Laparoscopic Gastric Sleeve
by Barbara Gibbons
The gastric sleeve involves removing 2/3 of the stomach with a stapling device and is the first part of a duodenal switch operation. It leaves a stomach tube instead of a pouch. In the case of a super morbidly obese person, this operation is offered because it allows good weight loss so the patient can get to a safe weight for the more radical bypass operation which can be done laparoscopically.
Some of the issues with this operation are:
1. Stomach tube may stretch up over time leading to late weight regain. The extent of this is currently unknown
2. The amount of weight reduction is in the region of 40-60% of excess wt lost over the
first 1-2 years.
3. There is no malabsorbtion to nutrients
4. If weight is regained the second stage of Duodenal Switch or Gastric Bypass can be added laparoscopically.
People with high risk heart issues often opt for this surgery as a first step toward the actual bypass operation. I have found 6 major rules for diet following this surgery. They are:
1. Only eat small amounts of food. Since the capacity of the stomach has changed, the amount of food taken in must change.
2. You will need more time to chew food properly and must decide which food you can chew enough to easily swallow.
3. Like with other WLS, never eat and drink at the same time. Reduction in capacity won’t allow you to have both and get in the amount of nutrients you need each day. Save the beverages for between meals.
4. Move around after you eat. Don’t lay down or just rest. The food you do eat will stay in the tube longer and will become very uncomfortable as it is surrounded by mucus from lack of motion after eating.
5. 5 meals a day are important. You won’t be able to eat enough food in only two or three meals. You also won’t be as susceptible to hunger pangs if you eat more often.
6. Monitor the calories in your beverages. Before drinking high calorie liquids, consider that most people take in a lot of calories with soft drinks, hot cocoa, and milk shakes. If you are going to partake of high calorie liquid, it should be as a protein shake to replace a meal.
One of the leading surgeons in the field of gastric sleeve surgery is Miller Karl, MD, Assoc. Professor of Surgery, Head of the Surgical Department, Hallein, Austria. Taken from his website is the following diet following the Gastric Sleeve operation. Remember that there is no malabsorption after this operation. That comes later if the patient chooses to continue to the bypass section of the surgery.
1.on the operation day, you get only tea in little sips. The remaining need for liquids is given by infusion
2. on the first day after the operation you get tea, as much as you want, and for lunch and dinner soup.
3. on the second day you get your first breakfast with tea or coffee, crisp bread with butter and jam. For lunch we serve mashed potatoes, mashed vegetables and mashed meat – only small portions. Please eat with a tea-spoon to enforce slow eating. Between breakfast and lunch and between lunch and dinner you get a snack – pureed fruits or yogurt. For dinner you can choose between several kinds of porridge with applesauce or a sandwich with cream.
Possible beverages are: coffee, tea, mineral water without gas, diluted orange or apple juice.
* after the third day, if you respond well to this diet, you get solid food like: potatoes, vegetables, fish, minced meat, dumplings e.g. – well done cooked but not mashed.
After the time in the hospital, you can start to make up your own menus. It is still important, that you eat little, often and chew the food thoroughly.
If you comply with all advices given on your diet, you should have no problems with the healing process. You should not lift any heavy objects for two weeks after your operation, as this may cause abdominal pain.
You must not take aspirin or any other drug such as non-steroid anti-rheumatic drugs, that may irritate your stomach, without gastric protection. Therefore you must inform your doctor of this advice (gastric mucosal prophylactic).
Points to remember with gastric sleeve surgery are first that it is NOT bypass surgery but patients tend to lose from 40 to 60% of their excess weight after this procedure. Only you can decide if this is enough weight loss for you. Second, it is a surgical option for cardiac patients that is considered safer by the medical community than other bypass operations. Third, it is NOT reversible because the 2/3 to 3/4 of the stomach that you are not going to use is removed. Fourth, it is considered less invasive than traditional weight loss surgeries.
It is mentioned that the greatest advantage of the sleeve is that it doesn’t involve any bypass so patients do not suffer those complications such as obstruction, anemia, osteoporosis, vitamin deficiency, and protein deficiency. Patients with heart disease, Crohn’s disease and many other conditions that make them high risk are able to have this surgery. Also, it can be performed laparoscopically on super morbidly obese patients. That said, it is also the case that patients often opt for the ‘second’ phase of the surgery which IS the gastric bypass in one form or another so that they can continue to lose weight and get to a healthy goal since as I mentioned before, most patients only lose 40 to 60% of their excess weight after the gastric sleeve surgery. So it could be said that the biggest disadvantage of the gastrectomy (gastric sleeve) is that it doesn’t necessarily produce the weight loss that people want for the long term and the result can well be a regain of weight.
Some of the risks for this surgery are post-op bleeding, small bowel obstruction, pneumonia and even death. The risk is only .05% to 1.0% for these complications. The medical advice is that the people best suited for this surgery are extremely overweight (needing to lose more than 200 pounds) or have co-morbidities that make them a high risk for other WLS.
After gastric sleeve surgery, the new stomach functions normally and there are few food restrictions. The change is only in the quantity of the food the patient can consume.
If you wish to view all the types of gastric sleeve surgery, go to the following link and scroll down the page about halfway and there is a brief explaination of each type of gastric sleeve surgery.
According to Dr Joya, these are the advantages and disadvantages of the gastric sleeve procedure:
Advantages of the Vertical Gastrectomy Weight Loss Surgery
The stomach is reduced in volume but tends to function normally so most food items can be consumed, albeit in small amounts.
Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin).
No dumping syndrome because the pylorus is preserved.
Minimizes the chance of an ulcer occurring.
By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated.
Very effective as a first stage procedure for high BMI patients (BMI>55 kg/m2).
Limited results appear promising as a single stage procedure for low BMI patients (BMI 30-45 kg/m2).
Appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures.
Can be done laparoscopically in patients weighing over 500 pounds.
Disadvantages of the Vertical Gastrectomy Weight Loss Surgery
Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass.
Higher BMI patients will most likely need to have a second stage procedure later to help lose the rest of the weight. Two stages may ultimately be safer and more effective than one operation for high BMI patients. This is an active point of discussion for bariatric surgeons.
Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss.
This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur.
Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure.
Considered investigational by some surgeons and insurance companies.
Back to Top