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SLEEVE GASTRECTOMY


The Sleeve Gastrectomy (Sleeve) procedure involves laparascopically removing the outer 85% of the stomach, leaving a slim tube of stomach which is about  a 2 oz. in size.  The slim tube of the stomach looks like a sleeve and thus is a descriptive term.  There is no sleeve that is placed in or around the stomach.  The sleeve procedure has been in different forms for decades but has only been in this current form for the last eight years, and yet it has rapidly become the most common procedure.  It is much less complicated than the gastric bypass procedure, and has far less complications.  It is nearly as effective as the gastric bypass in terms of weight loss and resolution of comorbidities. Patients lose 80% to 90% of their excess weight in a year and studies so far have shown the sleeve allows patients to keep a greater percentage of the weight off than with the gastric bypass or the band.
 
General procedure:
 
First the stomach is reduced in size using a surgical stapling technique by vertically transecting the stomach.  The transected stomach is then removed from the body.  This procedure is the only truly permanent procedure between the three procedures performed.
 
Post op:
 
The Sleeve is quite restricting at first as to the type and amount of food patients can consume.  Patients are asked to make a lifetime commitment to change in their diet.  The size of the new stomach pouch will no longer allow the same eating habits to exist as before surgery.  Patients progress from a liquid, to a soft food, to a regular food diet over several months.  Supplementation with protein drinks, a multivitamin, and vitamin B12 are required for the first six months.  These supplements are often not required at the end of six month to one year once a balanced diet is reached.
 
Advantages of the Gastric Sleeve New Procedure:


  1. Excellent weight loss: 80% to 90% of the excess weight in a 6 to 9-month period.
  2. Resolution of comorbidities: Resolution of noninsulin dependent type 2 diabetes, hypertension, and sleep apnea in the majority of patients.
  3. Low complication rate and next to zero mortality rate.
  4. Only 5% of patients with long-term weight regain.
 
Disadvantages of Gastric Sleeve:


  1. It is a permanent procedure.
  2. 1 in 100 patients may experience a leak requiring surgery to fix.
  3. 1 in 20 patients may need a second surgery for failure to loose enough weight or weight regain.
 
 
Robert V. McKeen, M.D.