Sleeve Gastrectomy: Procedure, Risks, Benefits, and Experienced Specialists

The sleeve gastrectomy is performed on severely overweight individuals who suffer from obesity and have made several unsuccessful attempts to lose weight. 

Generally, doctors recommend sleeve gastrectomy for patients with a Body Mass Index (BMI) of 35 or higher.

Patients should be at least 18 and no older than 65 years of age to undergo sleeve gastrectomy.

A sleeve gastrectomy is not suitable for:

• Patients with reflux disease characterized by severe acid reflux and heartburn
• Patients whose excess weight results from high-calorie, soft foods or liquids (sweet drinks, alcohol)

Sleeve gastrectomy is very effective: Within the first two years after the procedure, patients can lose 60 to 70 percent of their excess weight.

In addition to its high effectiveness, sleeve gastrectomy offers further advantages:

• a short and minimally invasive procedure
• Stomach function remains intact
• The closure of the stomach’s inlet and outlet remains intact

A major advantage of the sleeve gastrectomy is that many obesity-related comorbidities improve significantly.

These conditions primarily include:

• Type II diabetes
• High blood pressure
• Elevated blood lipid levels and cholesterol
• Back and joint pain
• Sleep apnea

Primarily, specialists in general and visceral surgery are responsible. Within the field of visceral surgery, gastroenterology specializes in surgery of the digestive tract.

Bariatric surgery is another subspecialty within visceral surgery that focuses specifically on surgical procedures for people with obesity.

In addition, there are specialized bariatric centers that take an interdisciplinary approach and are tailored to the needs of people with obesity.

Here, patients receive the best care, from diagnosis through treatment to follow-up care.

The sleeve gastrectomy is performed under general anesthesia using a minimally invasive surgical technique (laparoscopic surgery), which leaves only small scars.

The hospital stay lasts between 4 and 5 days. Several preoperative examinations must be conducted before the surgery.

These include, for example:

• an esophagogastroduodenoscopy
• a duodenoscopy
• an ultrasound of the liver, gallbladder, and pancreas

The surgery takes about one hour. The surgeon inserts surgical instruments into the abdominal cavity through small incisions in the abdominal wall. He then fills the cavity with gas (carbon dioxide).

This creates more space in the abdominal cavity and gives the surgeon a better view of the surgical site.

Using a stapler, the surgeon then removes the main portion of the stomach. He sutures the remaining narrow section of the stomach—from the esophagus to the duodenum—together.

The doctor then injects dye into the stomach through a nasogastric tube to check that the stapled seam is sealed. The seam is sealed if no dye leaks out.

In addition to the typical risks of general anesthesia, the following complications may occur with sleeve gastrectomy:

• Injury to blood vessels, leading to bleeding and postoperative hemorrhage
• Infections and inflammation
• Injuries to other organs
• Adhesions between organs in the abdomen
• Thrombosis and embolism
• Impaired wound healing
• Scarring
• Leaky sutures

Gastric bypass surgery cannot be reversed. Temporary nutritional deficiencies (vitamin and mineral deficiencies, protein deficiency) may occur after the procedure. 

However, these can be prevented or resolved through nutritional counseling.

Furthermore, there may be an increased incidence of gallstones as well as food intolerances.

If the patient overeats after the procedure, the sleeve gastrectomy may stretch and enlarge again (dilatation), and weight gain may resume.

The recovery period after surgery is about three weeks, after which the patient may return to work. The patient should avoid heavy lifting for four to six weeks.

During the first four weeks after surgery, you should consume only liquid or pureed foods. The sleeve gastrectomy must gradually adjust to solid foods. After a few weeks, you can generally resume eating all foods that you can tolerate.

Gastric resection is no substitute for a healthy lifestyle. You will only achieve long-term success if you adopt a fundamentally and permanently healthy diet, exercise regularly, and thus adjust your dietary and lifestyle habits.

In many cases, taking certain multivitamin supplements or receiving vitamin and iron injections is advisable or even necessary.

People with a reduced stomach can eat almost normally, just in smaller quantities. The following recommendations apply:

• Eat five to seven small meals a day
• Separate eating and drinking to prevent the tubular stomach from being flushed out
• Eat slowly and chew your food thoroughly
• Make sure your meals are well-balanced

Lifelong follow-up exams and nutritional counseling are necessary to sustainably manage weight loss and prevent nutritional deficiencies.

People who have had a sleeve gastrectomy or gastric bypass must be careful when taking medications that irritate the stomach.

These include, for example, pain relievers such as acetylsalicylic acid or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.

Stomach-friendly pain relievers include:

• acetaminophen or
• tramadol

You should also be cautious about drinking alcohol, as the effects of alcohol are significantly amplified by the reduced stomach size.

Patients with a sleeve gastrectomy should not donate blood, as this can lead to iron deficiency.