The Sleeve Gastrectomy
The sleeve gastrectomy is performed by Dr. Snyder in Houston and Cypress, Texas, using robotics. It involves removing about 80% of the greater curve of the stomach. This is a fixed restrictive procedure and is not adjustable. It will reduce the amount of food you are capable of eating, but that is not the main reason for the weight loss. The sleeve gastrectomy is a hormonal operation. That is, the removal of this particular part of the stomach, for reasons that are not fully understood, causes the release of specific hormones that control hunger. Patients report a quicker feeling of fullness and less hunger after this operation as compared to a gastric band, for example, which is a purely restrictive operation. There is also scientific evidence that shows that this part of the stomach that is removed is responsible for producing a hormone called ghrelin that acts on the brain to make you hungry. When this part of the stomach is removed, this hormone level drops and this decreases hunger even further.
The risk of the procedure is the same as with any other operation that uses staple. Primarily, there is a risk of bleeding or staple line leaks. However, the risk of these complications is very low (1-2%) and are usually identified and managed before the patient leaves the hospital after the operation. Another unique advantage of the sleeve gastrectomy is that it can be used as a bridging procedure. When it was first used in the early 1990’s, it was strictly used to bridge extremely large patients with super morbid obesity, have them lose some weight, then go back and complete a gastric bypass of biliary diversion. However, since patients were losing as much weight as was seen with gastric bypass, it became a standalone procedure in 2003. Since then, the results have been great. A patient can expect to lose up to 60% of their excessive weight after this operation within a one year period. Because of the “bridging” nature of the sleeve, it can be converted to any other bariatric procedure for any reason.
The long term complications and results of the sleeve are still pending. Since the operation became more popular only 10 years ago, it is hard to say with large number of patients what the ten year results are. One of the main concerns recently among bariatric surgeons is the risk of new onset heartburn or reflux disease, which can be as high as 15%. Many surgeons, including Dr. Snyder, have begun putting stitches in the diaphragm where the esophagus comes into the abdomen to prevent the reflux. Good data for this is still pending; however, Dr. Snyder is doing research currently to shed light on these questions (see my blog page). If you suffer from reflux problems before weight loss surgery, it may be more reasonable to consider a gastric bypass operation over the sleeve. Gastric bypass resolves reflux disease 99% of the time.
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