Sleeve gastrectomy explained

Sleeve gastrectomy

Sleeve gastrectomy or vertical sleeve gastrectomy, is a surgical weight-loss procedure, typically performed laparoscopically, in which approximately 75 - 85% of the stomach is removed,[1] [2] along the greater curvature,[3] which leaves a cylindrical, or "sleeve"-shaped stomach the size of a banana.[1] [2] Weight loss is affected not only through the reduction of the organ's size, but by the removal of the portion of it that produces ghrelin, the hormone that stimulates appetite. Patients can lose 50-70 percent of excess weight over the course of the two years that follow the surgery.[2] The procedure is irreversible,[4] though in some uncommon cases, patients can regain the lost weight, via resumption of poor dietary habits, or dilation of the stomach over time, which can require gastric sleeve revision surgery to either repair the sleeve or convert it to another type of weight loss method that may produce better results, such as a gastric bypass or duodenal switch.[5]

A meta-analysis of 174,772 participants published in The Lancet in 2021 found that bariatric surgery was associated with 59% and 30% reduction in all-cause mortality among obese adults with and without type 2 diabetes, respectively. This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes.[6]

Procedure

Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.[7]

Sleeve gastrectomy is the most commonly performed bariatric surgery worldwide.[8] [9] In many cases, sleeve gastrectomy is as effective as gastric bypass surgery, including improvements in glucose homeostasis before substantial weight loss has occurred. This weight-loss independent benefit is related to the decrease in gastric volume, changes in gut peptides, and expression of genes involved in glucose absorption.[10] [11]

The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia.[12] The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 36 and 40 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.[13]

Use in children and adolescents

Endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders[14] and the American Society for Metabolic and Bariatric Surgery,[15] sleeve gastrectomy is gaining popularity in children and adolescents. Studies by Alqahtani and colleagues have found that sleeve gastrectomy causes large weight loss in children and adolescents aged 5 to 21 years.[16] Moreover, they compared weight loss with adults and found comparable weight loss.[17] A study published in 2016 showed that growth progresses were unaffected after sleeve gastrectomy in children younger than 14 years of age.[18] Depression following the procedure has been noted in some individuals. Another side effect is insomnia. After this surgery many people can only sleep when they take melatonin or sleeping medications.[19]

Complications

Sleeve gastrectomy may cause complications; some of them are listed below:

Further reading

Micsorare stomac/ gastric sleeve - info related

Notes and References

  1. Web site: Sleeve gastrectomy. Mayo Clinic. en-US. live. April 21, 2023. April 14, 2023. https://web.archive.org/web/20230414153542/https://www.mayoclinic.org/tests-procedures/sleeve-gastrectomy/about/pac-20385183.
  2. Web site: What is Sleeve Gastrectomy?. Hackensack Meridian Health. en-US. live. April 21, 2023. March 7, 2023. https://web.archive.org/web/20230307032526/https://www.hackensackmeridianhealth.org/en/Services/Bariatrics/bariatric-treatments/sleeve-gastrectomy.
  3. Web site: Sleeve Gastrectomy. National Library of Medicine. Seeras, Kevin; Sankararaman, Senthikumar; Lopez, Peter P.. en-US. live. May 1, 2022. 30085577. April 21, 2023. February 15, 2023. https://web.archive.org/web/20230215060518/https://www.ncbi.nlm.nih.gov/books/NBK519035/.
  4. Web site: Sleeve Gastrectomy. Columbia University Department of Surgery. en-US. live. April 21, 2023. April 22, 2023. https://archive.today/20230422004235/https://columbiasurgery.org/conditions-and-treatments/sleeve-gastrectomy.
  5. Web site: Gastric Sleeve Surgery (Gastrectomy). Cleveland Clinic. en-US. April 26, 2024. April 26, 2024. https://archive.today/20240426181149/https://my.clevelandclinic.org/health/treatments/22931-gastric-sleeve-surgery.
  6. Syn. Nicholas L. Cummings. David E. Wang. Louis Z. Lin. Daryl J. Zhao. Joseph J. Loh. Marie. Koh. Zong Jie. Chew. Claire Alexandra. Loo. Ying Ern. Tai. Bee Choo. Kim. Guowei. So. Jimmy Bok-Yan. Kaplan. Lee M. Dixon. John B. Shabbir. Asim. Association of metabolic–bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants. The Lancet. May 2021. 397. 10287. 1830–1841. 10.1016/S0140-6736(21)00591-2. 33965067. 234345414.
  7. Web site: The History of Sleeve Gastrectomy: Bariatric Times. 2020-10-09. en-US. 2020-11-01. https://web.archive.org/web/20201101015357/https://bariatrictimes.com/the-history-of-sleeve-gastrectomy/. live.
  8. Chung AY, Thompson R, Overby DW, Duke MC, Farrell TM. Sleeve Gastrectomy: Surgical Tips . Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A . 28 . 8 . 930–937 . August 2018 . 30004814 . 10.1089/lap.2018.0392 . 51625639 .
  9. Spiegel HU, Skawran S . From longitudinal gastric resection to sleeve gastrectomy--revival of a previously established surgical procedure . Journal of Gastrointestinal Surgery . 15 . 1 . 219–28 . January 2011 . 20725800 . 3023025 . 10.1007/s11605-010-1293-9 .
  10. Hutch CR, Sandoval D . The Role of GLP-1 in the Metabolic Success of Bariatric Surgery . Endocrinology . 158 . 12 . 4139–4151 . December 2017 . 29040429 . 5711387 . 10.1210/en.2017-00564 .
  11. Cavin JB, Couvelard A, Lebtahi R, Ducroc R, Arapis K, Voitellier E, Cluzeaud F, Gillard L, Hourseau M, Mikail N, Ribeiro-Parenti L, Kapel N, Marmuse JP, Bado A, Le Gall M . Differences in Alimentary Glucose Absorption and Intestinal Disposal of Blood Glucose After Roux-en-Y Gastric Bypass vs Sleeve Gastrectomy . Gastroenterology . 150 . 2 . 454–64.e9 . February 2016 . 26481855 . 10.1053/j.gastro.2015.10.009 . 5214667 . free .
  12. Paluszkiewicz R, Kalinowski P, Wróblewski T, Bartoszewicz Z, Białobrzeska-Paluszkiewicz J, Ziarkiewicz-Wróblewska B, Remiszewski P, Grodzicki M, Krawczyk M . Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity . Wideochirurgia I Inne Techniki Maloinwazyjne = Videosurgery and Other Miniinvasive Techniques . 7 . 4 . 225–32 . December 2012 . 23362420 . 3557743 . 10.5114/wiitm.2012.32384 .
  13. Karmali S, Schauer P, Birch D, Sharma AM, Sherman V . Laparoscopic sleeve gastrectomy: an innovative new tool in the battle against the obesity epidemic in Canada . Canadian Journal of Surgery . 53 . 2 . 126–32 . April 2010 . 20334745 . 2845949 . 2014-04-11 . 2020-02-16 . https://web.archive.org/web/20200216222742/http://canjsurg.ca/vol53-issue2/53-2-126 . live .
  14. Web site: International Federation for the Surgery of Obesity and Metabolic Disorders . 2021-01-20 . 2020-11-29 . https://web.archive.org/web/20201129201752/https://www.ifso.com/ . live .
  15. Web site: Bariatric Surgery Procedures . The American Society for Metabolic and Bariatric Surgery (ASMBS) . 2014-03-12 . 2014-06-10 . https://web.archive.org/web/20140610034804/http://asmbs.org/obesity-and-surgery-learning-center/bariatric-surgery-procedures/ . live .
  16. Alqahtani AR, Antonisamy B, Alamri H, Elahmedi M, Zimmerman VA . Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years . Annals of Surgery . 256 . 2 . 266–73 . August 2012 . 22504281 . 10.1097/SLA.0b013e318251e92b . 5977126 .
  17. Alqahtani A, Alamri H, Elahmedi M, Mohammed R . Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study . Surgical Endoscopy . 26 . 11 . 3094–100 . November 2012 . 22648112 . 10.1007/s00464-012-2345-x . 22587054 .
  18. Alqahtani A, Elahmedi M, Qahtani AR . Laparoscopic Sleeve Gastrectomy in Children Younger Than 14 Years: Refuting the Concerns . Annals of Surgery . 263 . 2 . 312–9 . February 2016 . 26496081 . 10.1097/SLA.0000000000001278 . 32909515 .
  19. Web site: Depression after Gastric Bypass Surgery. Psychology Today. en-US. 2019-04-18.
  20. Web site: Gastric Sleeve Surgery: Common Risks and Complications. Gastric Sleeve Diet Guide. 16 March 2017. 2016-10-11. 2017-03-16. https://web.archive.org/web/20170316113455/http://www.gastricsleevedietguide.com/gastric-sleeve-risks-complications/. live.
  21. Web site: Gastric Sleeve Complications Post Surgery. BSIG. 5 August 2013. 23 July 2013. https://web.archive.org/web/20130723042310/http://www.bariatricguide.org/gastric-sleeve-complications/. live.
  22. Lupoli . Roberta . Lembo . Erminia . Saldalamacchia . Gennaro . Avola . Claudia Kesia . Angrisani . Luigi . Capaldo . Brunella . Bariatric surgery and long-term nutritional issues . World Journal of Diabetes . 2017 . 8 . 11 . 464–474 . 10.4239/wjd.v8.i11.464 . 5700383 . 29204255 . free .
  23. Web site: Depression after Gastric Bypass Surgery. Psychology Today. en-US. 2019-04-18.
  24. Stokar . Joshua . Ben-Porat . Tair . Kaluti . Donia . Abu-Gazala . Mahmud . Weiss . Ram . Mintz . Yoav . Elazari . Ram . Szalat . Auryan . January 2023 . Trabecular Bone Score Preceding and during a 2-Year Follow-Up after Sleeve Gastrectomy: Pitfalls and New Insights . Nutrients . 15 . 15 . 3481 . 10.3390/nu15153481 . free . 37571418 . 10421136 .
  25. Noria . Sabrena F. . Shelby . Rita D. . Atkins . Katelyn D. . Nguyen . Ninh T. . Gadde . Kishore M. . Weight Regain After Bariatric Surgery: Scope of the Problem, Causes, Prevention, and Treatment . Current Diabetes Reports . 2023 . 23 . 3 . 31–42 . 10.1007/s11892-023-01498-z . 36752995 . 9906605 .

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