SLEEVE GASTRECTOMY

 

 

 

 

          The “Sleeve Gastrectomy” refers to the operation depicted above.  Simply put, the operation involves dividing and stapling the stomach vertically from a point near the pylorus (entrance into the duodenum or small bowel) to a point near the angle of His ( near the junction of the esophagus with the stomach on the greater curvature).  This essentially creates a new stomach, a narrow tube with a banana shape.  Unlike the Roux-Y gastric bypass and adjustable gastric band, during this operation a large portion, about ¾, of the stomach is removed or resected.  This cannot be replaced. 

 

          The “Sleeve Gastrectomy” is actually part of a more involved malabsorptive procedure (performed infrequently in this country) called the Biliopancreatic Diversion/ Duodenal Switch.

 

                                                   

                                    

Since this operation functions by causing significant malabsorption, creating a very restricted gastric pouch was not needed.  Since the BPD/DS operation was used for patients with very high BMI’s and weights, some of them could not have the complete operation performed at one sitting.  The first stage was the “Sleeve Gastrectomy”, followed at a later time by the remainder of the operation.  However, it was found that some patients did well with the “Sleeve” alone and did not need the full operation.  Therefore, this operation is now being used as a “stand alone” operation.

 

 

ADVANTAGES

 

          ► Allows patients that require slow-release or long-acting medications to stay on these medications- 

              similar to adjustable gastric banding.

          ► No malabsorption-no requirement for long term vitamin supplements (although iron, B12, and folate

              deficiencies may occur).

          ► No “dumping syndrome”

          ► No internal hernias

          ► Maintains oral access to rest of bowel and biliary tract

          ► No adjustments

 

DISADVANTAGES

 

          ► Removal of a large portion of a normal stomach

          ► No long term follow-up data regarding weight loss or resolution of comorbidities

          ► No “dumping syndrome” or other mechanism to assist in changing eating habits or food choices

          ► In many cases will require second operation for success

 

 

          The place of the “Sleeve Gastrectomy” in the tool box of the bariatric surgeon is not clear.  It does not compare to the gastric bypass as a primary or stand alone operation, and it is not reversible or adjustable like the band.  It certainly can be used as a first stage operation in patients with very high BMI’s and weights, and is covered for this purpose by many insurance companies.  It is a good compromise operation for older patients with complicated medical issues that make the gastric bypass not an option.  Finally, it is a good operation for patients (i.e. bipolar, etc.), who require a combination of specific medications which must be taken without crushing or cutting, and those for whom following specific guidelines, maintaining close follow-up, or managing long term vitamin and mineral supplementation would be difficult.  It would generally not be a good operation for younger patients.