Bariatric surgery meaning

 

All you need to know about Laparoscopic Gastric Sleeve Surgery

A full guide for laparoscopic gastric sleeve surgery to solve the obesity problem safely. Obesity is a global disease with alarming statistical numbers. It increases the risk of developing multiple diseases.

According to the WHO, worldwide obesity has nearly tripled since 1975. Additionally, the World Obesity Federation predicts that by 2030, 1 billion people around the globe will be suffering from obesity. It is not about the good-looking. Obesity is a life-threatening condition carrying a higher risk of developing cardiovascular diseases, type 2 diabetes, and cancer.

Obesity can be assessed using Body Mass Index (BMI). It is an estimating body fat tool based on the weight-for-height relation. It is the most common tool used to estimate body fat. Nevertheless, it may be misleading in some conditions, as with athletes with a high BMI owned to their muscle bulk rather than fat. A BMI of 25 or higher is ranked overweight, while a BMI equal to or greater than 30 is considered obese.

A healthy diet to limit calorie intake combined with exercise is an excellent start to losing weight. But in case of failure or in certain conditions where obesity imposes health dangers, surgery will be the right option.

Bariatric surgery or weight loss surgery is a group of surgical options intended to perform changes to your digestive system to assist in weight loss. These types of surgery adopt multiple concepts, from inserting a band to squeeze the top of the stomach, removing a part of the stomach, and rerouting the food passages to bypass a part of the small intestine to decrease food absorption. Bariatric surgical options include Adjusted Gastric Band (AGB), Vertical Sleeve Gastrectomy (VSG), Roux-en-Y Gastric Bypass (RYGB), Biliopancreatic Diversion (BPD), and Biliopancreatic Diversion with a Duodenal Switch (BPD-DS).

Gastrectomy (partial or complete stomach removal) can be performed as an open surgery or laparoscopically. Laparoscopic gastric surgery (LGS) is carried out through multiple small incisions used to insert small operating instruments. The laparoscopic approach is a more conservative technique with fewer postoperative complications compared to the open surgical one.

Gastric sleeve surgery or vertical sleeve gastrectomy is the most commonly used procedure where around 80% of the stomach is removed, leaving behind a smaller portion similar to the size and shape of a banana. The reduced stomach size will lead to a decreased amount of food intake and elicit hormonal changes that help weight loss.

 

Goals of Gastric Sleeve Surgery

The basic solutions for weight loss include diet, exercise, and medication. Bariatric surgery is recommended only when:

·         All other solutions for weight loss have failed.

·         BMI higher than 40 (extreme obesity)

·         BMI 35 (obesity) when associated with serious illnesses such as diabetes, heart condition, and high blood pressure.

The main goal for gastric sleeve and other bariatric surgery is to alternate the digestive system by removing a part of the stomach and bypassing a part of the small intestine. That will treat obesity, and resolve medical conditions associated with it (diabetes, sleep apnea, high cholesterol, infertility, cancer, and hypertension).

Gastric sleeve surgery aims to decrease food intake and absorption. Additionally, Gastric Sleeve Surgery regulates hunger and increases fullness sensation through hormonal action.

The stomach tissue releases hormones that control the appetite or hunger signals. When the size of the stomach is reduced, there will be a diminished hormonal release and consequently loss of appetite.

Aside from obesity treatment, gastric sleeve surgery can also be used as a treatment for benign tumors, bleeding, peptic ulcers, and perforation in the stomach wall.

 

Pros and cons of Gastric Sleeve Surgery

Pros

-       Excellent weight loss and improved quality of life.

-       Resolving obesity-related health conditions such as diabetes, hypertension, and sleep apnea.

-       Reduced hunger sensation and amount of food intake.

-       Safe, minimally invasive, and short recovery time when performed laparoscopically.

-       Less risk for complications than other advanced bariatric surgical options as the intestine is not involved in the surgery.

Cons

-       Intra-operative complications such as bleeding, leaking at the staple line, and gastric fistula.

-       Micronutrient deficiency due to smaller stomach size and possible bypass of a part of the small intestine.

-       Irreversible procedure where 80% of the stomach is permanently removed.

-       Change eating habits after the surgery (smaller meals) and avoid carbonated beverages.

-       May induce heartburn or worsen the already existing pre-surgical heartburn.

How it works: Gastric Sleeve Surgery

·         Gastric sleeve surgery:

-       It is a type of bariatric surgery also known as Vertical Sleeve Gastrectomy (VSG).

-       It is a weight loss surgery that limits the amount of food intake. The surgery includes the stomach only; the small intestine is untouched.

-       Technique: It is performed under general anesthesia through laparoscopy. Small incisions are made on the upper abdomen. A tube is inserted into the stomach to act as a gauge to determine the size of the stomach to be kept. The stomach is sectioned vertically using a laparoscopic stapler and the left curved part is removed. The remaining part of the stomach is a vertical tube similar to a banana. Your surgeon will test the presence of any leaks through endoscopy or dyes.

-       Concept: A smaller stomach size leads to a quicker sensation of fullness, a decline in the release of the appetite-regulating hormone, and increased stomach motility which fasten the digestion procedure.

 

·         Other Bariatric Surgeries:

-       Adjustable Gastric Band:

The rationale behind this surgery is a band insertion at the top of the stomach to create a pouch. This band is adjusted through fluid injection through a port inserted below the skin. The pouch size controls the amount of food consumed before feeling full. It is a simple and reversible surgery but requires frequent visits for band size adjustment. This surgery shows a slow rate of weight loss and holds a risk of band slippage or erosion of the stomach wall with time. It has a minimal vitamin and mineral deficiency incidence compared to other bariatric surgeries.

-       Roux-en-Y Gastric Bypass (RYGB):

It is a more complex surgery that includes both the stomach and the small intestine. It is also known as gastric bypass. The stomach is split into two parts. A small pouch the size of an egg is hooked to the small intestine at a high level. The remaining section is bypassed from the food passage and attached to the intestine at a lower level. This gives the connections a Y appearance. It is very efficient in weight loss and effective in resolving diabetes. It holds a high risk for nutrient deficiency and bowel obstruction/ leakage. Tobacco and NSAIDs are contraindicated with this surgery to avoid ulcers. Post-surgical dumping syndrome (sickness, abdominal cramping, and diarrhea) is common after this surgery following sugar consumption.

-       Biliopancreatic Diversion (BPD) and Biliopancreatic Diversion with a Duodenal Switch (BPD-DS):

Both procedures are similar, where a considerable part of the stomach is removed. The remaining segment bypasses most of the small intestine to be linked near the duodenum. The only difference is the part of the stomach to be removed. In Biliopancreatic Diversion, the stomach is cut horizontally, and the lower part containing the valve regulating food passage from the stomach to the intestine is removed. While in Biliopancreatic Diversion with a Duodenal Switch, a vertical pouch similar to gastric bypass is created that conserves the valve. Both are highly effective in weight loss and resolving diabetes. However, they have a higher risk of developing bowel complications and nutritional plus vitamin deficiency.

Preparation before Gastric Sleeve Surgery

Pre-treatment

-       A thorough examination, imaging, and laboratory tests must be accomplished by your physician to make sure you are eligible for the surgery.

-       You may be enrolled in a nutritional counseling program to be psychologically prepared for the changes in your dietary routine after surgery.

-       You will be instructed to follow a healthy diet plan (sometimes a liquid diet only) one month before surgery to lose as much weight as possible.

-       Avoid smoking, alcohol, and blood-thinning medications such as aspirin before surgery.

-       Cease drinking and eating 12 hours before your surgery to make sure you have an empty stomach at the time of your surgery to avoid any complications.

 

Recovery after Gastric Sleeve Surgery

Post-treatment

-      Your surgeon may advise you to be hospitalized for 1-2 days after surgery to manage your pain and any side effects that may develop.

-      Regular follow-up visits and tests are recommended to monitor your general health and weight loss progress.

-      You may feel fatigued in the first few weeks of recovery following surgery due to the decreased food intake. The recovery period may take up to one month to feel normal again.

-      A strict diet plan after surgery is recommended to ensure safe stomach healing. Begin with liquid food such as protein shakes, yogurt, milk, and juices in the first 1-2 weeks. A Subsequent shift to puree and soft food for the following 2-3 weeks. Finally, regular food will be introduced five weeks after surgery. Never jump to regular food as this may elicit pain and vomiting.

-      You will be advised to change your eating habits to eat small frequent meals, eat slowly and chew well.

-      Multivitamins will be prescribed following your surgery to be taken permanently to avoid any vitamin deficiency.

Risks & side effects

Laparoscopic Gastric Sleeve surgery is a safe minimally invasive weight loss option compared to other bariatric surgeries.

Some rare general surgical complications may occur as bleeding, infection, sensitivity to anesthesia, and leakage from the staple line.

Vitamin deficiency following this type of surgery may happen. This can be avoided by regularly taking the vitamin supplements prescribed by your doctor after the surgery.

Some patients may experience worsened gastric acid reflux due to the smaller stomach size that can be managed through medications.

There may be a risk for weight regain and widening of the stomach sleeve if you don’t follow a healthy diet plan combined with exercises.

FAQs: Gastric Sleeve Surgery

Is gastric sleeve safe?

Gastric sleeve surgery is a safe procedure with rare risks that can be avoided by choosing a skilled surgeon and strictly following post-operative instructions. The risks of obesity and the accompanying health problems are by far more dangerous than the rare surgical risks.

Who should consider Gastric Sleeve Surgery?

The qualifying requirements for gastric sleeve surgery include:

-       BMI over 40 or at least 35 accompanied with at least one healthcare issue such as diabetes or hypertension

-       Failure to lose weight by any other method such as diet plan, exercises, and medications.

What are the benefits of Gastric Sleeve Surgery?

 

Gastric Sleeve Surgery decreases the stomach size which will be reflected in the amount of consumed food, appetite, and early fullness sensation. This will lead to great results in weight loss that help resolves associated medical conditions such as diabetes, hypertension, high cholesterol levels, and heart problems.

Will I ever gain weight again?

It is possible to regain some of the lost weight due to the expansion of the stomach sleeve. This can be avoided by following a healthy diet plan, exercising, eating small frequent meals, and having the motivational power to control your food consumption.

How long is the recovery time?

You may feel fatigued in the first few weeks of recovery following surgery due to the decreased food intake. It may take up to a month of recovery to feel normal again.

When can I eat regular food after surgery?

You will be required to follow a strict diet plan after surgery to ensure safe stomach healing. You will begin with liquid food for 1-2 weeks, then puree food and soft food for 2-3 weeks.  Finally, you will be able to consume regular food around 5 weeks after surgery. Never jump to regular food as this may elicit pain and vomiting.