Gastric Sleeve
What is a Sleeve Gastrectomy?
The SLEEVE GASTRECTOMY (SG), also known as the GASTRIC SLEEVE, has been performed by Dr Hatzifotis in Australia since at least 2008, and has now become the most commonly performed Weight Loss procedure in Australia, the USA, and around the world.
Currently in Queensland, approximately 80% of patients undergoing primary weight loss surgery are having the LAPAROSCOPIC SLEEVE GASTRECTOMY performed. More than 5000 Gastric Sleeve procedures are performed in Queensland every year now.
The SLEEVE GASTRECTOMY was originally designed as the first component of the more complicated and radical weight loss procedure called the DUODENAL SWITCH.
The SLEEVE GASTRECTOMY involves permanently removing the lateral 2/3 of the stomach with a stapling device. This reduces the size of the stomach from the size of a football to the size of banana. Another way of explaining the procedure is that it basically leaves a narrow stomach tube instead of a stomach sack. The holding capacity of the stomach is reduced from about 1.5-2 Litres of food and liquid down to about 200-250mls.
Dr Hatzifotis does this using a 32Fr (1cm) Bougie to calibrate the appropriate size of the Gastric Sleeve.
Despite the stomach sleeve being smaller, it still functions like a normal stomach. Food and nutrients continue to enter and leave in the same way, acid continues to be made to assist in digestion, and essential vitamins and minerals such as B12, calcium, folate and iron can be absorbed in the normal way.
The normal direction of food from the mouth into the stomach and then into the intestinal tract is not altered. The absorption of nutrients in the intestine is also not altered. There is no malabsorption to nutrients as there is with the GASTRIC BYPASS procedure.
As a result of this much smaller stomach, patients feel full after eating much less food. Patients who have had a SLEEVE GASTRECTOMY eat approximately 1/4 of what they used to eat.
The one major advantage of the SLEEVE GASTRECTOMY procedure over other weight loss procedures is that patients can eat a wider variety of foods. Most patients who have undergone SLEEVE GASTRECTOMY surgery can eat all the foods they used to eat prior to their surgery, but in much smaller quantities, and feel full for several hours.
The GASTRIC SLEEVE procedure is performed laparoscopically (keyhole surgery). However, unlike the GASTRIC BAND it is not reversible.
How Does It Work?
| The Sleeve Gastrectomy appears to work in 4 distinct ways: |
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| 1. The major reduction in stomach capacity allows patients to become full and satisfied with a much smaller meal, providing portion control. |
| 2. Levels of the hunger hormone Ghrelin are reduced by 50-65%, as the removed part of the stomach is rich in cells that make that hormone. Patients consistently report feeling less hungry between their meals as a result of this. |
| 3. There appears to be a change in the way that fatty foods are handled by the digestive track- patients frequently report losing their taste for foods high in fat and sugar such as fried food, chocolate and soft drink, which seem to make them feel more bloated, unsettled, or queasy. Dietitians like this aspect of the Sleeve as it helps patients adopt healthier eating habits. |
| 4. The narrower stomach created can lead to more rapid delivery of food into the lower intestine, which then causes the earlier release of intestinal gut hormones that make the patient feel satiated, less hungry and less interested in food sooner after a meal. |
What are the Advantages of the Sleeve Gastrectomy?
| Preferred Bariatric surgery for the majority of patients |
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| Safe procedure – Dr Hatzifotis has an outstanding safety record with an overall early complication rate of less than 1% |
| Dr Hatzifotis no longer performs GASTRIC BAND surgery as the GASTRIC SLEEVE is proven to be more successful long term and not as restrictive as the GASTRIC BAND. |
| Patients can eat normal foods and a greater variety of foods, but in smaller proportions. |
| Patients will lose on average 70% of their excess weight in the first 9-12 months following surgery |
| The procedure is performed laparoscopically through 5 small incisions - less pain, fewer respiratory complications & quicker recovery |
| Patients experience very few adverse issues when eating, as there are no alterations to the direction of food into the intestinal tract or to the digestion of food in the stomach or the absorption of nutrients in the intestine |
| No prosthetic device involved like with a GASTRIC BAND, therefore fewer long term risks |
| No adjustments every 4-6 weeks required, as with the GASTRIC BAND |
How Much Weight Will I Lose with a Sleeve Gastrectomy?
- You will lose approximately 70% of your excess weight in the first 9-12 months following surgery eg: If your BMI is 50.1 and you have a height of 163cm and weigh 133kg – your excess weight is 67kg. After surgery, you would be expected to lose approximately 47kg on average. Some patients will lose more.
- Most patients will lose most of their excess weight if they adopt healthy eating habits combined with regular physical activity. Some will lose all of their excess weight and more.
- Those committed to a healthy lifestyle change, will lose more weight than those who are less active and have unhealthy eating behaviours and diets.
What are the Risks of the Sleeve Gastrectomy?
As with any surgical procedure, the GASTRIC SLEEVE operation has risks which are important to clearly understand before proceeding.
The following is a comprehensive list of issues which can occur. Most of these complications are very rare.
Dr Hatzifotis takes measures directly aimed at reducing these risks, but if complications occur, additional treatment may be necessary.
Possible Acute Complications may include (but are not limited to):
- Fragile stomach - Due to the stomach being divided and stapled, and the new smaller stomach being held together with 3 rows of staples, the stomach will be fragile in the first 4-6 weeks while it is healing.
- Leak - Gastric Fluid may leak through the staple line. This occurs within the first few days after surgery, but may occur within 4-5 weeks following the procedure. It causes a serious infection around the outside of the Gastric Sleeve, and may requires urgent surgery to remove the infection and control the leak. Recovery may take several weeks following this complication.
The risk of a Leak complication with Dr
Hatzifotis is approx. between 1/500 to 1/1000 patients. The risk of developing this complication is primarily dependent on the surgeon's technique and precision in performing this procedure. It is also dependent on the patient’s ability to heal well after surgery and on the ability of the patient to adhere to their specific post-operative diet and post-operative instructions in the first 4-6 weeks
- Signs & Symptoms of a Leak - A leak is suspected if a patient develops fevers or abdominal pain in the early post- operative period.
- Treatment of a Leak - Early treatment is the key to managing this problem successfully, so it is important to be on the watch for these symptoms and return back to the hospital without delay if concerns exist. If you live outside Brisbane, Dr Hatzifotis will ask that you stay in Brisbane for a total of 2 weeks from the date of your surgery before returning home. This allows us to be able to help you quickly in the event of a staple line leak.
- Other Uncommon Complications – Precautions are taken in all patients to reduce any risks to the absolute minimum. The following complications are uncommon & unusual, and may occur following any surgical procedure:
- Internal injuries to nearby organs such as the spleen
- Bleeding - 1/1000 patients
- Blood clots in leg veins, lungs or abdomen - 1/1000 patients
- Infections in abdomen, chest or wounds
- Allergic reactions to anaesthesia or medications
What are the Long term Risks of the Sleeve Gastrectomy?
There are very few long term problems following a Sleeve Gastrectomy that have been reported to date.
Possible long term complications may include (but are not limited to):
- Gastric Sleeve stretched & Weight regain – It is an uncommon problem where the gastric sleeve may stretch leading to late weight regain. This may occur if a person regularly tries to eat more than the stomach can comfortably hold and isn’t following dietary advice appropriately. If you eat too much food at once this can stretch the small stomach pouch making it easier to take larger volumes at meal times in the future.
It is important that a person having a Sleeve Gastrectomy respects their new smaller stomach and avoids overeating. As with all weight loss procedures, there is a need to complement the surgery with changes in eating behaviours, lifestyle, and physical activity.
- Treatment: To reduce the risk of your sleeve stretching & weight-regain, it is highly recommended that a patient works with their sleeve as a tool, follows the Health Management Program, maintains regular contact with their surgeon, and makes a genuine attempt to improve diet and lifestyle.
However, in the event of a significant increase in the stomach capacity over time, there are a number of rescue procedures, such as a GASTRIC BYPASS that may be performed to help patients with ongoing weight loss.
- Gastro-Oesophageal Reflux - may occur in 5-10% of patients following a Sleeve Gastrectomy. The symptoms of this may only last a few months after surgery, but less commonly can continue long term. The reasons for developing gastro-oesophageal reflux following Sleeve Gastrectomy surgery are varied, but measures can be taken during your surgery to reduce the incidence of developing this post operatively. Some patients find that their gastro-oesophageal reflux improves after a Sleeve Gastrectomy surgery.
- Treatment: Medications such as Nexium or Somac, are easily available and very effective and may be prescribed to alleviate the symptoms of gastro-oesophageal reflux if it exists.
- Vitamin or Mineral Deficiencies - The incidence of developing any vitamin or mineral deficiencies after a Sleeve Gastrectomy surgery is low. It is less common than after a Gastric Bypass or Mini-Gastric Bypass surgery. Dr Hatzifotis recommends all patient take a daily multivitamin and calcium supplement following surgery to reduce the chance of this problem occurring. Your vitamin and mineral levels will be checked before surgery and 6months, 12months, and annually following surgery to detect these problems should they exist.
