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Laparoscopic Sleeve Gastrectomy (Gastric Sleeve)

Gastric Sleeve  cost:              5950 EUR (all-inclusive) Look what is included >>

Required BMI:                         Starting from 30kg/m2, depending on co-morbidities

Expected weight loss:             60-70% of excess body weight

Anaesthesia:                           General anaesthesia

Surgery time:                          1 – 1.5 hours

Hospital stay:                          2-3 nights

Sick leave:                               2 weeks

Operation reversible:               No

Need for supplements:            +

Laparoscopic gastric sleeve resectionIn this operation, 85% of the stomach is removed and a banana-shaped gastric tube with a diameter of approximately 2-2.5 cm and volume of 100-150ml/3.4-5 fl. oz  is formed.  This reduces the gastric volume and the quantities of food ingested.  In comparison, an average sized  normal stomach of  medium fullness is 1-1.5 litres / 34-50 fl. oz. The surgery is always performed laparoscopically.

 

How does Sleeve Gastrectomy (Gastric Sleeve) work?

Gastric Sleeve surgery reduces appetite (hunger) and the amount of food eaten. Appetite is reduced because the part of stomach that produces the hunger hormone  ghrelin is removed. A stomach reduced  in size to  100-150 ml / 3.4-5 fl. oz. as opposed to the normal size of 1500 ml / 50 fl. oz. fills up remarkably more quickly and the feeling of satiety is achieved by swallowing just a couple of mouthfuls. Also the  faster flow of food from the stomach’s tube to the small intestine plays a role in the reduction of appetite, as the small intestine’s contact with freshly swallowed food amplifies the feeling of a full stomach.

The main difference of sleeve gastrectomy compared with bypass surgery is that, in the case of gastric sleeve, food still flows through every part of the digestive system and therefore the absorption of nutrients (including vitamins and minerals) and medications is not affected. After the surgery, the stomach and duodenum can still be examined laparoscopically , which is important for patients with certain types of stomach and biliary diseases.

What are the long term effects of the gastric sleeve surgery?

Important! As with all medical procedures, individual results and experiences may vary. Long term effects of any gastric surgery are reliant on a patient making the necessary changes to lifestyle, particularly in relation to diet and exercise. 

There have been many studies conducted on the long term (more than 5 years) effects of gastric sleeve surgery. The loss of weight is expressed as an excess body weight loss percentage. A survey review article analysing 16 original studies concluded that 5 years  post-surgery the average excess body weight loss was 62.3% (ranging from 52% to 69% in the different  studies examined). 7 years after surgeries the patients had lost on average 67% of their excess body weight. The percentage of weight loss was  greater in those with a pre-surgery BMI  below 45 kg/m2

Important!  In cases where body weight loss is insufficient or body weight starts to rise, it is possible to convert a gastric sleeve into a gastric bypass

Many diseases connected to being overweight like sleep apnoea, type 2 diabetes, joint diseases, high blood pressure or polycystic ovary syndrome (PCOS)  improve or disappear as a result of  gastric sleeve surgery.

Sleeve gastrectomy may be advisable  for patients with:

  • a BMI below 45 kg/m2
  • aged over 70;
  • small bowel adhesions resulting from previous surgeries, making the patient unsuitable for laparoscopic bypass surgery;
  • a preference not to have to use as many vitamins and food supplements as are needed in the case of bypass surgery;
  • a propensity to develop anaemia as a result of iron deficiency even prior to the surgery;
  • the prospect of getting pregnant and giving birth;
  • the need to use a daily dose of pain killers like diclofenac or ibuprofen;
  • imminent or freshly performed organ transplant surgery;
  • a diagnosed inflammatory bowel disease (ulcerous colitis, Crohn’s disease);
  • a potential necessity for future endoscopic access to the stomach and duodenum.

Pros

  • Excess body weight loss of 60-65%;
  • Improved quality of life for 95% of patients;
  • The food flow in the digestive system doesn’t change;
  • Remission of type 2 diabetes: 55-60%;
  • Remission of sleep apnoea and snoring: 90%;
  • Disappearance or major relief from back and joint pain;
  • Reduced risk of developing dumping syndrome compared to bypass surgery;
  • Mortality rate of the surgery is low: less than 0.1%;
  • The risk of serious surgical complications (ones that need reoperation, blood transfusion or a hospitalisation of more than 1 week) is low: 2%;
  • Complications as a result of reduced absorption of vitamins and minerals are much more rare compared with bypass surgery;
  • The stomach and duodenum remain endoscopically examinable.

Cons

  • Weight loss is a little lower compared with bypass surgery;
  • Increased risk of weight regain in the years following surgery;
  • Not suitable for patients with a sweet tooth;
  • Increase in heartburn frequency  in 20% of  patients;
  • Reversal of the procedure and restoration of the original anatomy is not possible;
  • Increased recovery time compared with bypass surgery.

Possible complications

Early: peritonitis; post-surgery bleeding; thrombus of deep veins and lung artery; myocardial infarction; pneumonia; abdominal abscess; wound infections; narrowing of the stomach tube; difficulties  in swallowing.

Delayed: stretching of the stomach tube and weight regain after initial weight loss; heartburn; gallstones; constipation; diarrhoea; excess skin; loss of hair; dumping syndrome.

To summarise, sleeve gastrectomy  results in somewhat lower excess body weight loss than a gastric bypass but is technically easier to perform and helps to avoid certain specific adverse effects of bypass surgery like vitamin and mineral malabsorption. This operation is indicated  in particular for those whose  BMI is under 45kg/m2 or for those for whom a laparoscopic bypass operation would be difficult to perform due to small intestinal adhesions  as a result of previous surgeries.