Weight loss solutions- Gastric Sleeve

What is the Sleeve Gastrectomy?

The Sleeve Gastrectomy (also referred to as the Gastric Sleeve, Vertical Sleeve Gastrectomy, Partial Gastrectomy, or Tube Gastrectomy) is a relatively new procedure for weight loss. It involves the permanent removal of 85-90% of the stomach, performed under a General Anaesthetic using advanced laparoscopic keyhole surgery.

Although the physical size of the stomach is reduced, the normal direction of the food stream through the stomach and the rest of the intestinal tract is not altered. This means that all nutrients including vitamins, minerals and protein will continue to be absorbed normally. It simply reduces the holding capacity from about 1.5 litres of food and liquid to approximately 200mls. This allows a person to feel comfortably satisfied and full with a meal size approximately equivalent to a cup of food.

Typically, Sleeve Gastrectomy patients will have between 4-6 small meals per day, which is actually the ideal way to eat. Dietitians recommend small frequent meals as a way of avoiding big swings in Insulin levels and achieving a more even intake of calories as part of a healthier eating pattern.

Despite being smaller, the stomach sleeve still functions normally- 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 normally.

How does it work?

The Sleeve Gastrectomy appears to work in three distinct ways:

The major reduction in stomach capacity allows patients to become full and satisfied with a much smaller meal, providing portion control.
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.
There appears to be a change in way that fatty foods are handled by the digestive track- patients frequently report losing their taste for foods high in sugar and fat such as chocolate, fried food and soft drink, which seem to make them feel more bloated, unsettled, or queezy. Dietitians like this aspect of the Sleeve- it helps patients adopt healthier eating habits.

Am I Eligible?

The Sleeve Gastrectomy procedure may be suitable if:

You have a BMI of at least 35 (click here to check your BMI)
you have not been able to control your weight despite several genuine attempts at diet and exercise
Your weight problem is not caused by an underlying endocrinological disorder or medication
You are at least 16 years of age (note there is no upper age limit)
you are prepared to participate in long term medical follow-up

If you also have type-2 diabetes, high blood pressure, sleep apnoea, or other obesity related medical disorders, or have a family history of these problems, weight loss surgery may be especially beneficial in improving your health and longevity.

The Sleeve Gastrectomy procedure may not be possible if you have had some types of surgery on your stomach organ in the past. Examples of surgery that may make it impossible to have a Sleeve include anti-reflux or hiatus hernia surgery, and removal of part of your stomach to treat cancer or an ulcer. Please check with us if you have a history of any procedures on your stomach organ.

Converting from a Band to the Sleeve

It is possible to convert to the Gastric Sleeve if you have a Gastric Band, or have had one in the past, and have not succeeded in losing enough weight. However the conversion needs to be performed in 2 stages in order to reduce the risk of a staple line leak. The band is first removed to allow the reactive capsule that forms as a normal response to the Band to dissolve, and let the stomach wall thickness return to normal. Because the staples will need to go through this area, it is very important that the stomach wall is as normal as possible for good healing. The band removal procedure is very straight forward, and only takes about 30 minutes and can be done as day surgery. The Gastric Sleeve is then performed as a separate procedure 3 months later, and involves the usual 3-4 day stay in hospital.

The risks in converting from one type of bariatric procedure to another are higher than for a primary procedure. This increased risk has to be balanced against the perceived benefits of changing. It is important to understand why the Band has not worked for you. Everyone circumstances are unique, and Dr Taylor and the team will meet with you to go through your situation and explain your options.

What are the risks of Gastric Sleeve?

Because the stomach itself has to be divided, there are some additional risks over Gastric Banding in the early post-operative period. One problem is that gastric fluid may leak through the staple line if healing along the staple line is not perfect. This causes infection around the outside of the Gastric Sleeve, and can be quite serious. Recovery may take several weeks, and treatment usually involves the use of antibiotics, surgical drains, and gut rest.

Additional procedures such as re-operation and endoscopy are also commonly needed. The risk of this complication is around 1%, and 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.

If you live outside Sydney, our policy is that you stay in Sydney for a total of 2 weeks from the date of your surgery before returning home. This allows us to be able to help you in the event of a staple line leak. We have negotiated a reduced tariff at a local hotel for OClinic patients who do not have relatives or friends to stay with.

Other complications that can occur include internal injuries, bleeding, blood clots in the leg veins or lungs, infections in the abdomen, chest or wounds, and allergic reactions to anaesthesia or medication. These problems may occur following any surgical procedure, and precautions are taken in all patients to reduce these risks to the absolute minimum.

Our Results

We have performed over 400 sleeve gastrectomy procedures, and more than 2000 weightloss operations overall at OClinic. Our rate of significant complications is less than 1%, and we have never had a patient die. We carefully monitor all of our patient outcomes and would be more than happy to discuss our results with you in detail at your initial consultation.

Does my diet have to change after Sleeve?

There are no real dietary restrictions after the sleeve gastrectomy, and most people find they can continue to enjoy the same types of food as before, just in smaller amounts. Foods that can sometimes be challenging for the gastric band such as meat, stringgy vegetables and bread are generally OK with the sleeve. It is still important to eat slowly and chew well, and stop eating the moment you feel full. It usually takes between 3-6 months for the sleeve to fully settle in and eating quality improves greatly during this time. Our dieititans are here to help you at any time.

What will my recovery be like?

You will normally need to stay 3-4 days in hospital after your Gastric Sleeve operation. This is mainly to allow the temporary swelling around your Gastric Sleeve to settle before you go home. You will be feeling quite well however and will be able to comfortably watch TV, meet with family and friends, and go for short walks. Once you are drinking well, your IV drip can be removed and you can go home.

First two weeks at home

During the first two weeks at home, you will be on a liquid-only diet. It is important not to have any solid food during this time, as the Sleeve is still quite swollen and is not yet ready for normal food. Liquids will be fine though, including coffee and tea, protein shakes, smoothies, etc. It’s quite easy to be filled up during this phase as you will not be hungry because of the removal of the hunger hormone producing cells in the Sleeve Gastrectomy. You will be provided with a lot of clear instructions and literature by our dietitians, and you are welcome to call the clinic for advice at any time.

Time off work

As a minimum you should take one week off work after the Sleeve operation. Most people take two weeks off (including the time spent in hospital), and this is a comfortable timeframe. We are more than happy to provide a medical certificate (for work which does not mention the type of surgery you've had). You will be provided with pain relief tablets after surgery and most patients find they rarely need more than a couple of tablets once they go home- this is because the operation is performed via small keyhole incisionslaparoscopically.

Appointments after surgery

At the two week mark, you will come back in to Oclinic for further medical and dietary consultations. (These are all included in your initial cost payment). At this point, most patients feel they've mostly recovered from the surgery and are ready to return to normal life activities. Your wounds will be checked to make sure that they are healing properly, but no sutures need to be removed as Dr Craig Taylor uses invisible self-absorbing sutures underneath the skin. You will be able to progress your diet to include soft foods and purees at this point, for the next two weeks. After four weeks, you will be able to return to eating normal solid food again.

From then on, we will schedule clinic appointments (medical, dietary and psychological) every 3 months for you until your goal weight is reached. Of course, if any problems arise, you can come back any time in between at no charge. Phone consultations can be arranged if it is difficult for you to attend the clinic in person.

Once your goal weight is reached (typically by 9-12 months), your appointments can start to become less frequent, however we like to keep in touch at least once per year long term to check that everything is going well. There will be no additional cost to you at any time from OClinic.

Click here to read about Gastric banding.