number of patients will feel fewer hunger pangs as a result of a sleeve procedure. This is due to the removal of the fundus of the stomach that produces the hunger hormone ghrelin. Not all patients receive this benefit.
Q: If The Gastric Sleeve Was Originally Part Of A Duodenal Switch (DS), Why Don’t I Go All The Way With The DS?
A: The duodenal switch is an experimental procedure. While it does offer exceptional weight loss potential, it is complex, comes with a number of additional risks and considerations and may not be covered by your insurance. Additionally, the gastric sleeve is very effective as a standalone procedure and many patients will not require going any further.
Q: Is The Gastric Sleeve Right For Me?
A: The gastric sleeve is appropriate for a wide range of patients. However, you will not know if it is right for you without a thorough pre-operative examination and a consultation with one of our surgeons. The gastric sleeve is currently the most popular weight loss surgery procedure in the US, so plenty of other patients are finding it is the right choice for them. We encourage you to attend one of our free weight loss seminars.