The vertical sleeve gastrectomy, or gastric sleeve for short, is a popular bariatric procedure due to its weight loss results and perceived simplicity. The gastric sleeve surgery is the most straightforward of the invasive bariatric procedures, leaving many overweight patients wondering if they would be a good candidate for gastric sleeve surgery.
Who Is a Candidate for Gastric Sleeve Surgery
A good candidate for gastric sleeve surgery is someone who is looking to lose 65 and 75% of their excess weight and have a BMI range of 35 to 45. Typically, we look at the gastric bypass or duodenal switch for patients with a BMI above 45, as these procedures produce more significant weight loss results.
The gastric sleeve is recommended for patients with a high surgical risk. We classify a high-risk patient as someone who has had a transplant, has severe heart disease or has a lung condition. Since the gastric sleeve takes less time to perform (under anesthesia for less time) and has a faster recovery period, the patient's body will be under less stress.
The gastric sleeve is also an excellent operation for patients who may be more concerned about vitamin deficiencies after their bariatric procedure. Although all bariatric procedures can result in malnutrition due to the limited food intake causing lower nutritional support, the gastric sleeve is the least aggressive in causing deficiencies. The gastric sleeve only creates a restrictive effect, while the bypass and duodenal switch create a malabsorptive effect due to re-routing the intestines.
Therefore, if your surgeon is concerned about nutritional deficiencies, they may advise that you are a good candidate for gastric sleeve surgery. However, all patients will still be required to take bariatric vitamins after their procedure to lower the risk of nutritional deficiencies.
How the Gastric Sleeve is Performed
The gastric sleeve removes a large portion of the stomach to limit the patient's food intake, thus resulting in weight loss. Although the gastric sleeve is a non-reversible procedure, it can be revised to a gastric bypass if needed.
During gastric sleeve surgery, the surgeon will place a tube in the stomach along the inner curve. The tube acts as a guide, so the surgeon knows how much of the stomach to remove. The surgeon will then staple the stomach from the lower edge to the upper edge, allowing the stomach's outer part to be removed.
What is left is a tubular, banana-shaped stomach that is 70 to 80% smaller than its original size. Since the new stomach has a smaller volume, patients will feel full faster off of smaller portions of food, ultimately leading to weight loss.
Additionally, science points to an overall reduction in hunger due to a decrease in ghrelin. Ghrelin is the hunger hormone produced in the stomach. Since a significant portion of the stomach is removed, a reduction in ghrelin production becomes evident.
The gastric sleeve surgery takes about 30 minutes to perform, as opposed to the gastric bypass and duodenal switch, which take upwards of one hour to complete. Patients can expect to stay in the hospital about 24 hours after their bariatric procedure, yet some bariatric surgeons are sending their patients home the same day as their procedure.
Risks Associated with Gastric Sleeve Surgery
Like any major surgical procedure, the gastric sleeve has associated risks. Before considering becoming a candidate for gastric sleeve surgery, it is important to be familiar with the potential complications, which will vary based on the patient’s health.
First, we want to define the difference between a consequence and a complication. A consequence is the result of the procedure itself. For example, hair loss is a consequence of bariatric surgery. On the contrary, a complication is an unintended outcome.
With the gastric sleeve, there are minor and major complications. Minor complications can are managed relatively easily, while major complications may result in reoperation. Some minor complications of gastric sleeve surgery include:
- Minor wound or skin infection
- Excess / loose skin
- Vomiting or nausea
- Acid reflux (heartburn)
- Development of gallstones or gallbladder disease
- Nutritional deficiencies as a result of food bypassing the stomach
Major complications of gastric sleeve surgery, and all bariatric procedures, include internal bleeding, blood clots in the legs or lungs, or a gastric leak.
The gastric sleeve is an excellent bariatric procedure that helps patients lose weight and regain their health. Patients who are interested in losing a significant amount of weight while reducing their overall risk, compared to other bariatric procedures, are good a candidate for gastric sleeve surgery.