Obesity Surgical Options - Sleeve Gastrectomy
The sleeve gastrectomy (SG) is a restrictive weight loss operation. The outer part of the stomach is removed and the shape of the stomach is changed from a sac to a long narrow tube (sleeve). The gastric volume is reduced from approximately 2L to 100-150 mL
The main effect of the SG is from the reduced volume of the stomach and hence only a small amount of food results in the feeling of fullness and satiety. Using the SG as a tool for portion control allows the committed patient to eat 3 small meals per day and feel satisfied, unlike being on a diet. The subsequent reduction in caloric intake will result in weight loss. Good food choices as well as regular exercise are also necessary to optimise outcome.
Recent studies have shown that the top fundus part of the stomach which produces the hunger hormone Grehlin is being removed during sleeve gastrectomy. This usually resulted in loss of hunger feeling, although it does tend to lessen with time.
This procedure was initially used as a staged procedure for management of the heavier and more risky patients. It was used to reduce the initial weights of these high risk patients so that they can then have subsequent gastric bypass surgery.
Increasingly SG has been performed as a stand alone procedure with acceptable results in the medium term (Excess weight lost of 60 – 65 %). The main surgical complications are bleeding and leakage from the cut edge of the remaining stomach (reported 1-3 %)
A recent positional statement from ASMBS (American Society for Metabolic and Bariatric Surgery) has accepted the sleeve gastrectomy as stand-alone procedure with a risk/benefit profile between laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass. More long-term data is required for documentation of durability of the procedure of which there is only minimal data available at the moment.