Sleeve Gastrectomy

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.

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.

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.

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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.

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. Patients will be on a modified diet for the first 6 weeks during the healing stage.

Patients' physical activity is limited to walking in the first 6 weeks and strenuous physical activity should be avoided.

Leak 

Gastric Fluid may leak through the staple line. This may occur anytime within 4-5 weeks following the procedure.

A leak is suspected if a patient develops fevers or abdominal pain in the early post-operative period.

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.

Leak complication with Dr Hatzifotis is approx. between 1/500 to 1/1000 patients.

Gastro-Oesophageal Reflux

This may occur in approximately 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.

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 to reduce the chance of this problem occurring.