Sleeve Gastrectomy

The sleeve gastrectomy developed from both as an open operation called the Vertical Banded Gastroplasty (VBG) and as part one of a two stage procedure called the Biliary-Pancreatic Diversion (BPD). Over time it has rightfully become a stand-alone procedure which is now performed laparoscopically (LSG). In basic terms, the stomach size is reduced by removing 80-90% of it using those special sealing and cutting staplers – these use tiny titanium staples. The stomach that is stapled off is removed and can be sent to the laboratory for microscopic analysis if you want. Obviously, having a smaller stomach limits how much patients can eat because the new stomach is only around 100-150ml in volume. But the LSG is also associated with some hormone changes. The part of the stomach that is removed, is the part that produces hunger hormone (ghrelin) so that patients feel less hungry. Also the smaller stomach empties quicker than before and this makes patients feel full so that they eat less. Although not strictly a ‘malabsorptive’ operation, I advise patients to take extra (supplemental) vitamins and minerals every day and have regular blood tests to check that their vitamin and mineral levels are healthy. Although deficiencies are uncommon after LSG, it is possible and can be damaging so it’s safer and healthier to use supplements.

Weight loss is rapid in the first three months after surgery but it can take 18 months after a LSG for weight loss to plateau. Every person is different and it depends on the commitment and lifestyle changes that patients make but on average, patients loss around 25% of their total body weight or around 60% of their excess weight with a LSG over 18 months. But everyone is different, some lose weight faster, some slower, some lose more than this and some less. There is no way to predict exactly how much weight that patients will lose but it is uncommon not to lose some weight. This weight loss can lead to significant improvements in medical conditions such as diabetes and hypertension. Some patients go into complete ‘remission’ from their type II diabetes - meaning that they no longer require medication such as insulin or oral tablets to help them control their sugars or see improvements in their ‘sugars’. Hypertension and high cholesterol can also resolve and sleep apnoea also often improves. 

It is important to make permanent changes in lifestyle in the first couple of years after surgery while the operation is working best. As over time, the operation’s effects do fade as the sleeve will stretch over years.

· Small meals & less hunger

· Feel fuller quicker and stay fuller for longer

· Lose 25% of total body weight 

· No bypassed bowel means that the bowel is intact and the same configuration – this means that your duodenum can be accessed easily by an endoscope if necessary

· Effects on co-morbidities: resolution of type 2 diabetes, improvement in hypertension, reduce sleep apnoea etc.

· Further surgery still possible – such as conversion to a gastric bypass 

· Technically straightforward and possible up to the highest BMI

· Relatively low risks

· Small meals

· Rates of post surgery reflux high at 20%, severe reflux in 4%

· Around 25% of patients regain weight by 10 years – usually due to failure to change lifestyle

· 10% of patients fail to lose as much weight as expected

· Staple line leak in 1% (rarely life threatening but can be difficult to heal)

· In theory a permanent non-reversible procedure – stapled stomach is removed

· Daily vitamin/mineral supplements for life with annual blood tests