Gastric Sleeve Surgery

Laparoscopic sleeve gastrectomy has recently become the most frequently performed weight loss surgery.  The reason for the ascendance of the sleeve’s popularity is largely due to the fact that the surgery is less technically challenging than a laparoscopic gastric bypass, but gives results which approach those achieved by bypass patients.  The risk profiles for the procedures are similar.   The preparation for surgery, postoperative recovery, and long-term diet are similar as well.  However, the mechanisms making each surgery effective differ.  The sleeve gastrectomy primarily utilizes restriction to limit caloric intake.  This is initially aided by a change is the signals which control the hunger drive.  Most patients will feel little hunger for the first one to two years following surgery.  Unlike the gastric bypass, the gastric sleeve does nothing to alter the absorption of calories.  All calories and nutrients consumed are absorbed in the same manner as before surgery.  The long-tern data on results of patients who have undergone sleeve gastrectomy are still being collected.  There are early indications that the rate at which weight is re-accumulated is likely faster following sleeve gastrectomy than gastric bypass.

How it Works

The sleeve gastrectomy was named as a description of the shape of the remaining stomach after the majority of the organ has been removed. The surgery involves five small incisions in the abdominal wall, and the use of a laparoscopic camera to allow visualization into the abdomen. The blood vessels along the left, greater curvature, side of the stomach are sealed and divided. This includes those vessels between the stomach and the spleen. A surgical stapler is then used to remove all but a small tube or “sleeve” shaped portion of the stomach connecting the esophagus with the small intestine. Thus, following surgery the route that food travels is not changed, but the volume in the stomach is drastically reduced. The sleeve will allow a full feeling following only three or four bites. The resected stomach is removed during surgery and can never be replaced. Therefore, the sleeve can be revised into a gastric bypass or duodenal switch, but cannot be reversed.