Medicine:Sleeve gastrectomy

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Short description: Surgical weight-loss procedure involving reduction of stomach size
Sleeve gastrectomy
Gastric sleeve icon.svg
Diagram of a gastric sleeve
ICD-9-CM43.89

Sleeve gastrectomy or vertical sleeve gastrectomy, is a surgical weight-loss procedure, typically performed laparoscopically, in which approximately 75 - 85% of the stomach is removed,[1][2] along the greater curvature,[3] which leaves a cylindrical, or "sleeve"-shaped stomach the size of a banana.[1][2] Weight loss is affected not only through the reduction of the organ's size, but by the removal of the portion of it that produces ghrelin, the hormone that stimulates appetite. Patients can lose 50-70 percent of excess weight over the course of the two years that follow the surgery.[2] The procedure is irreversible,[4] though in some uncommon cases, patients can regain the lost weight, via resumption of poor dietary habits, or dilation of the stomach over time, which can require gastric sleeve revision surgery to either repair the sleeve or convert it to another type of weight loss method that may produce better results, such as a gastric bypass or duodenal switch.[5]

A meta-analysis of 174,772 participants published in The Lancet in 2021 found that bariatric surgery was associated with 59% and 30% reduction in all-cause mortality among obese adults with and without type 2 diabetes, respectively.[6] This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes.[6]

Procedure

Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.[7]

Sleeve gastrectomy is the most commonly performed bariatric surgery worldwide.[8][9] In many cases, sleeve gastrectomy is as effective as gastric bypass surgery, including improvements in glucose homeostasis before substantial weight loss has occurred. This weight-loss independent benefit is related to the decrease in gastric volume, changes in gut peptides, and expression of genes involved in glucose absorption.[10][11]

Sleeve gastrectomy surgery

The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia.[12] The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 36 and 40 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.[13]

Use in children and adolescents

Endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders[14] and the American Society for Metabolic and Bariatric Surgery,[15] sleeve gastrectomy is gaining popularity in children and adolescents. Studies by Alqahtani and colleagues have found that sleeve gastrectomy causes large weight loss in children and adolescents aged 5 to 21 years.[16] Moreover, they compared weight loss with adults and found comparable weight loss.[17] A study published in 2016 showed that growth progresses were unaffected after sleeve gastrectomy in children younger than 14 years of age.[18] Depression following the procedure has been noted in some individuals. Another side effect is insomnia. After this surgery many people can only sleep when they take melatonin or sleeping medications.[19]

Complications

Sleeve gastrectomy may cause complications; some of them are listed below:

  • Sleeve leaking (occurs 1 in 200 patients)
  • Blood clots (happens 1% of the time)
  • Wound infections (occurs in about 10 to 15% of post-op patients)
  • Strictures (occurs in 3.5% of post-op patients)[20]
  • Aversion to food, and nausea[21]
  • Damage to the vagus nerve which will cause constant nausea
  • Gastroparesis, with a delay in moving food from the stomach to the small intestine
  • Vomiting
  • Internal bleeding
  • Esophageal spasm/pain
  • Gastroesophageal Reflux Disease (GERD)
  • Lack of gastric intrinsic factor result in vitamin B12 deficiency[22]
  • Depression after surgery[23]
  • Reduced bone health[24]
  • Weight regain [25]

References

  1. ↑ 1.0 1.1 "Sleeve gastrectomy" (in en-US). Mayo Clinic. https://www.mayoclinic.org/tests-procedures/sleeve-gastrectomy/about/pac-20385183. 
  2. ↑ 2.0 2.1 2.2 "What is Sleeve Gastrectomy?" (in en-US). Hackensack Meridian Health. https://www.hackensackmeridianhealth.org/en/Services/Bariatrics/bariatric-treatments/sleeve-gastrectomy. 
  3. ↑ Seeras, Kevin; Sankararaman, Senthikumar; Lopez, Peter P. (May 1, 2022). "Sleeve Gastrectomy" (in en-US). National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK519035/. 
  4. ↑ "Sleeve Gastrectomy" (in en-US). Columbia University Department of Surgery. https://columbiasurgery.org/conditions-and-treatments/sleeve-gastrectomy. 
  5. ↑ "Gastric Sleeve Surgery (Gastrectomy)" (in en-US). Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/22931-gastric-sleeve-surgery. 
  6. ↑ 6.0 6.1 Syn, Nicholas L.; Cummings, David E.; Wang, Louis Z.; Lin, Daryl J.; Zhao, Joseph J.; Loh, Marie; Koh, Zong Jie; Chew, Claire Alexandra et al. (2021-05-15). "Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants". The Lancet 397 (10287): 1830–1841. doi:10.1016/S0140-6736(21)00591-2. ISSN 1474-547X. PMID 33965067. 
  7. ↑ "The History of Sleeve Gastrectomy: Bariatric Times" (in en-US). https://bariatrictimes.com/the-history-of-sleeve-gastrectomy/. 
  8. ↑ "Sleeve Gastrectomy: Surgical Tips". Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A 28 (8): 930–937. August 2018. doi:10.1089/lap.2018.0392. PMID 30004814. 
  9. ↑ "From longitudinal gastric resection to sleeve gastrectomy--revival of a previously established surgical procedure". Journal of Gastrointestinal Surgery 15 (1): 219–28. January 2011. doi:10.1007/s11605-010-1293-9. PMID 20725800. 
  10. ↑ "The Role of GLP-1 in the Metabolic Success of Bariatric Surgery". Endocrinology 158 (12): 4139–4151. December 2017. doi:10.1210/en.2017-00564. PMID 29040429. 
  11. ↑ "Differences in Alimentary Glucose Absorption and Intestinal Disposal of Blood Glucose After Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy". Gastroenterology 150 (2): 454–64.e9. February 2016. doi:10.1053/j.gastro.2015.10.009. PMID 26481855. 
  12. ↑ "Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity". Wideochirurgia I Inne Techniki Maloinwazyjne = Videosurgery and Other Miniinvasive Techniques 7 (4): 225–32. December 2012. doi:10.5114/wiitm.2012.32384. PMID 23362420. 
  13. ↑ "Laparoscopic sleeve gastrectomy: an innovative new tool in the battle against the obesity epidemic in Canada". Canadian Journal of Surgery 53 (2): 126–32. April 2010. PMID 20334745. PMC 2845949. http://www.canjsurg.ca/vol53-issue2/53-2-126/. Retrieved 2014-04-11. 
  14. ↑ "International Federation for the Surgery of Obesity and Metabolic Disorders". http://www.ifso.com. 
  15. ↑ "Bariatric Surgery Procedures". The American Society for Metabolic and Bariatric Surgery (ASMBS). http://asmbs.org/obesity-and-surgery-learning-center/bariatric-surgery-procedures. 
  16. ↑ "Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years". Annals of Surgery 256 (2): 266–73. August 2012. doi:10.1097/SLA.0b013e318251e92b. PMID 22504281. 
  17. ↑ "Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study". Surgical Endoscopy 26 (11): 3094–100. November 2012. doi:10.1007/s00464-012-2345-x. PMID 22648112. 
  18. ↑ "Laparoscopic Sleeve Gastrectomy in Children Younger Than 14 Years: Refuting the Concerns". Annals of Surgery 263 (2): 312–9. February 2016. doi:10.1097/SLA.0000000000001278. PMID 26496081. 
  19. ↑ "Depression after Gastric Bypass Surgery" (in en-US). http://www.psychologytoday.com/blog/the-antidepressant-diet/201403/depression-after-gastric-bypass-surgery. 
  20. ↑ "Gastric Sleeve Surgery: Common Risks and Complications". Gastric Sleeve Diet Guide. 2016-10-11. http://www.gastricsleevedietguide.com/gastric-sleeve-risks-complications/. 
  21. ↑ "Gastric Sleeve Complications Post Surgery". BSIG. http://www.bariatricguide.org/gastric-sleeve-complications/. 
  22. ↑ Lupoli, Roberta; Lembo, Erminia; Saldalamacchia, Gennaro; Avola, Claudia Kesia; Angrisani, Luigi; Capaldo, Brunella (2017-11-15). "Bariatric surgery and long-term nutritional issues". World Journal of Diabetes 8 (11): 464–474. doi:10.4239/wjd.v8.i11.464. ISSN 1948-9358. PMID 29204255. 
  23. ↑ "Depression after Gastric Bypass Surgery" (in en-US). http://www.psychologytoday.com/blog/the-antidepressant-diet/201403/depression-after-gastric-bypass-surgery. 
  24. ↑ Stokar, Joshua; Ben-Porat, Tair; Kaluti, Donia; Abu-Gazala, Mahmud; Weiss, Ram; Mintz, Yoav; Elazari, Ram; Szalat, Auryan (January 2023). "Trabecular Bone Score Preceding and during a 2-Year Follow-Up after Sleeve Gastrectomy: Pitfalls and New Insights" (in en). Nutrients 15 (15): 3481. doi:10.3390/nu15153481. ISSN 2072-6643. 
  25. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9906605/

Further reading

Micsorare stomac/ gastric sleeve - info related



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