What is gastric sleeve surgery?
Gastric sleeve surgery also known as sleeve gastrectomy consists of removing a large part of the stomach (about 80%) and the remaining part is stapled or sutured and attached to the nearest portion of the esophagus and duodenum forming a new stomach in order to reduce caloric intake and to moderate glucose, cholesterol and triglyceride levels.
No other organs are manipulated during this procedure, and it is performed in 1 to 2 hours.
Generally, there are no risks during surgery. The previous nutritional control and examinations determine the safety to be received in the operating room.
Gastric sleeve surgery is considered a minimally invasive procedure.
This is because of the tiny incisions needed to insert the laparoscope, a thin, tubular device consisting of a camera and a lamp to guide the surgery.
In addition, the surgeon uses more tools to achieve the removal of most of the stomach.
During the surgery, the patient is under anesthesia and is monitored to avoid any risk that may complicate his or her health.
What are the benefits?
As long as the patient is committed to following the required indications, it is estimated that during the first two years after surgery more than 50% of excess body weight can be lost in order to achieve a better weight-height balance.
Likewise, the reduction of the risk of suffering potentially fatal diseases is attributed.
Such as hyperlipidemias, type 2 diabetes, high blood pressure, stroke, myocardial infarction, obstructive sleep apnea and heart disease.
Rapid filling (early satiety) due to the reduced size of the new stomach leads to a decrease in the patient’s overall weight over the next few months.
The reduced food intake and the diet implemented for the gastric sleeve to function properly prevents further food consumption.
Likewise, the hormone ghrelin, capable of regulating food intake and body weight, is reduced after surgery.
This is another factor associated to the reduction of food consumption in patients with gastric sleeve.
Who is gastric sleeve surgery for?
In most cases, gastric sleeve surgery is necessary in overweight patients with pulmonary or cardiac comorbidities.
Patients with a body mass index (BMI) equal to or greater than 35 (obesity) and with an unhealthy lifestyle are most likely to require this bariatric surgery procedure.
Conscious management of diet, cholesterol levels, triglycerides and glucose control are of clinical relevance in candidates for bariatric intervention.
As long as better results are obtained, patients will obtain greater benefits.
Intervention is recommended when a strict diet does not work after several months or years.
Or when the consumption of medications capable of reducing weight does not achieve changes and due to complications that do not allow exercise.
Recommendations before surgery
The family doctor usually indicates to the patient a greater responsibility in the food consumed until before the surgery.
Medications that may harm or alter the patient’s response to the anesthesia and the functioning of the stomach are also restricted.
It is also suggested to start with physical activity to reduce the risks, as well as to benefit the levels of lipids, carbohydrates and proteins.
What are the risks during and after surgery?
In every surgery, problems arise during the surgical intervention, depending on the procedure and the patient’s health.
In the case of gastric sleeve surgery, there may be complications related to general surgery and gastric sleeve surgery.
- Complications due to anesthesia: It is usually tolerable in most patients, although it causes some side effects, from headaches, nausea, dizziness, dry mouth or tiredness.
- Hemorrhage: There will always be tiny or excessive hemorrhages depending on the area to be treated. In these cases corrective management represents a fundamental measure to control bleeding, by means of blood transfusions, blood plasma or fluids to recomposition of blood loss.
- Deep vein thrombosis (DVT): DVT is a common problem after leaving the operating room, and is due to the generation of a clot in the venous circulation, most commonly in the lower extremities of the body. In turn, this problem can lead to pulmonary embolism, stroke or myocardial infarction. Thermal blankets and anticoagulant medications are recommended in the postoperative process.
- Pulmonary diseases: The most common pulmonary problems are associated with pulmonary embolism and pneumonia. Both can be prevented as long as the necessary care has been provided. It is important to monitor patients with asthma, COPD, cystic fibrosis, among other lung conditions.
- Surgical wound infection: It is necessary to monitor the state of the renovated stomach, verify the resistance of staples or sutures and keep the surrounding area sterile.
The main points of interest in gastric sleeve surgery are:
- Stenosis: It occurs in extreme cases where the stomach causes a partial or total constriction, stopping the gastrointestinal transit.
- Elevation of stomach acidity: The elevation depends on the foods restricted once the operation is done, spicy or acidic foods are associated with higher stomach acidity.
- Gastric leakage: Depending on the resistance of the sutures or staples, gastric acid leakage may be avoided or may occur, the patient should be monitored.
- Vitamin and mineral deficiency: Part of the resected stomach is necessary for the absorption of both compounds, so the patient will be forced to take vitamin supplements for an indefinite period of time until normal stomach function is restored.
- Weight gain or malnutrition: It is essential that the patient has a healthy lifestyle after surgery, otherwise he/she will not have the expected results.
It is necessary to follow the indications of the family doctor in order to reduce the risk of causing any of these problems.
As long as the instructions are followed to the letter, it is possible to avoid any adverse effects that may occur.
Are there other alternatives?
As explained above, gastric sleeve surgery is the resource to resort to when normal diets, exercise or size-reducing medications do not work as expected.
Gastric bypass surgery is also part of the bariatric surgery variants.
It consists of separating the area closest to the esophagus from the rest of the stomach and joining it with the first portion of the small intestine.
The smaller stomach pouch is mainly used for the transport of the food bolus through the gastrointestinal tract, while the larger one is necessary for the formation of gastric juice and digestive enzymes.
However, gastric bypass is a more tedious procedure to perform due to its complexity and safety.
There is another useful surgical method to lose weight, this is the gastric band surgery.
It works by means of a silicone band that decreases the speed in the passage of food, generating an early satiety without affecting the stomach.
What to expect after surgery?
In general, bariatric surgeries are effective in reducing cholesterol levels after the operation.
This cholesterol reduction is independent of weight reduction and the action of insulin against glucose.
It is focused on obtaining body weight control by reducing body size to improve health through a controlled diet and constant physical activity.
Consider the following points:
- During the first month after surgery, protein-rich foods, pureed and soft foods should be consumed.
- Chew adequately each portion of food consumed, at least chewing 20-30 times when eating meals.
- Take breaks to hydrate and avoid mixing food with beverages, otherwise you may generate greater satiety.
- Restrict high-calorie processed foods.
- Maintain a balanced intake of vitamin and mineral supplements.
- Walking and aerobic exercise for at least 30 minutes a day.
For the same reason, it is vital to go to our primary care physician when there are risks and antecedents that support the need for immediate surgery.