Sleeve Gastrectomy
Obesity and its comorbities are increasing at an alarming rate. In the United States, morbid obesity has reached epidemic proportions, affecting up to 30% of population. Bariatric surgery is the only effective long-term treatment for morbid obesity, reducing comorbidities and improving quality of life. Based on NIH (National Institute of Health ) guidelines, surgery is indicated for patients with Morbid obesity.
Bariatric surgical operations are now one of the most commonly performed gastrointestinal operations in the United States. This is thought to be due to the increased incidence and greater acceptability by primary physicians and the patients as result of Laparoscopic access.
 Candidates include those with Body Mass Index (BMI) above 40, and BMI above 35 with associated obesity-related health conditions such as type II Diabetes, Hypertension, Sleep Apnea, severe Arthritis, Asthma, Hypercholesterolemia, Cardiovascular diseases.
Morbid obesity is defined as twice the ideal body weight as calculated from the Metropolitan Life Insurance height/ weight tables. It can be identified by patient's BMI which at some centers is recorded as part of initial vital signs. BMI is calculated by dividing the weight in Kilograms by square of the height in Meters (Kg/m2). Individuals whose BMI is between 25 and 29.9 are termed overweight. Those with BMI between 30 and 35 are considered obese; those with BMI between 35 and 40 are severely obese, whereas those above 40 are morbidly obese. BMI above 50 is known as super obesity.
Surgical procedures for the treatment of morbid obesity fall into one of two categories, Restrictive and Malabsorbtive (or a combination of the two). Adjustable Silicone Gastric Banding (LAP-BAND) and Sleeve Gastrectomy are purely restrictive operations. Roux-En-Y Gastric Bypass is also a restrictive operation but with malabsorptive component.
Laparoscopic Sleeve Gastrectomy
Sleeve gastrectomy is a new procedure that induces weight loss by restricting food intake. With this procedure, the surgeon removes approximately 80 percent of the stomach laparoscopically so that the stomach takes the shape of a tube or "sleeve." The remaining stomach can hold 100-150 ml volume.
Studies have shown that Ghrelin, a hunger regulating hormone, is reduced following this operation. This is due to removal of segment of stomach which is responsible for Ghrelin production. The superior weight loss after Sleeve Gastrectomy compare with Gastric Banding is thought to be due to this long-term effect.
This operation is performed laparoscopicaly and is shown to be safer compared to Gastric Bypass procedure. This is mainly due the fact that the natural anatomy of Gastro-Intestinal tract is not changed. As there is no Malbasorbtive component to this operation, therefore possibility of protein and vitamin malnutrition is less compared to Gastric Bypass surgery. Also possibility of obstruction and ulceration dumping are close to zero. Unlike LAP-BAND there is no implantable component in this operation and there is no need for adjustment. Also unlike LAP-BAND this operation is not reversible.
Anatomy
 This procedure generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from 3-5 ounces (100-150cc). The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded. The Roux-en-Y gastric bypass stomach can be reconnected (reversed) if necessary. Note that there is no intestinal bypass with this procedure, only stomach reduction. The lack of an intestinal bypass avoids potentially costly, long term complications such as marginal ulcers, vitamin deficiencies and intestinal obstructions.
The Sleeve Gastrectomy Operation
The operation is done with 5 small incisions, and takes about an hour to do. We do a "leak test" in the operating room before we complete the operation. Having the Laparoscopic Sleeve Gastrectomy involves an overnight stay in the hospital. There is no nasogastric tube. Recovery time is about one week.
Sleeve Gastrectomy - Laparoscopic Sleeve Gastrectomy - Anatomy - The Operation
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