History and Trend of the Gastric Sleeve
Initially, the most restrictive aspect of the biliopancreatic diversion duodenal switch operation was the gastric sleeve. The gastric sleeve was then used as the first-stage operation for very obese patients who had duodenal switch surgery to reduce perioperative risks. Some patients lost enough weight after the gastric sleeve surgery to avoid the second-stage duodenal switch surgery. Because of these findings, bariatric surgeons began to consider gastric sleeve surgery as a stand-alone bariatric procedure. In 2004, the first laparoscopic gastric sleeve surgery was performed. The number of gastric sleeve surgeries has increased nearly every year over the last decade. Gastric sleeve procedures now account for more than half of all bariatric surgeries performed in Turkey.
How much weight will I lose following the Gastric Sleeve procedure?
- People typically lose 60–70% of their excess weight.
- 10–20 pounds in the first two weeks; most patients lose about one pound per day.
- The first three months saw an excess weight loss of 35–45%.
- In the first six months, 50–60% of excess weight is lost.
- 60–70% of excess weight loss in the first year.
- Most people lose weight between 12 and 24 months after surgery.
- The success rate of gastric sleeve surgery is approximately 80–90%.
Improvement of Obesity Related Health Problems
- Large clinical trials and studies have shown that gastric sleeve surgery resolves or improves many obesity-related health problems, including:
Diabetes mellitus - type 2: The majority of studies found that after gastric sleeve surgery, 60–80% of patients with type 2 diabetes could achieve disease remission or improvement.
- Hypertension
- Fatty liver syndrome
- High cholesterol levels
- Obstructive sleep apnea
- The cancer risk is reduced.
- PCOS
- Asthma
- Migraine
- Join the anguish.
- Depression and other psychological issues
- Infertility
- Low testosterone: gastric sleeves can increase testosterone levels naturally.
- Incontinence of the bladder
- Gout
Recovery after Surgey
- The procedure takes between 40 and 70 minutes.
- Typically, patients are released from the hospital after 1-2 nights.
- All patients are encouraged to walk as soon as three to four hours after surgery.
- In general, pain after surgery is easily manageable. Most patients take less pain medication than is recommended.
- After 2-4 weeks, most patients return to work or school. Due to the low calorie intake of the liquid diet, fatigue is common during the first two weeks. The majority of patients, however, do not feel hungry during this stage of the diet. The energy level quickly improves after the soft diet is introduced, which occurs approximately 2 weeks after surgery. After surgery, we occasionally allow patients to work from home 2-3 days per week.
- Patients can begin exercising after 4 weeks.
Complications and Risks
- With the advancement of surgical techniques and surgeon experience over the last decade, the gastric sleeve has become an overall safe bariatric surgical procedure. However, complications during and after surgery are still possible. The following are the most common complications and risks associated with gastric sleeve surgery:
- Leakage from the staple line is a common but serious side effect of gastric sleeve surgery. The reported leak rate ranges from 0.7 to 3%. At UCLA, we prioritize surgical techniques in order to reduce all complications. We have yet to experience a leak from the gastric sleeve surgery at UCLA.
- Stricture/stenosis - We had one stricture among our first 20 gastric sleeve procedures in the past. We haven't had any restrictions in the last five years.
- Bleeding Blood Clot Heart Burn - This is a highly contentious topic in bariatric surgery, with inconsistent data from various centers. In our experience, most patients who had heartburn prior to surgery see an improvement in their symptoms after surgery as a result of weight loss. Some patients may experience new heartburn, which is usually treatable with over-the-counter anti-acid medications.
- Deficiency in nutrients or vitamins
- Weight Regain- After 1-2 years, all bariatric procedures experience slight weight regain, with 10-20% of patients experiencing significant weight regain after gastric sleeve surgery. Many centers collected data after 5 years of follow up to show that the majority of patients can maintain their weight loss after Gastric Sleeve Surgery.
- Excess skin removal may be covered by insurance in some cases.
Diet After Gastric Sleeve Surgery
- Day 1: Pure liquid diet Some surgeons allow patients to drink water after surgery for a few hours.
- Day 2–14: Complete liquid diet (protein shakes, yogurt, broth, milk, and juice).
- Weeks 3–5: Diet of soft foods
- Five weeks after surgery, patients can begin introducing regular food. They are encouraged to eat small amounts of food at each meal and to eat more frequently.
- Following surgery, all patients must take a multivitamin and B complex.
Comparison of the Gastric Sleeve to Other Types of Bariatric Procedures
- Laparoscopic gastric banding (Lap-Band) was once a popular procedure. However, due to the high rate of long-term complications and poor weight loss, the number of lap-band surgeries in Turkey and around the world has been declining year after year. At this time, most large academic Turkish bariatric surgery centers rarely perform the lap-band procedure.
- Roux-en-Y laparoscopic surgery The gold standard of bariatric surgery is gastric bypass surgery. However, due to its technical simplicity and lower long-term complication rates, gastric sleeve surgery has surpassed gastric bypass surgery as the most popular bariatric surgery in recent years.
Advantage of Gastric Sleeve versus Gastric Bypass Surgery
- The gastric sleeve surgery is technically much simpler. Gastric sleeve surgery typically takes 40–70 minutes to complete, whereas gastric bypass surgery takes approximately 2–3 hours.
- With the gastric sleeve procedure, there is a much lower risk of nutrient or vitamin deficiency. Furthermore, there is no malabsorption in gastric sleeve patients.
- Gastric bypass patients may experience long-term complications such as bowel obstruction, marginal ulcers, and internal hernias. These complications are extremely unlikely to occur in gastric sleeve patients.
