Comprehensive Guide on Sleeve Gastrectomy

Sleeve gastrectomy, also known as vertical sleeve gastrectomy (VSG), is one of the most commonly performed bariatric surgeries worldwide. This weight loss procedure has gained popularity due to its effectiveness, simplicity, and fewer complications compared to other surgical options. Designed to help individuals struggling with obesity, sleeve gastrectomy not only supports significant weight reduction but also improves obesity related health conditions such as type 2 diabetes, hypertension, and sleep apnea.

Also known as vertical sleeve gastrectomy (VSG), this procedure involves reducing the size of the stomach to limit food intake and suppress appetite. Unlike other bariatric surgeries, sleeve gastrectomy does not involve rerouting the intestines, making it a simpler and safer option for many patients. It not only facilitates significant and sustained weight loss but also helps resolve serious obesity related conditions such as type 2 diabetes, high blood pressure, sleep apnea, and metabolic syndrome.

What Is Sleeve Gastrectomy?

Sleeve gastrectomy is a restrictive bariatric surgery that reduces the size of the stomach by approximately 75-80%. During the procedure, a large portion of the stomach is surgically removed, leaving a narrow, sleeve-shaped pouch that resembles a banana. Unlike gastric bypass surgery, sleeve gastrectomy does not involve rerouting the intestines. The smaller stomach restricts food intake and reduces hunger by impacting the production of hunger-regulating hormones such as ghrelin.

This surgery is typically performed laparoscopically, meaning it requires only small incisions and involves minimal scarring and faster recovery.

Who Is a Candidate for Sleeve Gastrectomy?

Sleeve gastrectomy is generally recommended for individuals with a Body Mass Index (BMI) of 40 or higher, or those with a BMI of 35 or more who suffer from serious obesity-related health conditions such as :-

1. Type 2 diabetes

2. High blood pressure

3. Obstructive sleep apnea

4. Non-alcoholic fatty liver disease

Additionally, candidates must have tried other weight loss methods, such as diet and exercise, without long-term success. Commitment to long-term lifestyle changes, including healthy eating and regular physical activity, is essential for sustained results after surgery.

How Sleeve Gastrectomy Works?

The sleeve gastrectomy procedure works primarily through two mechanisms: restriction and hormonal changes.

1. Restriction :- By creating a smaller stomach pouch, patients feel full with much smaller food portions, resulting in a significant reduction in daily calorie intake.

2. Hormonal Changes :- The removal of the part of the stomach that produces ghrelin, the hunger hormone, leads to decreased appetite and improved insulin sensitivity, which can significantly benefit patients with type 2 diabetes.

Unlike gastric bypass, sleeve gastrectomy does not cause malabsorption, meaning nutrients are absorbed normally, which reduces the risk of severe nutritional deficiencies.

The Procedure: What to Expect?

Sleeve gastrectomy is typically performed under general anesthesia and takes about 60 to 90 minutes. It is done laparoscopically, using small incisions in the abdomen.

Steps involved :-

1. Several small incisions are made in the abdomen.

2. A laparoscope (a thin, flexible tube with a camera) is inserted.

3. Around 75-80% of the stomach is removed.

4. The remaining portion is shaped into a tube or “sleeve.”

5. Surgical staples are used to close the stomach.

Most patients stay in the hospital for 1–2 days post surgery and are encouraged to walk soon after the procedure to promote circulation and prevent blood clots.

Benefits of Sleeve Gastrectomy

Sleeve gastrectomy offers several benefits that make it a popular choice among both surgeons and patients.

1. Significant Weight Loss :- On average, patients lose 60-70% of their excess body weight within the first 12 to 18 months.

2. Improved Health Conditions :- Many patients experience improvement or remission of obesity-related conditions such as type 2 diabetes, high blood pressure, sleep apnea, and high cholesterol.

3. Minimally Invasive :- Laparoscopic technique means shorter hospital stays, less pain, and quicker recovery.

4. No Foreign Devices :- Unlike gastric banding, no devices are implanted.

5. No Intestinal Bypass :- This lowers the risk of long-term nutrient deficiencies.

Potential Risks and Complications

As with any surgical procedure, sleeve gastrectomy carries some risks. While it is considered safe, potential complications include :-

1. Bleeding

2. Infection

3. Leakage from the staple line

4. Gastroesophageal reflux disease (GERD)

5. Nutritional deficiencies (especially if dietary recommendations are not followed)

To minimize these risks, it’s crucial to work closely with a multidisciplinary bariatric team that includes a surgeon, dietitian, and physician.

Recovery and Diet After Sleeve Gastrectomy

Recovery Timeline :-

1. First Week :- Patients start with a clear liquid diet and gradually move to full liquids.

2. Weeks 2–3 :- Pureed foods are introduced.

3. Weeks 4–5 :- Soft foods are allowed.

4. After 6 Weeks :- Transition to solid foods begins with a focus on lean protein, vegetables, and whole grains.

Physical activity can usually resume within 3–4 weeks, starting with light exercises like walking.

Regular follow-ups are essential for tracking progress, managing any side effects, and ensuring proper nutrition.

Long Term Lifestyle Changes

Sleeve gastrectomy is a powerful tool, but it is not a magic solution. Long term weight loss success depends on significant lifestyle changes :-

1. Healthy Eating Habits :- Eating small, nutrient-dense meals, avoiding high-fat and high-sugar foods, and staying hydrated.

2. Physical Activity :- Incorporating regular exercise to maintain weight loss and improve cardiovascular health.

3. Mental Health Support :- Counseling or support groups can help address emotional eating and body image issues.

Patients must also commit to lifelong vitamin and mineral supplementation to avoid deficiencies, especially vitamins B12, D, iron, and calcium.

Sleeve Gastrectomy vs. Other Bariatric Surgeries

When compared with other weight loss surgeries, sleeve gastrectomy offers a middle ground solution.

1. Versus Gastric Bypass :- While bypass may result in slightly more weight loss, sleeve gastrectomy has fewer complications and no risk of intestinal blockage or “dumping syndrome.”

2. Versus Gastric Banding :- Sleeve gastrectomy does not require device implantation or regular band adjustments and generally results in greater weight loss.

Ultimately, the best surgical option depends on the patient’s individual health status, goals, and preferences.

Conclusion

Sleeve gastrectomy is a transformative procedure that can significantly improve the quality of life for individuals struggling with severe obesity. With its ability to deliver sustainable weight loss, improve or resolve chronic conditions, and require fewer post op complications, it’s no surprise that it has become a leading choice in bariatric surgery.