Using laparoscopic keyhole surgery, a sleeve gastrectomy is performed, removing 70-80% of the stomach. This helps to reduce the “hunger hormone” and leaves behind a smaller 'sleeve' of stomach that holds less and restricts the amount of food you can eat before feeling full.
This option offers a permanent solution with positive lifestyle improvements in health and quality of life. As with all weight loss surgery, it requires a lifelong commitment to a healthy diet and exercise plan. As the surgery is a minimally invasive lapascopic procedure, this greatly helps to reduce recovery time and generally results in less pain than open surgical procedures.
Nutritional deficiencies are less likely to occur following gastric sleeve surgery, as food absorption is not affected. In addition, levels of the appetite stimulant ghrelin fall after gastric sleeve surgery, which may be a reason why patients experience a marked loss of appetite.
The amount of weight loss varies from patient to patient, but the overall reduction in quantity of food that can enter the stomach, will lead to a noticeable loss of weight.
It is important that you are fully aware of the implications before committing to gastric sleeve surgery as it requires a change to the way you think about food, eating and drinking, and exercise. Losing weight before surgery will help with your recovery, increase your rate of weight loss and help with the transition to a post-operative diet.
Once surgery is agreed, you will need to follow a strict diet in the two weeks prior to the operation in order to prepare your body for the surgery. A pre-operative diet will help shrink your liver and also reduce fat in your abdomen, allowing the surgeon to operate more easily and safely.
You will also be advised to stop smoking as this will increase your risk of getting an infection after surgery, which can slow down your recovery. It can also make your surgery less effective and can lead to complications.
A general anaesthetic will be administered and using laparoscopic keyhole surgery, a sleeve gastrectomy is performed, removing up to 75% of the stomach. This procedure leaves behind a smaller 'sleeve' of stomach that holds less and therefore restricts the amount of food you can eat before feeling full. This procedure is considered to be halfway between a gastric band and gastric bypass.
The sleeve is accurately sized by a tube, which is passed down through the mouth and has a similar effect to a gastric band. It is a permanent and restrictive procedure that takes around 60-90 minutes to perform and does not require long-term follow up or adjustment.
Multivitamins are recommended following this procedure, although the nutritional impact is minimal. Most patients have rapid weight loss within the first year and then experience a gradual decline in weight loss.
Detailed post-operative follow-up is necessary for all bariatric surgery and this is no different. However, follow-up to a sleeve gastrectomy is more straightforward than most, being mainly limited to an assessment of weight loss and any possible nutritional deficiencies.
In most cases only a two night stay in hospital is sufficient, at which point the patient would normally be discharged with a five day course an antacids and blood thinners. Return to work will depend on the type of work you do, but most people will be able to return to work 2-3 weeks later, following your surgeon’s advice.
You will have access to a dietician for nutritional advice and support, and you will have face to face follow up appointments and check-ups afterwards to monitor your progress.
In the two week post-operative period you will be permitted to only take liquids, before easing yourself into more solid foods. Whilst you are off you will be advised to avoid sleeping or sitting for long periods, and to push yourself to be generally mobile, as this will help you avoid blood clots forming. You should also avoid lifting heavy objects and you should not drive. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.
Following surgery you will need to change your eating patterns and your diet, eating smaller amounts and choosing carefully which foods you eat. Your dietician may suggest dietary supplements to ensure you get the nutrients you need for energy and good health.
All surgery, even minimally invasive laparoscopic surgery, has risks such as bleeding, infections or clots forming in the legs and travelling to the lungs. Apart from these, there is a very small risk with a sleeve gastrectomy of leakage from the staples. In the unlikelihood of this happening, it would occur within the first two days and would require a return to surgery to correct the problem.
It is likely that you may have some bruising, pain and swelling on your skin around your wounds. If you should require pain relief after your surgery, or if you experience any side-effects, it is important to discuss this with your surgeon.
Other weight loss options include lifestyle changes, weight-loss programs, psychological treatments and medication. The effectiveness of each of these options will depend on the problem and the individual concerned:
Lifestyle changes involve making changes to diet, undertaking exercise and altering other lifestyle habits, either on their own or with the aid of a self-help support group.
Weight-loss programmes set out an eating pattern and give dietary advice, as well as an exercise programme.
Psychological treatments can support the patient's thoughts, feelings and actions towards themselves and their relationship with food, eating and exercise.
Medications; There are new medicines on the market which may help you lose weight, which can be prescribed by your GP.
In our experience, most candidates for weight loss surgery have already undergone some or all of the other treatment options. The specialist team at Benenden Hospital, led by your consultant, will discuss how effective these weight loss methods have been for you to establish if surgery is an option and how they can support you in the future.