Sleeve Gastrectomy
One of the most common bariatric procedures that has performed worldwide so what is sleeve gastrectomy it is one of the most common and most popular bariatric procedures that is performed all over the world it is normally performed in a minimally invasive fashion or a keyhole fashion either laparoscopic or in some of the countries robotic it is not reversible once a portion of the stomach is cut out we cannot actually rejoin it it is effective in majority of the cases up to 85 percent of the cases the biggest Advantage is it allows natural eating habits and with major complications being in the range of one to five percent most of that is leak it is one of the safest bariatric procedures out there it has fewer problems and if need be it can be converted to other bypasses in the future without compromising the anatomy of the bowel.
So it was introduced in late 1990s at that point of time it was done in an open fashion the first Keyhole or laparoscopic sleep gastrectomy was performed in 2000 and since then it has gained huge uh popularity so who actually qualifies for Sleep gastrectomy it depends on a number of factors and that needs to be decided as a discussion between yourself as well as your specialist it majorly depends on your BMI with the current International guidelines anybody over the BMI of 30 or body mass index of 30 qualifies for a bariatric surgery it’s ideally suited for class 1 and Class 2 obesity although we do it sometimes in class three obesity as part of other procedure or as a first stage leading on to more complex bypasses it also depends on presence or absence of other medical issues such as diabetes high blood pressure and sleep apnea and as well as presence or absence of reflux so how actually it works so sleep gastrectomy involves taking out about 75 to 80 percent of your stomach thereby reducing the capacity of the stomach so the reduced capacity reduces the appetite as such forcing you to eat less and less now having taken out majority of the stomach where a hormone called gurlin is produced we actually make sure that the girl in production is reduced gerlin is a appetite stimulant so less of curdling means better satiety or early satiety the other mechanism with which slea gastrectomy induces weight loss is controlling two other hormones cholecystokinin and pancreatic polypeptide that are produced in the small bowel they are normally appetite supplements by increasing these hormones which is the effect of sleep gastrectomy the appetite is furthermore increased sorry furthermore decreased so how it is done it is mainly done in a keyhole fashion with either four or five laparoscopic or robotic ports a stomach is converted into a tube by firing of multiple Staples and removal of about 75 to 80 percent of the stomach on the left hand side thereby converting the whole stomach into a tube thereby reducing the volume and the volume reduces appetite and brings about early satiety and as I said before it has a normal passage of food without disturbing the anatomy for future operations or majorly in any sense how does it compare to other bariatric procedures now one of the most common bariatric procedures out there apart from sleep is a ruin-wide bypass or a R1 y gastric bypass so sleeve achieves about 60 percent of the excess weight loss compared to 70 excess weight loss of the bypass so what is what is excess weight loss considering 25 as 25 BMI as the ideal BMI any excess weight beyond that is called excess weight and we tend to achieve about 60 to 70 percent of excess weight loss by doing sleeve gastric 2. the weight loss is consistent the success rates are about 80 percent the effects on diabetes is significant especially if the diabetes is mild or severe sleeve gastrectomy is probably one of the best choices it might not be the case if the diabetes is moderately controlled or moderately severe in which case the bypass is probably a better option the complications rates are much smaller in the range of one to five percent the nutritional deficiencies or nutritional effects are much lower and eating is not usually a problem now in terms of other side effects there are some GI side effects such as diarrhea and constipation which is also associated associated with other bariatric surgeries dumping is not noticed in sleeve generally but on the other hand the complication that we need to keep an eye on or a side effect is the reflux the sleeve being a tube increases the pressure in the tube that only forces the acid to go up now not everybody gets affected by it but it needs to be kept an eye on what happens after the sleeve gastrectomy it’s ideal and it’s preferable and recommended that you follow up with your surgeon as well as the dietitian for at least the first two to three years ideally lifelong first two to three years is a crucial period where the weight loss is maximum but at the same time the weight regain or plateauing of the weight is also seen in the first two years and this is where additional intervention or treatment by a surgeon or dietitian is vital endoscopic surveillance or having gastroscopy regularly is something that is becoming more popular the reason behind this is as I have said before sleep gastrectomy converts the stomach into a tube and potentially increases the reflux now the reflux is reflux affects the quality of life but also the amount or the degree of reflux can also give rise to something called balanced esophagus paroxysophagus may or may not be symptomatic and it’s a condition that can give rise to cancers of the food pipe or the esophagus so ideally long-term follow-up by both The insurgents dietitian with frequent uh sorry with uh endoscopic surveillance is preferable now long-term outcomes are achieved by following certain rules and surgery helps with the physiology of the appetite but it does not fix poor nutritional choices or bad eating behaviors which is what we need to fix as well if need be a psychologist will be included in the multidisciplinary team to help the patients along with the surgeons and the dietitians lifestyle and eating habits must change for a long-term outcome especially in the first two years because as I said before the weight loss is maximum in the first two years as well as weight regain or plateauing is also seen in around second and third year at the same time so finally surgery plus lifestyle together is what gives us success as well as sustained success but a sustained success and long-term outcome.
So it was introduced in late 1990s at that point of time it was done in an open fashion the first Keyhole or laparoscopic sleep gastrectomy was performed in 2000 and since then it has gained huge uh popularity so who actually qualifies for Sleep gastrectomy it depends on a number of factors and that needs to be decided as a discussion between yourself as well as your specialist it majorly depends on your BMI with the current International guidelines anybody over the BMI of 30 or body mass index of 30 qualifies for a bariatric surgery it’s ideally suited for class 1 and Class 2 obesity although we do it sometimes in class three obesity as part of other procedure or as a first stage leading on to more complex bypasses it also depends on presence or absence of other medical issues such as diabetes high blood pressure and sleep apnea and as well as presence or absence of reflux so how actually it works so sleep gastrectomy involves taking out about 75 to 80 percent of your stomach thereby reducing the capacity of the stomach so the reduced capacity reduces the appetite as such forcing you to eat less and less now having taken out majority of the stomach where a hormone called gurlin is produced we actually make sure that the girl in production is reduced gerlin is a appetite stimulant so less of curdling means better satiety or early satiety the other mechanism with which slea gastrectomy induces weight loss is controlling two other hormones cholecystokinin and pancreatic polypeptide that are produced in the small bowel they are normally appetite supplements by increasing these hormones which is the effect of sleep gastrectomy the appetite is furthermore increased sorry furthermore decreased so how it is done it is mainly done in a keyhole fashion with either four or five laparoscopic or robotic ports a stomach is converted into a tube by firing of multiple Staples and removal of about 75 to 80 percent of the stomach on the left hand side thereby converting the whole stomach into a tube thereby reducing the volume and the volume reduces appetite and brings about early satiety and as I said before it has a normal passage of food without disturbing the anatomy for future operations or majorly in any sense how does it compare to other bariatric procedures now one of the most common bariatric procedures out there apart from sleep is a ruin-wide bypass or a R1 y gastric bypass so sleeve achieves about 60 percent of the excess weight loss compared to 70 excess weight loss of the bypass so what is what is excess weight loss considering 25 as 25 BMI as the ideal BMI any excess weight beyond that is called excess weight and we tend to achieve about 60 to 70 percent of excess weight loss by doing sleeve gastric 2. the weight loss is consistent the success rates are about 80 percent the effects on diabetes is significant especially if the diabetes is mild or severe sleeve gastrectomy is probably one of the best choices it might not be the case if the diabetes is moderately controlled or moderately severe in which case the bypass is probably a better option the complications rates are much smaller in the range of one to five percent the nutritional deficiencies or nutritional effects are much lower and eating is not usually a problem now in terms of other side effects there are some GI side effects such as diarrhea and constipation which is also associated associated with other bariatric surgeries dumping is not noticed in sleeve generally but on the other hand the complication that we need to keep an eye on or a side effect is the reflux the sleeve being a tube increases the pressure in the tube that only forces the acid to go up now not everybody gets affected by it but it needs to be kept an eye on what happens after the sleeve gastrectomy it’s ideal and it’s preferable and recommended that you follow up with your surgeon as well as the dietitian for at least the first two to three years ideally lifelong first two to three years is a crucial period where the weight loss is maximum but at the same time the weight regain or plateauing of the weight is also seen in the first two years and this is where additional intervention or treatment by a surgeon or dietitian is vital endoscopic surveillance or having gastroscopy regularly is something that is becoming more popular the reason behind this is as I have said before sleep gastrectomy converts the stomach into a tube and potentially increases the reflux now the reflux is reflux affects the quality of life but also the amount or the degree of reflux can also give rise to something called balanced esophagus paroxysophagus may or may not be symptomatic and it’s a condition that can give rise to cancers of the food pipe or the esophagus so ideally long-term follow-up by both The insurgents dietitian with frequent uh sorry with uh endoscopic surveillance is preferable now long-term outcomes are achieved by following certain rules and surgery helps with the physiology of the appetite but it does not fix poor nutritional choices or bad eating behaviors which is what we need to fix as well if need be a psychologist will be included in the multidisciplinary team to help the patients along with the surgeons and the dietitians lifestyle and eating habits must change for a long-term outcome especially in the first two years because as I said before the weight loss is maximum in the first two years as well as weight regain or plateauing is also seen in around second and third year at the same time so finally surgery plus lifestyle together is what gives us success as well as sustained success but a sustained success and long-term outcome.
