Sleeve Gastrectomy

doctor ramana with his patient after her obesity surgery


The sleeve is a minimally invasive surgical weight-loss procedure in which the stomach is reduced to about 20% of its actual size. How do we do that? By removing the baggy part of the stomach along the greater curve of the organ. The stomach that is left is a tube that leads from the foodie to the beginning of the small gut (duodenum). The sleeve operation, done by firing endoscopic staplers, transforms the stomach to a tube or sleeve-like structure. This procedure diminishes the size of the stomach permanently, though there could be some expansion of the stomach later in life. It is performed laparoscopically and is irreversible. It is the most popular weight loss operation in the whole world, as well as in India.

How is Sleeve Gastrectomy performed?

The sleeve is begun by making 3 to 5 tiny nicks in the abdomen and is performed with the help of the laparoscope. During this procedure, approximately 80 percent of the stomach is removed by firing endoscopic staplers one after the other, parallel to the lesser curvature of the stomach. At the end of it, the baggy part along the greater curve is disconnected, leaving behind a narrow gastric tube or ”sleeve” that extends from the food pipe to the first part of the duodenum (or end of the stomach). The intestines are neither removed nor bypassed during this operation. This procedure takes 30 minutes or an hour to get done and is a preferred choice in higher risk patients, younger people and super-super obese patients.

How does Sleeve Gastrectomy aid in weight loss?

Sleeve Gastrectomy is a restrictive procedure and limits the amount of the intake of the food you eat by reducing the size of your stomach. You would feel full even after eating a small quantity of food. Additionally; it decreases ghrelin, a hunger hormone produced by the stomach. GLP-1 is a hormone that is increased after the sleeve. This hormone is possibly responsible for the powerful anti-diabetic actions of the sleeve. The sleeve leads to early satiety, another way of saying that you will feel full after eating a very small portion of food (some may feel full after eating 2 pieces of chicken kebab).

What are the benefits of Sleeve Gastrectomy?

Apart from the improvement in all the obesity-related complications, the sleeve dramatically improves the quality of your life. The hospitalization is typically for just one day. The patient walks from Day One and is encouraged to walk regularly, drive, bathe normally and do things like desk work, shopping, going to friends’ homes, and even office work.

Is Sleeve Gastrectomy a better choice for me?

For many super-super-obese patients (BMI>60) the sleeve is the first choice, with its high safety profile. In adolescents, kidney transplant patients and those with heart and liver conditions, it usually is the first choice as well. You must consult your doctor for the best choice for the bariatric surgical procedures.

In addition, many surgeons prefer the sleeve as their default operation of choice.

When is a sleeve not a good idea?

If you have significant acidity due to hiatus hernia, a sleeve is usually not our first choice. The RNY gastric bypass is the best option then. If there is a patient who has had weight regain after a previous sleeve, then a re-sleeve is not usually the best choice.

What are the side-effects of the sleeve?

Though considered a very safe operation suitable for a wide spectrum of bariatric patients, the sleeve does have its small share of faults. A leak is a dreaded complication that makes the life of the patient (and the surgeon) miserable. Multiple procedures, investigations and intravenous lines pumping antibiotics and other drugs are part of the “mother-in-law leak” scenario. However, in good centers, the incidence of a leak would be under 1 in 100!

Similarly, bleeding from the staple line is a rare complication, and is seen in patients who are on blood thinners (low molecular weight heparin). Rarer but important complications include twisting of the sleeve, migration of the stomach tube into the chest cavity and blood clots in the veins of the liver (portal/mesenteric vein thrombosis) are some truly horrendous side effects that, fortunately, are very rare. More common side effects are usually longer term and include late weight regain, reflux (acidity) and hair loss. This is by no means a full list, but usually you would be briefed by your surgeon about the specific side effects you should worry about.

Will I lose weight after my sleeve?

Yes, of course! It is entirely normal to expect massive weight loss after a well done sleeve. One word of caution is, of course, to reiterate that any operation is as good as its patient’s post-operative followup and compliance with the lifestyle changes that we talk about. This means that if you want to keep drinking beer or colas and munching chips as a routine, the surgery is not going to do much for you. If, on the other hand, you allow the surgery to work by eating more veggies and protein containing foods, walk and follow an active lifestyle, and keep following up with the bariatric team, you will likely be happy and healthy for a very long time. Many many patients have had their entire lives turned around as if by a miracle!

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