Sleeve Gastrectomy

How Does it Work?





The Sleeve Gastrectomy consists of the complete removal of approximately 80-90% of the stomach. This gives the patient a much smaller stomach capacity which fills up on a small amount of food. The term “Sleeve” refers to the shape of the remaining stomach after most of it is removed, because it looks like a tube or a sleeve, rather than an external sleeve having been placed around the stomach, which is a common misconception.

The sleeve gastrectomy certainly gives patients appetite suppression, which is an important part of how it works and it's one of the major reasons why patients feel less interested in food after the surgery. It results in decrease in the hunger hormone, ghrelin. The sleeve has also helped patients decrease diabetes, high blood pressure, sleep apnea, joint pain and cholesterol levels. The average weight loss after the sleeve gastrectomy is slightly less than for the gastric bypass, (but better than the band, according to the research) but remember - the biggest determinant of your success with ANY surgery is your compliance with the program - lifetime followup with your surgeon and a lifetime commitment to eating healthy and exercising.

One advantage of the sleeve gastrectomy is that it doesn't involve operating on the small intestine, which is helpful for patients who have scar tissue surrounding their small intestine, perhaps from prior operations, hernia or from radiation damage after cancer treatment.

The sleeve gastrectomy and the gastric bypass are the two most popular operations in the country, so many patients ask about the differences between the two. It's important to understand how different operations work, so each patient can make the decision that is best for them. With so many options these days - gastric bypass, V Bloc, sleeve, band, Orbera balloon, it can be overwhelming. The most important thing is to keep an open mind and ask questions during your consultations with Dr. Ellner. You may have medical or behavioral reasons to consider one type of surgery more strongly than the others. Here are some facts about the sleeve gastrectomy that address some of the common questions that arise during initial consultation with Dr. Ellner.

The sleeve gastrectomy is IRREVERSIBLE. The gastric bypass (and the gastric banding, VBloc , and Orbera balloon) are all reversible operations. If a patient has a complication such as severe GERD, obstruction, twisting of the remaining stomach or a leak, the surgery may need to be switched to a gastric bypass. It is important to recognize that this type of surgery doesn't result in the patient getting a "normal" gastric bypass, because most of the stomach has been removed with the sleeve and a "first-time-around" gastric bypass leaves the "old stomach" in place because the body still uses the acid that it makes to digest food normally.

Long term success and complication rates of the sleeve gastrectomy are unknown, because it is a relatively new operation. The complications are being better understood and better treated with time and outcomes are certainly improving every year.

The leak rate after sleeve gastrectomy has been found to be double that of the gastric bypass. This has improved with time, however, and the leak rate after sleeve gastrectomy should continue to decline.

It is extremely important to NOT overeat after this surgery, as it places undue strain on the stomach staple line, which can rupture and cause a potentially fatal leak. This is important for patients to remember for the rest of their lives.

Some patients (up to 30% in the study above) of patients who undergo the sleeve gastrectomy will need another operation/procedure to repair a complication. This number is dropping drastically as the sleeve is better understood and patients are having less complications. Advancements have been made in the last few years that have decreased the complication rate already and further improvements are on the horizon.

Leaks after a sleeve gastrectomy can be fatal, just as they may be with any surgery. However, it is important to know that leaks after a sleeve frequently take many months (and sometimes multiple procedures/hospitalizations) to heal. Thankfully, leaks are extremely rare.

The predominant complication after a sleeve gastrectomy is increased gastro-esophageal reflux disease (GERD). In severe cases, this can cause permanent damage to the esophagus. The most effective treatment for this is re-operation is conversion to a gastric bypass. Other complications are stomach herniation into the chest, bleeding, obstruction and stricture (the stomach tube tightens down and food won't pass through).

If a patient fails to lose the desired weight with the sleeve, or has severe medical complications, the sleeve can sometimes be converted to a gastric bypass. However, it will never function as a “first time” gastric bypass because the original sleeve operation removed most of the stomach. The stomach that remains in place in a “first time” gastric bypass has the function of making digestive chemicals that allow digestion and absorption of nutrients from food. The sleeve operation removes most of the stomach so these chemicals are no longer present.

The stomach capacity after a sleeve gastrectomy is about the size of a cucumber. This helps limit the amount of food a patient has to eat before they feel full.

One aspect of the sleeve that has been improved is decreasing re-expansion of the remaining stomach. Surgeons have learned more about the best technique to perform a sleeve gastrectomy, in an effort to reduce the risk of weight regain as a result of stomach stretch.

The long term effects of permanently removing the majority of the stomach are still unknown. Patients who undergo the sleeve gastrectomy need to be closely monitored by their surgeon for malnutrition, vitamin deficiencies and hormonal abnormalities for the rest of their lives. Long term monitoring is critical in all patients who have bariatric surgery of any kind. Following up with your surgeon not only decreases your chances of having a problem, but it substantially improves your long term success!

The long term weight loss after sleeve gastrectomy is unknown. Initial studies have shown that the best pateint for a sleeve gastrectomy may be someone who might be satisfied with a 50 or 75 pound loss. Many patients fall into this category and are very happy with their sleeve surgery! Losing 50-75 pounds generally results in improvement in diabetes, joint pain, cholesterol levels, sleep apnea and blood pressure.

How well the sleeve gastrectomy will work in the long term to help weight related medical problems go away is also unknown. This will become clearer as the data is tracked in the coming years.

The above complications and concerns are certainly being studied and worked on by bariatric surgeons, in an effort to make the surgery more effective and less risky. The sleeve gastrectomy is still a new operation, so more statistics and data are being amassed every year. Dr. Ellner will be happy to share the most recent findings with you!

All surgeries have risk. It is important to remember that when considering bariatric surgery, the risk of having serious health problems and even death due to obesity is much higher than the risk of surgery. Many thousands of patients have undergone the sleeve gastrectomy and are advocates. Indeed, most bariatric patients will tell you that having weight loss surgery was the best decision they ever made, no matter what operation they had!

Please bring your questions to your consultation with Dr. Ellner so you can be fully informed of the risks and benefits of all of your options!