What is Sleeve Gastrectomy?

What is Sleeve Gastrectomy?

Sleeve gastrectomy is one of the most preferred and well-established surgical procedures in obesity (bariatric) surgery. When performed by an experienced team with appropriate equipment, it enables significant weight loss in the first 3 months and continues to be effective for up to 18–24 months. In addition to aiding weight loss, it can also improve or resolve many obesity-related conditions. Historically, sleeve gastrectomy dates back quite some time; over the years, accumulated data has shown that its benefits are substantial while its side effects remain relatively limited.

What Does Sleeve Gastrectomy Involve?

Sleeve gastrectomy is a procedure in which approximately 80% of the stomach is surgically removed, leaving a smaller, tube-shaped stomach. This method is typically performed laparoscopically (i.e., via “keyhole” or “closed” surgery), significantly reducing postoperative pain and promoting faster recovery. Every surgical intervention carries some level of risk, but sleeve gastrectomy has a comparatively low risk profile and allows most patients to return to their daily routines within a short period.

How Is Sleeve Gastrectomy Surgery Performed?

1. Anesthesia and Incisions
   • The surgery is done under general anesthesia, so the patient feels no pain.
   • The surgeon makes 4–6 small incisions (about 1 cm each) in the abdomen. Through these incisions, a camera (laparoscope) and surgical instruments are introduced to access the stomach.
2. Stomach Resection
   • Using a specialized stapler, the surgeon removes approximately 80% of the stomach. A thin, tube-like stomach (often compared to the shape of a “sleeve”) is left in place.
   • The part of the stomach responsible for secreting the hunger hormone ghrelin is largely removed, which naturally helps reduce appetite.
3. Completion of the Operation
   • The surgery typically lasts around 60–90 minutes.
   • If any issue arises that prevents laparoscopic (closed) surgery from continuing, the surgeon may switch to an open technique, but this is rare.
4. Recovery
   • After surgery, the patient’s adaptation process usually begins within a few days.
   • Because it is a minimally invasive procedure, postoperative pain is generally low, and recovery is relatively fast.

Who Is a Candidate for Sleeve Gastrectomy?

Not everyone who struggles with excess weight is a suitable candidate for sleeve gastrectomy. Patients are evaluated based on specific criteria:

• Body Mass Index (BMI) over 40
  Individuals with a BMI above 40 are classified as morbidly obese. In such cases, sleeve gastrectomy is often considered if the patient has been unsuccessful with diet and exercise.
• BMI Between 35–40 with Obesity-Related Conditions
  Patients within this BMI range who also suffer from conditions such as Type 2 diabetes, hypertension, or sleep apnea may be eligible for surgery.
• Age Criterion
  Usually recommended for individuals aged 18–65. However:
  • Under 18: Surgery may be possible with parental/guardian consent if the situation is very high risk and other methods (diet, exercise) have failed.
  • Over 65: Candidates are carefully evaluated for overall health and potential surgical risks.
• No Severe Psychological or Substance-Abuse Issues
  Patients should not have uncontrolled psychiatric conditions that impair understanding of the procedure’s risks and benefits. Additionally, alcohol or substance dependence typically contraindicates surgery.

How Much Weight Can You Lose with Sleeve Gastrectomy?

Weight loss after sleeve gastrectomy follows a general pattern:

• First Month: About 10% of excess weight is lost.
• End of Third Month: Approximately 20% of the initial excess weight may be lost.
• End of Sixth Month: Around 30% of excess weight is typically lost.
• By 18th Month: Patients can lose roughly 40% (or more) of their initial excess weight.

Example: A patient weighing 150 kg (with a high BMI) could reasonably be expected to lose around 60 kg over 18 months (dropping to ~90 kg), provided they follow medical advice on diet, exercise, and lifestyle.

It’s crucial to note that individual results vary based on factors such as metabolism, age, gender, adherence to diet, physical activity, and any coexisting health conditions. Ensuring adequate protein intake is especially important to protect muscle mass during rapid weight loss.

Preoperative Preparation: Is Diet Necessary Before Sleeve Gastrectomy?

Some patients with a BMI over 50 (often referred to as super obese) may be advised to follow a special preoperative diet. This helps reduce liver size and lower surgical risks. If your BMI is under 50 and there are no other complicating factors, you might not need a strict preoperative diet—but always follow your surgeon’s and dietitian’s guidance. A well-structured diet and exercise program pre- and post-surgery greatly enhances long-term success.

Postoperative Pain and Recovery

Because sleeve gastrectomy is usually performed laparoscopically, large incisions are avoided, resulting in:

• Minimal Incision Discomfort
  Only small incisions are made. Patients often experience minor pain around these areas for a few days, but it is generally well-managed with medication.
• Gas-Related Pain
  During the operation, the abdominal cavity is inflated with carbon dioxide for better visibility. Although most gas is released after surgery, some may remain, causing temporary shoulder or upper abdominal pain. Light walking helps dissipate this gas more quickly.

Alcohol Consumption After Surgery

Alcohol is discouraged, especially during the first 6 months after surgery, for three key reasons:

1. High Calorie Content
   Alcohol can undermine weight loss efforts because of its high caloric value.
2. Lower Tolerance
   With a significantly reduced stomach volume, even a small amount of alcohol can lead to higher blood alcohol levels.
3. Digestive Discomfort
   Many alcoholic beverages can cause bloating and indigestion, which are harder to tolerate with a smaller stomach.

Nutrition After Sleeve Gastrectomy

While sleeve gastrectomy significantly reduces the stomach size, long-term weight loss success relies heavily on proper diet and lifestyle changes.

• Protein Intake
  Because of reduced stomach capacity, prioritizing protein is critical to maintain muscle mass.
• Gradual Progression
  1. Week 1: Clear liquids
  2. Week 2: Thicker liquids (soups, broths)
  3. Week 3: Puréed/soft foods
  4. Week 4: Soft solids
  5. Week 5+: Transition to regular solid foods, guided by a dietitian.
• Solid–Liquid Separation
  Avoid consuming liquids and solids simultaneously. Wait about 30 minutes before or after a meal to drink fluids. This helps prevent overfilling the stomach and mitigates the risk of stretching it.

Stenosis (Narrowing) After Sleeve Gastrectomy

A small percentage of patients (roughly 2–3%) may experience stenosis (narrowing) where the new stomach shape or stapled area becomes too tight. Symptoms can include:

• Difficulty swallowing
• Frequent vomiting or regurgitation
• Persistent feeling that food is “stuck” in the chest

If these symptoms persist beyond the initial 3–6 months of healing, endoscopic evaluation is recommended. Endoscopic balloon dilatation is commonly used to correct narrowing. In more resistant cases, a revision surgery (for instance, converting to gastric bypass) may be needed, but this is rare.

Leakage After Sleeve Gastrectomy

Leakage is one of the most concerning—but rare—complications (1–2% incidence) in bariatric surgery. It occurs if the stapled area of the stomach does not seal properly, allowing gastric fluid to leak into the abdominal cavity. Warning signs include:

• High fever
• Abdominal pain
• Heart palpitations
• General malaise

Most leaks occur within the first 2 weeks. If a leak is detected, treatment depends on its severity:

• Minor Leak: May be managed with endoscopic stent placement and drainage.
• Major Leak: Could require a return to surgery to repair the leak site.

Prevention involves careful surgical technique, using quality equipment, placing reinforcement sutures or staples, and strictly following the postoperative diet (especially in the first two weeks).

Does the Stomach Enlarge Again After Sleeve Gastrectomy?

Immediately post-surgery, the stomach’s capacity might be around 100–150 ml (approximately one small teacup). Over the first year, it may expand slightly to 200–250 ml, but it generally does not return to its original size.

• Regaining Weight
  Weight regain is usually due to high-calorie snacking, poor dietary choices, or lack of exercise rather than the stomach stretching back to original dimensions. Adhering to lifestyle modifications is key to sustaining weight loss.

Fasting (Ramadan or Other Extended Fasts) After Sleeve Gastrectomy

Long periods of fasting are not recommended in the early stages (first 6–12 months), as patients need regular, small meals or snacks to meet protein and fluid requirements. Prolonged hunger and thirst can lead to dehydration, electrolyte imbalances, dizziness, and other health issues. If you wish to fast for religious or personal reasons, consult your bariatric surgeon or dietitian to see if and when it might be safe to do so.

Is Weight Regain Possible After Sleeve Gastrectomy?

Sleeve gastrectomy primarily restricts the volume of the stomach and does not affect nutrient absorption (unlike certain bypass procedures). While patients typically lose a substantial percentage of their excess weight within the first 18–24 months, long-term success depends on:

• Diet Compliance: Avoiding frequent, high-calorie meals
• Regular Exercise: Maintaining or increasing muscle mass helps keep the weight off
• Behavioral and Psychological Support: Engaging with dietitians, psychologists, or support groups can prevent a return to unhealthy eating patterns

Some slight weight regain can happen after 2+ years; however, if you follow your prescribed nutrition and exercise regimen, regaining a significant amount of weight is less likely.