Gastric sleeve surgery - Medical specialists

In contrast to the gastric bypass, the digestive tract is not affected by the gastric sleeve. The sleeve gastrectomy is a globally recognized and extremely effective method of weight reduction. Since the number of overweight people is constantly increasing, the method is being used more and more frequently.

When is a sleeve gastrectomy performed?

Sleeve gastrectomy is performed in severely overweight people who suffer from obesity and have already undergone several unsuccessful weight loss attempts. As a rule, doctors perform gastric sleeve surgery in patients with a Body Mass Index (BMI) of 35 or more. For a gastric sleeve surgery, the patient should be at least 18 and at most 65 years old. A sleeve gastrectomy is not suitable for:

• Patients with reflux disease with severe acid reflux and heartburn
• Patients whose overweight is the result of high-calorie, soft foods or liquids ( soft drinks, alcohol)

How exactly is a gastric sleeve surgery performed?

Gastric sleeve surgery is performed under general anesthesia using a minimally invasive surgical technique (keyhole surgery) that leaves only small scars. Patients have to stay at the hospital for 4 to 5 days. Some preliminary examinations must be carried out before the surgery. These include, for example, an endoscopic examination of the oesophagus, stomach and duodenum as well as an ultrasound of the liver, gall bladder and pancreas.

The surgical procedure takes about an hour. Via small holes in the abdominal wall, the surgeon inserts the surgical instruments into the abdominal cavity and fills it with gas (carbon dioxide). This gives the surgeon more space in the abdominal cavity and a better view of the surgical area. Using a stapler, the surgeon removes most of the stomach. The remaining narrow stomach from the esophagus to the duodenum is sutured together.

The doctor then directs dye into the stomach via a stomach probe to check if the clamp suture is sealed. The suture is sealed if no dye is leaking. After the surgery, the patient has to recover for about three weeks before being allowed to work again. Heavy lifting should now be avoided for four to six weeks.

What are the advantages of a gastric sleeve?

The sleeve gastrectomy is very effective: within the first two years after the surgery, patients can already lose 60 to 70 percent of their excess weight. In addition to its high effectiveness, the gastric sleeve has other advantages:

• short and gentle procedure
• the functionality of the gastrointestinal tract remains intact
• Closure of the stomach entrance and exit remains in place

A great advantage of the gastric sleeve is that many accompanying diseases of obesity improve significantly. Such diseases are above all:

• Diabetes Type II
• Hypertension
• elevated blood fat levels and cholesterol
• Back and joint pain
• Sleep apnea

What are the risks and side effects of a sleeve gastrectomy?

In addition to the usual risks of general anesthesia, the following complications may occur during a gastric sleeve surgery:

• Injuries to blood vessels resulting in bleeding and secondary bleeding
• infections
• Injuries to other organs
• adhesions of organs in the abdomen
• Thromboses and embolisms
• Disorders of wound healing
• scarring
• leaky sutures

A gastric sleeve is not reversible. A temporary nutritional deficiency (vitamin and mineral deficiency, protein deficiency) may occur after the procedure. However, this can be prevented or remedied by appropriate nutritional counselling. Furthermore, the occurrence of gallstones may increase and food intolerances may occur. If the patient eats excessively after the procedure, the gastric sleeve can stretch and enlarge again (dilatation).

What must a patient with a gastruc sleeve consider?

Within the first four weeks after the surgery you should only eat liquid or mashed food. The gastric sleeve must gradually get used to solid food. After a few weeks, you will be able to eat all the foods you tolerate.

A gastric sleeve does not replace a healthy lifestyle. You can only achieve long-term success if you eat a healthy diet and exercise regularly. In many cases, multivitamin supplements or vitamin and iron injections are advisable or even necessary. The following recommendations apply to people with a gastric sleeve:

• Eat five to seven small meals a day.
• Separate food and drink to prevent rinsing of the gastric sleeve.
• Eat slowly and chew well.
• Make your meals a well-balanced diet.

Lifelong aftercare and nutritional counselling are necessary to ensure lasting weight loss and prevent deficiencies. People with gastric sleeves or gastric bypass must be careful when taking medications that irritate the stomach. These include painkillers such as acetylsalicylic acid or NSAIDs such as ibuprofen. Pain killers that are gentle on the stomach are paracetamol or tramadol. You should also be careful when consuming alcohol, because the effect of alcohol is significantly increased due to the reduced stomach size. It is not recommended for patients with a gastric sleeve to donate blood, as an iron deficiency may occur.