Gastric Sleeve or Sleeve Gastrectomy
Laparoscopy or Minimally Invasive Bariatric Weight-Loss Surgery
Laparoscopic procedures for weight loss surgery employ the same principles as their “open” counterparts and produce similar excess weight loss. Not all patients are candidates for this approach, just as all bariatric surgeons are not trained in the advanced techniques required to perform this less invasive method. The American Society for Metabolic and Bariatric Surgery recommends that laparoscopic weight loss surgery should only be performed by surgeons who are experienced in both laparoscopic and open bariatric procedures.
Gastric Sleeve or Sleeve Gastrectomy Surgery
More and more people are asking us about “Sleeve Gastrectomy” as a bariatric operation. The Sleeve Gastrectomy is a restrictive bariatric procedure which probably does have some metabolic effects but it does not appear to be as significant as the gastric bypass. (See more about restrictive procedures here.) During this procedure, the surgeon creates a small, sleeve out of the stomach by removing most of the stomach. The gastric reservoir is larger than the stomach pouch created during Roux-en-Y bypass—and is about the shape and size of a banana.
Some surgeons use the sleeve as a primary bariatric operation and some use it as the first part in a staged approach to treating very high risk patients. The American Society for Metabolic and Bariatric Surgery (ASMBS) has not recognized the sleeve as an accepted primary operation and I would advise patients to read the ASMBS statement on the sleeve to gain further insight.
The WBC approach to the sleeve is as follows:
- The early data (1 to 3 years) on weight loss and resolution of co-morbidities seems good.
- The programs that do enough sleeves to be able to report data are few in number and therefore it is hard to make comparisons.
- The sleeve has only been done in any significant numbers for the past few years and therefore we do not have even enough 5 year data.
- Since we lack the data, it is impossible to know the durability of the operation. Will the weight loss and resolution of co-morbidities be sustainable?
- There is some indication that at 5 years the results are poorer than at 3 years
Therefore:
- It is hard to give patients good information (informed consent) about the sleeve and how the patient will do over time.
But:
- WBC is not opposed to doing sleeve gastrectomies in the proper setting. The patient needs to understand we don’t know as much about the outcomes and the patient needs to have all operations presented to them in as un-biased a fashion as possible.
It is important to know:
- Since the sleeve gastrectomy removes the majority of the stomach, it can not be reversed, from that standpoint.
- If a leak does occur following a sleeve operation, the complications from the leak can be much more severe than a laparoscopic banding or even a gastric bypass.
The sleeve gastrectomy operation does have the advantage that it does not bypass the duodenum and therefore Calcium and Iron absorption maybe improved when compared to the gastric bypass. The fact that the duodenum is not bypassed may be a disadvantage because the effect on Diabetes may not be as significant as the gastric bypass. In addition, all of the stomach that remains can be evaluated with an endoscopy whereas the “defunctional” stomach can not generally be seen after a gastric bypass. (This advantage is more theoretically important than clinically important for most patients.)
