Diagram of a gastric sleeve
This article needs additional citations for verification. (February 2019) (Learn how and when to remove this template message)
Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve or tube like structure. The procedure permanently reduces the size of the stomach, although there could be some dilatation of the stomach later on in life. The procedure is generally performed laparoscopically and is irreversible.
Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.
Sleeve gastrectomy is the most commonly performed bariatric surgery worldwide. In many cases, sleeve gastrectomy is as effective as gastric bypass surgery, including improvements in glucose homeostasis before substantial weight loss has occurred. This weight-loss independent benefit is related to the decrease in gastric volume, changes in gut peptides, and expression of genes involved in glucose absorption.
The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia. The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 36-40 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.
Use in children and adolescents
Endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders and the American Society for Metabolic and Bariatric Surgery, sleeve gastrectomy is gaining popularity in children and adolescents. Studies by Alqahtani and colleagues have found that sleeve gastrectomy causes large weight loss in children and adolescents aged 5 to 21 years. Moreover, they compared weight loss with adults and found comparable weight loss. Recent reports from the group show that growth progresses unaffected after sleeve gastrectomy in children younger than 14 years of age. Although this surgery helps immensely with losing weight the main side effect to this surgery afterwards in the depression that follows the weight loss. This may be because you are realizing that some foods may never be eaten again, or your chemical imbalance is thrown off. It could also be because of the lack of carbohydrates, which throws off the serotonin levels in your body. Another side effect is insomnia. Many people after this surgery can only sleep when they take melatonin or sleeping medications.
Sleeve gastrectomy may cause complications; some of them are listed below:
- Sleeve leaking (occurs 1 in 200 patients)
- Blood clots (happens 1% of the time)
- Wound infections (occurs in about 10-15% of post-op patients)
- Strictures (occurs 3.5% of post-op patients)
- Aversion to food and nausea
- Damage to the vagus nerve which will cause constant nausea
- Gastroparesis, with a delay in moving food from the stomach to the small intestine
- Esophageal spasm/pain
- Gastroesophageal Reflux Disease (GERD)
- Depression after surgery
There are basically three cost categories for sleeve gastrectomy surgery: pre-operative (all fees associated with preparing the patient for surgery including professional fees, lab work and testing), the surgery itself (including surgeon, surgical assistant, anesthesia and hospital fees) and post-op costs (follow-up physician office visits, vitamins and supplements). Pre-operative costs may include a psychological assessment as required by your physician/surgeon and/or your health insurance carrier.
Out of pocket costs for the sleeve gastrectomy surgery itself may be offered to the patient as a packaged price or charged separately by the surgeon's office, hospital, and other providers. Packaged prices may or may not include pre-op and post-op care, depending on the surgical practice.
Average costs for sleeve gastrectomy surgery are US$19,000 in the United States, although this varies widely between states; South Dakota and Texas offer the lowest average cost at about $12,000 while the most expensive surgeries are performed in Alaska (average about $58,000).In India, it costs between 4-5000US$ for this procedure, all charges inclusive. In Turkey this operation costs $6,000. In Jordan the total cost is around $4,000, which includes all pre-surgery tests, x-ray and hospital fees. In New Zealand the cost is approximately $20,000. In Egypt this surgery costs about $2000–2500. Superannuation in Australia may be accessed by patients to fund the cost of surgery.
In Europe, gastric sleeve surgery is cheaper than in the United States. In eastern countries like Poland, Lithuania and Estonia this surgery costs about $6,000. In the UK a patient pays about $12,600. The most expensive countries are Germany and Italy. Prices of gastric surgery range between $23,500 - $26,200. In Denmark, the typical price is $9,600 dollars as of February 2018 at a private hospital.
- Chung AY, Thompson R, Overby DW, Duke MC, Farrell TM (August 2018). "Sleeve Gastrectomy: Surgical Tips". Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 28 (8): 930–937. doi:10.1089/lap.2018.0392. PMID 30004814.
- Spiegel HU, Skawran S (January 2011). "From longitudinal gastric resection to sleeve gastrectomy--revival of a previously established surgical procedure". Journal of Gastrointestinal Surgery. 15 (1): 219–28. doi:10.1007/s11605-010-1293-9. PMC 3023025. PMID 20725800.
- Hutch CR, Sandoval D (December 2017). "The Role of GLP-1 in the Metabolic Success of Bariatric Surgery". Endocrinology. 158 (12): 4139–4151. doi:10.1210/en.2017-00564. PMC 5711387. PMID 29040429.
- Cavin JB, Couvelard A, Lebtahi R, Ducroc R, Arapis K, Voitellier E, Cluzeaud F, Gillard L, Hourseau M, Mikail N, Ribeiro-Parenti L, Kapel N, Marmuse JP, Bado A, Le Gall M (February 2016). "Differences in Alimentary Glucose Absorption and Intestinal Disposal of Blood Glucose After Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy". Gastroenterology. 150 (2): 454–64.e9. doi:10.1053/j.gastro.2015.10.009. PMID 26481855.
- Paluszkiewicz R, Kalinowski P, Wróblewski T, Bartoszewicz Z, Białobrzeska-Paluszkiewicz J, Ziarkiewicz-Wróblewska B, Remiszewski P, Grodzicki M, Krawczyk M (December 2012). "Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity". Wideochirurgia I Inne Techniki Maloinwazyjne = Videosurgery and Other Miniinvasive Techniques. 7 (4): 225–32. doi:10.5114/wiitm.2012.32384. PMC 3557743. PMID 23362420.
- Karmali S, Schauer P, Birch D, Sharma AM, Sherman V (April 2010). "Laparoscopic sleeve gastrectomy: an innovative new tool in the battle against the obesity epidemic in Canada". Canadian Journal of Surgery. 53 (2): 126–32. PMC 2845949. PMID 20334745.
- "International Federation for the Surgery of Obesity and Metabolic Disorders".
- "Bariatric Surgery Procedures". The American Society for Metabolic and Bariatric Surgery (ASMBS).
- Alqahtani AR, Antonisamy B, Alamri H, Elahmedi M, Zimmerman VA (August 2012). "Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years". Annals of Surgery. 256 (2): 266–73. doi:10.1097/SLA.0b013e318251e92b. PMID 22504281.
- Alqahtani A, Alamri H, Elahmedi M, Mohammed R (November 2012). "Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study". Surgical Endoscopy. 26 (11): 3094–100. doi:10.1007/s00464-012-2345-x. PMID 22648112.
- Alqahtani A, Elahmedi M, Qahtani AR (February 2016). "Laparoscopic Sleeve Gastrectomy in Children Younger Than 14 Years: Refuting the Concerns". Annals of Surgery. 263 (2): 312–9. doi:10.1097/SLA.0000000000001278. PMID 26496081.
- "Depression after Gastric Bypass Surgery". Psychology Today. Retrieved 2019-04-18.
- "Gastric Sleeve Surgery: Common Risks and Complications". Gastric Sleeve Diet Guide. 2016-10-11. Retrieved 16 March 2017.
- "Gastric Sleeve Complications Post Surgery". BSIG. Retrieved 5 August 2013.
- "Depression after Gastric Bypass Surgery". Psychology Today. Retrieved 2019-04-18.
- Gastric Sleeve: 14 Ways It Will Affect You, Bariatric Surgery Source, retrieved 30 November 2017
- Carroll L (4 January 2014). "Superannuation tapped to fund weight-loss surgery". The Sydney Morning Herald.
- Gastric Sleeve - price comparison - check the prices around the world, Beauty Poland, retrieved 22 November 2018
- Bariatric Surgery Insurance: Complete Patient Guide, Bariatric Surgery Source, retrieved 19 April 2015
- Media related to Sleeve gastrectomy at Wikimedia Commons