Sleeve Gastrectomy

About Sleeve Gastrectomy

Sleeve gastrectomy removes most of the stomach along its greater curvature, leaving a narrow tube shaped stomach. It has become the most commonly performed bariatric operation in the world. Originally developed as the first stage of the more complex duodenal switch for very high risk patients, it was later found to be effective as a standalone procedure. The operation is performed laparoscopically: the blood vessels along the greater curvature are divided, and the stomach is stapled lengthwise alongside a calibration tube from near the pylorus up to the angle of His. Some surgeons reinforce the staple line to reduce bleeding and leaks. Compared with gastric bypass it is technically simpler, involves no intestinal connections, avoids dumping syndrome and leaves the stomach and duodenum accessible to endoscopy. Weight loss is substantial though on average somewhat less than after bypass. Removal of the fundus, which produces the hunger hormone ghrelin, contributes to reduced appetite, and type 2 diabetes often improves. Complications include staple line leaks, typically near the junction with the esophagus and difficult to treat, bleeding, narrowing of the sleeve and gastroesophageal reflux, which can develop or worsen after surgery. Some patients regain weight over time, and conversion to gastric bypass or duodenal switch is performed for weight regain or severe reflux. Long term nutritional monitoring is part of follow up.