Sleeve gastroplasty is a form of stomach reduction to treat obesity. During the operation, most of the stomach is removed, so that only a piece is left that looks like a sleeve, and the patient becomes saturated much faster as a result. Below you will find out all about the most important aspects of the operation, its benefits and risks.
What is Sleeve Gastroplasty?
Sleeve gastroplasty or sleeve resection is a stomach reduction surgery to treat obesity. The technique is based on the principle of food restriction. As a result of the intervention, the size of the stomach is reduced to about the size of a small banana. This means that the stomach is filled with a small amount of food. Stomach filling leads to the stretching of the stomach walls, which in turn gives rise to a feeling of fullness.
Moreover, sleeve gastroplasty seems to stimulate appetite inhibiting hormonal processes. There are signs that after sleeve resection the stomach produces a very low quantity of the so-called hunger hormone "ghrelin" and thus the appetite is further decreased. Concurrently, the appetite inhibiting neurotransmitters are released. These include, for example, GPP-1 and peptide YY.
Neurotransmitters have a positive effect on various metabolic processes (metabolism). Therefore, stomach reduction surgery is increasingly referred to as metabolic surgery. For example, many patients with diabetes mellitus type 2 have significantly improved after surgery.
Sleeve gastroplasty is increasingly being performed all over the world. In Germany, sleeve resection is the most common intervention in bariatric surgery.
Preparation for Sleeve Gastroplasty
Certain preoperative examinations should be carried out immediately before the operation. These include screening of the esophagus, stomach and duodenum (esophagogastroduodenoscopy) to detect the occurrence of pathological changes, such as inflammation, ulcers or tumors. In addition, ultrasound of the epigastric area can be performed to monitor the state of the liver, gallbladder and pancreas. To prepare for anesthesia, an ECG and, if necessary, a pulmonary functional test are also required.
Particularly in cases of severe obesity (BMI over 40 kg/m²) with fatty liver disease, the so-called liquid diet rich in protein is recommended before sleeve gastroplasty. It should start approximately 10-14 days in advance depending on the clinic. During this time, the patient should eat only liquid, protein-rich food. The use of this liquid diet is intended to reduce slightly the weight and fatty liver hepatosis. You can get detailed information concerning this preoperative liquid diet directly from your doctor.
How the Operation Proceeds
During sleeve gastroplasty, most of the stomach is removed. There should be left from two to three centimeters of a thin sleeve (gastric sleeve) with a capacity of approximately 80-120 milliliters.
Sleeve gastroplasty is performed under general anesthesia. But there is usually no need for large incisions in the abdominal wall, the intervention is carried out minimally invasively through a few small incisions in the abdominal wall. The operation lasts a little longer than one hour and is usually carried out in several stages.
- After the surgical instruments and cameras are inserted, the abdominal cavity is filled with gas (usually carbon dioxide) to provide better access to the organs and visibility.
- Then the surgeon uses the so-called stapler to suture along the curved lower edge of the stomach (high curvature). The stapler has two functions. It separates the lower part of the stomach, and at the same time the incision is fastened with clips that connect the edges of the wound and seal the gastric sleeve. This means that there is no need for time-consuming manual suturing.
- The separated part of the stomach is removed from the abdomen through one of the accesses in a special plastic bag. Finally, a colored substance is injected into the stomach via the stomach probe. This is to check the integrity of the clip seam along the resection line. If the colored substance is not visible anywhere, the operation can be completed.
For Whom Sleeve Gastroplasty Works
Sleeve gastroplasty is an effective way to lose weight for people with an extremely high body mass index (BMI) of 40 kg/m². In the case of concomitant conditions such as diabetes, which can improve as a result of weight loss, sleeve gastroplasty is indicated with a BMI of 35 kg/m² or more.
The prerequisite is that the patient has made several unsuccessful attempts to lose weight (through diet and lifestyle changes) under medical supervision. The patient must be between 18 and 65 years of age.
Sleeve Gastroplasty as an Intermediate Objective
For people who are extremely overweight, sleeve gastroplasty is sometimes performed as the first step in complex bariatric surgery. When the patient loses weight and thus the surgical risks are reduced, the second step is to perform another more effective operation, such as a biliopancreatic shunting or a Roux-en-Y gastric bypass. These procedures not only restrict food intake (restriction), but also reduce absorption (malabsorption).
Who Sleeve Gastroplasty is not Suitable for
Sleeve gastroplasty is not suitable for people who are overweight as a result of the consumption of soft, high-calorie food or beverages, for example, when consuming large quantities of sweets, sweet or alcoholic beverages, as such food passes through the gastric sleeve almost without stopping, and fails to fill it and cause a feeling of fullness.
In these cases, a more appropriate option is malabsorption, such as gastric bypass. Sleeve gastroplasty is also not suitable for people with reflux disease. Gastric juice reflux and heartburn may worsen after surgery.
Effectiveness of Sleeve Gastroplasty
The chances of success in terms of weight loss with sleeve gastroplasty are very high. The first studies show that, on average, the patients were able to lose from 33 to 83% of their excess weight. Since sleeve gastroplasty is a relatively recent surgical technique, there is no long-term data on the effects of this technique.
Some people regain weight a few years after the weight loss. A technique very similar to sleeve gastroplasty, the so-called " gastric canal mill gastroplasty", helps to understand the long-term expectations. During this nowadays uncommon operation, a gastric sleeve is also created and the rest of the stomach remains in the body. This technique, similar to sleeve gastroplasty, according to the study of five-year data, has shown a loss of up to 60% of excess weight.
Advantages of Sleeve Gastroplasty over Other Techniques
In contrast to other surgical techniques in the case of sleeve gastroplasty, the function of the stomach is generally preserved. The cardia and the gatekeeper are also retained. Therefore, after a postoperative gradual return to normal nutrition patients can eat almost everything again, only in smaller amounts.
The intervention requires less time and is more sparing than, for example, gastric bypass. But on the other hand, sleeve resection is significantly more effective than gastric banding.
After the operation, patients need to artificially replenish vitamin B12 levels in the body with injections (intramuscularly or as short-term infusions) throughout their lives, as the intestine can no longer absorb adequate amounts of vitamin B12. The reason for this is that most of the stomach is removed and there is insufficient "internal factor", the protein required to absorb vitamin B12 from the intestine.
Sleeve gastroplasty cannot be reversed if, for example, the patient has successfully lost weight.
Risks and Complications
As with any operation, problems and complications can arise during and after sleeve gastroplasty. In addition to the typical risks associated with the use of anaesthesia, these risks also apply:
- Blood vessel damage with bleeding
- Damage to other organs
- Disorderly closure of the sutures or suture infection
- Gastric suture line leaks (suture failure) resulting in penetration of stomach contents into the abdominal cavity and risk of peritoneal inflammation (peritonitis)
- Temporary gastrointestinal dysfunction
- Abdominal adhesions
Compared to other bariatric interventions, sleeve resection results in a negligible percentage of complications. Individual risks are highly dependent on the patient's state of health.
After sleeve gastroplasty, nutrition, usually for 1-2 weeks, consists of soft or liquid food. The doctor then gives you a nutrition plan so that you can gradually return to a normal eating pattern. Over a long period of time, the daily meal is divided into 5-7 small meals.
Basically, a few weeks after sleeve gastroplasty, all foods are allowed again if the body tolerates them well. However, in order to reduce weight effectively, it is necessary to radically and for a long time change the eating habits and lifestyle. Sleeve gastroplasty is only one, though effective, way of treating obesity.