Diagnosis of Sleeve Gastrectomy

Sleeve gastrectomy, also known as vertical sleeve gastrectomy (VSG), is one of the most commonly performed bariatric (weight loss) surgeries in the world. It involves removing a large portion of the stomach, leaving behind a smaller, sleeve shaped stomach about the size of a banana. While the procedure has proven to be safe and effective, a thorough diagnosis and preoperative evaluation is essential to determine a patient’s eligibility and optimize surgical outcomes.

But before undergoing any surgical intervention, a patient must go through a comprehensive diagnostic and evaluation process. When people refer to the “diagnosis of sleeve gastrectomy,” they are generally speaking about the extensive medical, psychological, and nutritional assessments used to determine whether an individual is a suitable candidate for the procedure.

Understanding the Role of Diagnosis of Sleeve Gastrectomy

It’s important to clarify that sleeve gastrectomy is not diagnosed as a disease; rather, the procedure is considered as a treatment option for individuals who suffer from morbid obesity or obesity related conditions. The term “diagnosis of sleeve gastrectomy” usually refers to the diagnostic and clinical evaluations that take place before the surgery to determine whether a person is a suitable candidate.

These evaluations involve medical history analysis, physical examinations, lab tests, imaging studies, and psychological screening, among other components.

Who Qualifies for Sleeve Gastrectomy?

Before diving into the diagnostic steps, it’s crucial to understand the criteria used to assess eligibility for sleeve gastrectomy. Patients are typically considered for the surgery if they meet any of the following :-

1. A Body Mass Index (BMI) of 40 or higher (extreme obesity)

2. A BMI between 35 and 39.9 with serious obesity-related health problems such as type 2 diabetes, sleep apnea, or high blood pressure

3. In some cases, a BMI of 30 to 34.9 with uncontrolled metabolic conditions may also be considered

These benchmarks guide physicians in recommending further diagnostic workups for surgical planning.

Diagnosis of Sleeve Gastrectomy

1. Medical History and Physical Examination :- The diagnostic journey usually begins with a detailed medical history. This includes reviewing :-

   1. The patient’s weight history

   2. Any previous attempts at weight loss (e.g., diet, exercise, medications)

   3. Presence of obesity-related conditions like hypertension, diabetes, GERD, or joint disorders

   4. Past surgeries and current medications

   5. Lifestyle factors including alcohol, tobacco, and drug use

   A physical exam helps assess general health and identify any underlying medical conditions that may affect the surgical outcome or recovery.

2. Laboratory Tests and Blood Work :- A range of blood tests is necessary to ensure the body is functioning well enough to handle the stress of surgery and anesthesia. Common lab investigations include :-

   • Complete Blood Count (CBC) :- To check for anemia or infections

   • Liver Function Tests (LFTs) :- As liver health can be affected in obesity

   • Thyroid Function Tests (TFTs) :- To rule out hypothyroidism

   • Fasting Blood Glucose or HbA1c :- To detect diabetes

   • Lipid Profile :- To assess cholesterol levels

   • Kidney Function Tests (KFTs) :- To evaluate renal status

   • Vitamin and Mineral Panel :- As deficiencies are common in obese individuals

   These tests help doctors tailor preoperative care and address any deficiencies or abnormalities before surgery.

3. Imaging and Diagnostic Scans :- Certain imaging studies play a crucial role in the preoperative evaluation. These may include :-

   • Abdominal Ultrasound or CT Scan :- Used to detect fatty liver disease, gallstones, or abdominal abnormalities. A healthy liver and gallbladder are essential for minimizing surgical risks.
   • Chest X-ray :- Helps identify any cardiopulmonary issues like lung infections or heart enlargement that may complicate anesthesia.
   • Electrocardiogram (ECG or EKG) :- This simple test detects heart rhythm abnormalities or previous heart damage that could increase the risk during surgery.

4. Endoscopy (EGD) :- Many surgeons recommend an upper gastrointestinal endoscopy (EGD) to check for esophagitis, gastritis, ulcers, or H. pylori infection before surgery. This helps prevent post operative complications like acid reflux or delayed healing.

   If any gastrointestinal issues are found, they are treated first before proceeding with the surgery.

5. Psychological Evaluation :- Bariatric surgery involves not only physical changes but also significant emotional and behavioral adjustments. A psychological assessment helps determine whether the patient is mentally and emotionally prepared for the lifestyle changes required after sleeve gastrectomy.

   During this evaluation, a mental health professional checks for :-

   • History of eating disorders

   • Presence of depression or anxiety

   • Motivation for surgery

   • Understanding of post surgery commitments

   If necessary, patients may be referred for counseling or behavioral therapy before being cleared for surgery.

6. Nutritional Assessment :- A visit with a bariatric dietitian is a mandatory part of the diagnostic process. This session covers :-

   • Understanding the patient’s dietary habits

   • Educating them on post operative nutrition

   • Identifying any nutrient deficiencies

   • Planning a weight loss diet to follow before and after the surgery

   Some programs also require patients to lose a specific amount of weight before surgery to prove compliance and reduce liver size for better surgical access.

7. Sleep Study for Sleep Apnea :- Many obese individuals suffer from obstructive sleep apnea (OSA) without knowing it. A polysomnography (sleep study) may be ordered to confirm the diagnosis. If OSA is present, CPAP therapy is usually initiated before surgery to lower anesthetic risks.

8. Multidisciplinary Team Review :- After all evaluations are complete, the case is presented to a multidisciplinary bariatric team, which typically includes :-

   • Bariatric surgeon

   • Anesthesiologist

   • Psychologist

   • Dietitian

   • Medical physician (e.g., endocrinologist or internist)

   Together, they review the findings and decide whether the patient is ready and safe to undergo sleeve gastrectomy.

Conclusion

Sleeve gastrectomy is not a one size fits all solution. Its success relies heavily on thorough preoperative diagnosis and evaluation. These assessments ensure that patients are suitable for the surgery, help avoid complications, and contribute to long-term weight loss and health improvement.