Restrictive (including gastric band/lapBand)

Sleeve Gastrectomy

The Sleeve Gastrectomy (SG) is a new bariatric procedure that works by restricting the amount of food a person can eat. The operation consists of removing ¾ of the stomach (see diagram) via keyhole (laparoscopic) surgery. Surgeons see it as

1. an effective operation in its own right and,
2. the first operation of a two-part plan, particularly for people in the superobese class with high BMI.

The complications for the SG are less than those of the Gastric Bypass and Biliopancreatic Diversion (BPD) and the SG still allows significant loss of excess weight. In patients with a high BMI and inadequate weight loss, the SG can be converted to a Gastric Bypass or BPD in a second operation but with much less risk (after weight loss has occurred). Obviously, if weight loss were sufficient, no further surgeries would be necessary

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Expected Weight Loss

This combined approach has tremendously decreased the risk of weight loss surgery for high risk patients even when the risk of the two surgeries is taken into account.

Most patients can expect to lose 40 to 60% of their excess body weight over a 12-month period with the SG alone. The timing of the second procedure will vary according to the degree of weight loss, typically 6 - 18 months (or not at all).

Advantages

• Stomach volume is reduced in size, but it functions normally so food can be eaten in only small amounts. The types of foods eaten are not altered.
• Minimizes the chance of an ulcer occurring in the stomach
• SG has only a small risk of bowel blockage or vomiting from a blocked stomach. Much less risk of food intolerance than after a gastric band.
• Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2).
• If there are problems with the small bowel that make it impossible to perform a gastric bypass or BPD, this is another option (along with the Gastric Band) for surgery.
• Can be performed via keyhole surgery much more easily than the gastric bypass and the BPD.
• Short hospital stay
• Early return to work
• Less pain than for open surgery (large cut necessary)

Disadvantages

• IT IS NOT REVERSIBLE. Although the other major surgeries for obesity are difficult to reverse, they are not impossible. Because the stomach is partly removed, it cannot be replaced. This operation is for life.
• Because this procedure is fairly new the long-term outcomes are unknown. Certainly with all the surgeries that are available for weight loss there is a late regain of a small proportion of the weight lost. The value of this in the case of the SG is unknown.
• Patients with a high BMI to begin with may need further surgery (Gastric Bypass or BPD) if weight loss is inadequate.
• As with all the restrictive type of operations, soft foods and fluids that are high in calories are not restricted, and inadequate weight loss may result. Foods such as ice cream, cheeses, dips, soft drinks, chocolate must be taken sparingly.
• Because part of the stomach needs to be removed, the stomach that is left must be closed. This is done with a stapling instrument. Because of this closure there is a risk of holes occurring where it has been stapled. This is termed a 'leak' and can have a large impact on you're recovery.