Sleeve gastrectomy or vertical sleeve gastrectomy, is a surgical weight-loss procedure, typically performed laparoscopically, in which approximately 75 - 85% of the stomach is removed,[1][2] along the greater curvature,[3] which leaves a cylindrical, or "sleeve"-shaped stomach the size of a banana.[1][2] Weight loss is affected not only through the reduction of the organ's size, but by the removal of the portion of it that produces ghrelin, the hormone that stimulates appetite. Patients can lose 50-70 percent of excess weight over the course of the two years that follow the surgery.[2] The procedure is irreversible,[4] though in some uncommon cases, patients can regain the lost weight, via resumption of poor dietary habits, or dilation of the stomach over time, which can require gastric sleeve revision surgery to either repair the sleeve or convert it to another type of weight loss method that may produce better results, such as a gastric bypass or duodenal switch.[5]
| Sleeve gastrectomy | |
|---|---|
 Diagram of a gastric sleeve | |
| ICD-9-CM | 43.89 |
A meta-analysis of 174,772 participants published in The Lancet in 2021 found that bariatric surgery was associated with 59% and 30% reduction in all-cause mortality among obese adults with and without type 2 diabetes, respectively. This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes.[6]
Procedure
editSleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.[7]
Sleeve gastrectomy is the most commonly performed bariatric surgery worldwide.[8][9] In many cases, sleeve gastrectomy is as effective as gastric bypass surgery, including improvements in glucose homeostasis before substantial weight loss has occurred. This weight-loss independent benefit is related to the decrease in gastric volume, changes in gut peptides, and expression of genes involved in glucose absorption.[10][11]
The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia.[12] The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 36 and 40 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.[13]
Use in children and adolescents
editEndorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders[14] and the American Society for Metabolic and Bariatric Surgery,[15] sleeve gastrectomy is gaining popularity in children and adolescents. Studies by Alqahtani and colleagues have found that sleeve gastrectomy causes large weight loss in children and adolescents aged 5 to 21 years.[16] Moreover, they compared weight loss with adults and found comparable weight loss.[17] A study published in 2016 showed that growth progresses were unaffected after sleeve gastrectomy in children younger than 14 years of age.[18] Depression following the procedure has been noted in some individuals. Another side effect is insomnia. After this surgery many people can only sleep when they take melatonin or sleeping medications.[19]
Complications
editThis section needs additional citations for verification. (January 2024) |
Sleeve gastrectomy may cause complications; some of them are listed below:
- Sleeve leaking (occurs 1 in 200 patients)
- Blood clots (happens 1% of the time)
- Wound infections (occurs in about 10 to 15% of post-op patients)
- Strictures (occurs in 3.5% of post-op patients)[20]
- Aversion to food, and nausea[21]
- Damage to the vagus nerve which will cause constant nausea
- Gastroparesis, with a delay in moving food from the stomach to the small intestine
- Vomiting
- Internal bleeding
- Esophageal spasm/pain
- Gastroesophageal Reflux Disease (GERD)
- Lack of gastric intrinsic factor result in vitamin B12 deficiency[22]
- Depression after surgery[23]
- Reduced bone health[24]
- Weight regain[25]
References
edit- ^ a b "Sleeve gastrectomy". Mayo Clinic. Archived from the original on April 14, 2023. Retrieved April 21, 2023.
- ^ a b c "What is Sleeve Gastrectomy?". Hackensack Meridian Health. Archived from the original on March 7, 2023. Retrieved April 21, 2023.
- ^ Seeras, Kevin; Sankararaman, Senthikumar; Lopez, Peter P. (May 1, 2022). "Sleeve Gastrectomy". National Library of Medicine. PMID 30085577. Archived from the original on February 15, 2023. Retrieved April 21, 2023.
{{cite web}}: CS1 maint: multiple names: authors list (link) - ^ "Sleeve Gastrectomy". Columbia University Department of Surgery. Archived from the original on April 22, 2023. Retrieved April 21, 2023.
- ^ "Gastric Sleeve Surgery (Gastrectomy)". Cleveland Clinic. Archived from the original on April 26, 2024. Retrieved April 26, 2024.
- ^ Syn, Nicholas L; Cummings, David E; Wang, Louis Z; Lin, Daryl J; Zhao, Joseph J; Loh, Marie; Koh, Zong Jie; Chew, Claire Alexandra; Loo, Ying Ern; Tai, Bee Choo; Kim, Guowei; So, Jimmy Bok-Yan; Kaplan, Lee M; Dixon, John B; Shabbir, Asim (May 2021). "Association of metabolic–bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants". The Lancet. 397 (10287): 1830–1841. doi:10.1016/S0140-6736(21)00591-2. PMID 33965067. S2CID 234345414.
- ^ "The History of Sleeve Gastrectomy: Bariatric Times". Archived from the original on 2020-11-01. Retrieved 2020-10-09.
- ^ Chung AY, Thompson R, Overby DW, Duke MC, Farrell TM (August 2018). "Sleeve Gastrectomy: Surgical Tips". Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 28 (8): 930–937. doi:10.1089/lap.2018.0392. PMID 30004814. S2CID 51625639.
- ^ Spiegel HU, Skawran S (January 2011). "From longitudinal gastric resection to sleeve gastrectomy--revival of a previously established surgical procedure". Journal of Gastrointestinal Surgery. 15 (1): 219–28. doi:10.1007/s11605-010-1293-9. PMC 3023025. PMID 20725800.
- ^ Hutch CR, Sandoval D (December 2017). "The Role of GLP-1 in the Metabolic Success of Bariatric Surgery". Endocrinology. 158 (12): 4139–4151. doi:10.1210/en.2017-00564. PMC 5711387. PMID 29040429.
- ^ Cavin JB, Couvelard A, Lebtahi R, Ducroc R, Arapis K, Voitellier E, Cluzeaud F, Gillard L, Hourseau M, Mikail N, Ribeiro-Parenti L, Kapel N, Marmuse JP, Bado A, Le Gall M (February 2016). "Differences in Alimentary Glucose Absorption and Intestinal Disposal of Blood Glucose After Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy". Gastroenterology. 150 (2): 454–64.e9. doi:10.1053/j.gastro.2015.10.009. PMID 26481855. S2CID 5214667.
- ^ Paluszkiewicz R, Kalinowski P, Wróblewski T, Bartoszewicz Z, Białobrzeska-Paluszkiewicz J, Ziarkiewicz-Wróblewska B, Remiszewski P, Grodzicki M, Krawczyk M (December 2012). "Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity". Wideochirurgia I Inne Techniki Maloinwazyjne = Videosurgery and Other Miniinvasive Techniques. 7 (4): 225–32. doi:10.5114/wiitm.2012.32384. PMC 3557743. PMID 23362420.
- ^ Karmali S, Schauer P, Birch D, Sharma AM, Sherman V (April 2010). "Laparoscopic sleeve gastrectomy: an innovative new tool in the battle against the obesity epidemic in Canada". Canadian Journal of Surgery. 53 (2): 126–32. PMC 2848639. PMID 20334745. Archived from the original on 2020-02-16. Retrieved 2014-04-11.
- ^ "International Federation for the Surgery of Obesity and Metabolic Disorders". Archived from the original on 2020-11-29. Retrieved 2021-01-20.
- ^ "Bariatric Surgery Procedures". The American Society for Metabolic and Bariatric Surgery (ASMBS). Archived from the original on 2014-06-10. Retrieved 2014-03-12.
- ^ Alqahtani AR, Antonisamy B, Alamri H, Elahmedi M, Zimmerman VA (August 2012). "Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years". Annals of Surgery. 256 (2): 266–73. doi:10.1097/SLA.0b013e318251e92b. PMID 22504281. S2CID 5977126.
- ^ Alqahtani A, Alamri H, Elahmedi M, Mohammed R (November 2012). "Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study". Surgical Endoscopy. 26 (11): 3094–100. doi:10.1007/s00464-012-2345-x. PMID 22648112. S2CID 22587054.
- ^ Alqahtani A, Elahmedi M, Qahtani AR (February 2016). "Laparoscopic Sleeve Gastrectomy in Children Younger Than 14 Years: Refuting the Concerns". Annals of Surgery. 263 (2): 312–9. doi:10.1097/SLA.0000000000001278. PMID 26496081. S2CID 32909515.
- ^ "Depression after Gastric Bypass Surgery". Psychology Today. Retrieved 2019-04-18.
- ^ "Gastric Sleeve Surgery: Common Risks and Complications". Gastric Sleeve Diet Guide. 2016-10-11. Archived from the original on 2017-03-16. Retrieved 16 March 2017.
- ^ "Gastric Sleeve Complications Post Surgery". BSIG. Archived from the original on 23 July 2013. Retrieved 5 August 2013.
- ^ Lupoli, Roberta; Lembo, Erminia; Saldalamacchia, Gennaro; Avola, Claudia Kesia; Angrisani, Luigi; Capaldo, Brunella (2017). "Bariatric surgery and long-term nutritional issues". World Journal of Diabetes. 8 (11): 464–474. doi:10.4239/wjd.v8.i11.464. PMC 5700383. PMID 29204255.
- ^ "Depression after Gastric Bypass Surgery". Psychology Today. Retrieved 2019-04-18.
- ^ Stokar, Joshua; Ben-Porat, Tair; Kaluti, Donia; Abu-Gazala, Mahmud; Weiss, Ram; Mintz, Yoav; Elazari, Ram; Szalat, Auryan (January 2023). "Trabecular Bone Score Preceding and during a 2-Year Follow-Up after Sleeve Gastrectomy: Pitfalls and New Insights". Nutrients. 15 (15): 3481. doi:10.3390/nu15153481. PMC 10421136. PMID 37571418.
- ^ Noria, Sabrena F.; Shelby, Rita D.; Atkins, Katelyn D.; Nguyen, Ninh T.; Gadde, Kishore M. (2023). "Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment". Current Diabetes Reports. 23 (3): 31–42. doi:10.1007/s11892-023-01498-z. PMC 9906605. PMID 36752995.
Further reading
edit- Pitombo C (2008). Obesity surgery: principles and practice. McGraw Hill Professional. p. 177. ISBN 978-0-07-149492-2. Archived from the original on 2021-01-20. Retrieved 2020-11-07.
- Nguyen NT, De Maria EJ, Ikramuddin S, Hutter MM (2008). The SAGES Manual: A Practical Guide to Bariatric Surgery. Springer. p. 131. ISBN 978-0-387-69170-1. Archived from the original on 2021-01-20. Retrieved 2020-11-07.
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