Sleeve Gastrectomy (Gastric Sleeve)
What Is A Gastric Sleeve?
A sleeve gastrectomy (or gastric sleeve) is a surgical procedure designed to limit your food intake and thus aid in losing weight. During the procedure, a portion of your stomach is removed, reducing the size available to take in food by up to 75%. This means that you feel fuller much quicker when eating, and will therefore take in fewer calories.
Can I Have A Sleeve Gastrectomy?
As a sleeve gastrectomy is normally used for patients who are severely overweight, the eligibility criteria are slightly different from other weight loss procedures. You will be eligible for a sleeve gastrectomy if:
- You have a BMI (Body Mass Index) of at least 35.
In a private setting, whether you are eligible varies from practice to practice, however they often use similar criteria to those above with the extra criteria of not being able to lose the weight through conventional methods such as exercise and/or healthy diet alone.
NHS or Private?
You may be able to qualify for a sleeve gastrectomy procedure on the NHS if you are deemed to have a "life-threatening" level of obesity, defined as:
- If you have a BMI of 40 or above.
- If you have a BMI of 35 or above coupled with a serious health condition that would improve on losing weight (e.g. hypertension or type II diabetes).
If you do not qualify for an NHS procedure, or simply prefer private treatment, a sleeve gastrectomy will cost between £8,900-£15,000 at a private clinic, depending on your individual circumstances and the provider you use. Most private clinics offer finance packages to help you pay for your procedure and many offer interest free credit deals.
If opting for a private procedure you should thoroughly research the reputation of your provider as well as the costs involved for the procedure and aftercare.
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How Is It Performed?
Gastrectomy is performed under general anaesthetic, and can either be done via keyhole or open surgery. Keyhole (laparoscopic) surgery requires a number of small incisions and a slender operating instrument with a camera and light at the end.
Patients who have keyhole surgery tend to recovery slightly quicker than those who have open surgery, which requires a cut of around 30cm along the abdomen. In a sleeve gastrectomy, the surgeon will remove the left side of the stomach leaving a longer but smaller, sausage shaped pouch through which food can be digested. The initial incisions are then sealed with sutures.
How Much Weight Can I Expect To Lose?
Watch Mr Chris Sutton, Consultant Specialist Bariatric Surgeon at Tonic Cosmetic Surgery, explain how much weight gastric sleeve patients can expect to lose as a result of their surgery:
"With a sleeve gastrectomy average weight loss is about 70% of the patient’s excess weight and that’s a similar sort of figure for a gastric bypass, be it a mini gastric bypass or a Roux-en-Y gastric bypass."
Mr Chris Sutton, Consultant Specialist Bariatric Surgeon at Tonic Cosmetic Surgery
Dieting Before Gastric Sleeve Surgery
In preparation for your surgery you will have to observe a full liquid diet for 2 weeks before undergoing your procedure. This is beneficial for numerous reasons, as it:
- Gets you used to limiting your food intake ready for your new postoperative diet.
- Reduces the size of your liver, making the surgery easier and quicker.
During this two-week period, you should avoid all solid foods, sticking solely to the following food and drinks:
- Fruit juices (pulp is allowed).
- Fruit ice lollies.
- Sugar, honey, and syrups.
- Soup broth (chunky soups not allowed).
- Butter, margarine and oil.
- Cream, custard, plain ice cream, frozen yogurt, and sorbets.
- Carbonated drinks (e.g. ginger ale, lemonade etc.).
- Liquid drink supplements such as Ensure.
- Tea or coffee (cream, milk and sugar are allowed).
Potential Side Effects
Potential side effects specific to a sleeve gastrectomy include:
- Acid reflux (heartburn). You will most likely be given medication to control the production of stomach acid.
- Vitamin deficiency due to a reduced area for their absorption. If you suffer from deficiencies as a result of your procedure (or perhaps just as a precaution) you will be given vitamin supplements to boost your vitamin intake.
- "Dumping syndrome", which occurs when sugary or starchy foods that would normally be broken down in the stomach pass into your small intestine, drawing in water. This can lead to symptoms such as faintness, sweating and palpitations as well as bloating, nausea indigestion and diarrhoea. You can help to combat dumping syndrome by avoiding sugary or liquid foods and increasing the fibre in your diet. You may also benefit from eating more slowly and resting for a short time after eating.
Your surgeon should discuss all of these potential side effects with you before your procedure to make sure you are fully aware.
Watch Mr Chris Sutton, Consultant Specialist Bariatric Surgeon at Tonic Weight Loss Surgery Ltd, describe the side affects associated with gastric sleeve surgery:
"Side effects following a sleeve gastrectomy very low indeed. As long as there wasn’t a problem at the initial operation such as a bleed or a leak, a sleeve is probably one of the easiest operations to live with. Patients can eat almost any food but obviously in a smaller portion. They often don’t feel hungry following the sleeve because the parts of the stomach that’s removed removes what’s called the Gherlin Secreting Cells, the Gherlins are hormones that drive appetite and it’s made in the part of the stomach that is removed following a sleeve gastrectomy."
Mr Chris Sutton, Consultant Specialist Bariatric Surgeon at Tonic Weight Loss Surgery Ltd
Diet Following Gastric Sleeve Surgery
Following a sleeve gastrectomy procedure you will have to follow a strict diet plan to slowly reintroduce food into your diet. For the first two to three days you will be allowed only liquids, beginning with small sips of water. For the following 2-4 weeks you will then progress onto thin soups and pureed foods taken in 4-6 small portions throughout the day. Once these meals are tolerated well you can begin eating mashed foods along with plenty of water, before moving onto more solid foods and a healthy balanced diets from 6 weeks onwards.
In the long term you will be encouraged to eat a healthy balanced diet avoiding sugary or fatty foods; you should also eat in small portions throughout the day.
Recovery and Adjusting Your Lifestyle
You will probably be able to return home a few days following your gastrectomy procedure and will be provided with a detailed diet plan (and described above) and painkillers should you still be sore.
The biggest change to your lifestyle will be the alterations to your diet and eating habits. Not only will you have to eat small portions more often than before, you will also have to restrict the amounts of sugary and fatty foods you consume and increase your fibre intake.
In addition you may also have to take vitamin supplements as a result of the procedure, either in tablet or injection form.
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Risks and Complications
In addition to the possible side effects mentioned above there are also a number of risks of complications associated with undergoing a sleeve gastrectomy procedure. Like any surgical procedure there are a number of general risks, such as potential nausea and vomiting, infection, internal bleeding and reactions to the anaesthetic. More specifically there is a risk of leakage from the where the stomach was closed, which may mean a further procedure to repair the join and stop the leakage.
Your surgeon should discuss all of these potential risks and complications with you before your procedure to make sure you are fully aware.
Results Of Surgery
- Overall sleeve gastrectomy procedures are highly effective in treating obesity, with excess weight losses of up to 75%. However this weight loss is a little less and is usually a little slower less than that seen with a gastric bypass procedure and it may take up to 3 years to see the final results.
- The benefits of losing so much excess weight can be highly beneficial; in addition to increasing mobility it can also improve weight related conditions such as type II diabetes, arthritis, hypertension, obstructive sleep apnoea and high cholesterol.
Alternatives To Sleeve Gastrectomies
There are numerous weight loss options available today other than sleeve gastrectomies. In addition to natural weight loss through healthy eating and exercise, or more alternative methods such as hypnotherapy, there are also other surgical procedures (if you are eligible), including:
- Gastric band surgery.
- Gastric bypass surgery.
- Gastric balloon insertion.
- Primary obesity surgery endolumenal (POSE) surgery.