Also known as tube gastrectomy, is where approximately 70 - 80% of the stomach is completely removed effectively turning the stomach, which is like a big bag normally into a small tube. The biggest advantage is that there is no foreign device to fail or cause obstruction and there is no major alteration in the gastro-intestinal tract. Patients will feel full with an entrée size portion, but also once they get beyond the normal post-operative recovery period can eat most foods, which is a major advantage over gastric banding.
The other major effect of the procedure is to remove the part of the stomach that secretes Ghrelin, a hormone that plays a major role in determining how hungry we get. When normal people go on a diet as they lose weight the stomach starts to produce more and more Ghrelin, which acts on the brain to increase appetite. Often people who are dieting have the sensation that they are starving to death. Patients who have had a sleeve gastrectomy generally have a greatly reduced appetite, and as they lose weight they do not suffer the hunger pains experienced by dieters.
Sleeve gastrectomy is suitable for most morbidly obese patients. It has a clear role in super obese or high-risk patients where it may be used as the first operation in a staged 2-part surgery to greatly reduce the operative risks in these patients. Following the sleeve gastrectomy patients are allowed to lose weight for 12 months at which stage they are reassessed to determine whether they have lost enough weight which many will have.
If weight loss has not been satisfactory patients can then have a second operation where they are converted to either a gastric bypass or bilio-pancreatic diversion procedure. This combination or 2 stage approach greatly reduces the risk in other wise high-risk patients and ultimately allows a much more effective procedure to be performed. Sleeve gastrectomy as a stand-alone procedure may also be performed in individuals as an alternative to either laparoscopic gastric banding or laparoscopic gastric bypass. It is an especially good option for country patients as there is not the same need for intensive follow up and readjustments required with gastric banding.
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