The sleeve gastrectomy, also called sleeve stomach, is the one surgical method for weight reduction. Already 50% of bariatric surgery patients receive a sleeve gastrectomy - and the trend is increasing. In this procedure, most of the stomach (about 90%) is removed, leaving only a tubular remnant stomach. This means that the patient can only eat small amounts of food, which usually results in massive weight loss.
For patients with extreme forms of obesity (BMI over 50 kg/m²) or with massive secondary diseases, there is the possibility of so-called "staged concepts". In this case, the overweight patients receive a tube stomach in a first operation in order to initially lose some weight. In a second operation, for example, a so-called "duodenal switch" can be performed (see also: Biliopancreatic diversion with duodenal switch ), which causes more effective weight loss. By dividing the operation into two parts, the risk of mortality can be reduced from 6% to 1% with this procedure.
Sleeve gastrectomy from when?
The prerequisite for sleeve gastrctomy surgery is that the structured, conservative therapy for weight reduction has been completely exhausted. Conservative therapy includes dietary, exercise and behavior modification, and possibly psychological therapy.
The indication for surgical therapy is usually based on the patient's BMI (body mass index). Thus, in case of failure of conservative therapy and a BMI over 40 kg/m² or a BMI over 35 kg/m² with secondary diseases (e.g. diabetes , hypertension ), surgical intervention should be discussed.
There is no standard intervention that is suitable for every patient. Therefore, for each patient must be individually assessed which method ( gastric banding , gastric bypass , gastric balloon ) is the best. The choice of method is influenced by BMI, age, sex and secondary diseases of the patient.
What are the advantages of the sleeve gastrectomy?
The sleeve gastrectomy method results in a strong reduction of the stomach filling volume, which means that only small amounts of food can be absorbed. After three years, an average of 66% of excess weight has been lost and 66% of diabetes caused by excess weight has regressed.
The normal digestive tract is maintained during this procedure, which is why deficiencies in vitamins and minerals are very rare. However, since the sleeve gastrectomy usually results in massive weight loss in a very short time, it is still recommended to take vitamins and minerals in consultation with a physician.
Due to the loss of the hormone ghrelin, patients have a reduced feeling of hunger and fewer cravings. Since the gastric outlet muscle (pylorus) is preserved in the sleeve gastrectomy, the patients do not develop a "dumping syndrome" as in the case of gastric bypass. In this case, there is an intolerance to foods with a high sugar or fat content. After the operation to the sleeve gastrectomy, a gastroscopy is still possible.
What are disadvantages of sleeve gastrectomy?
Weight loss is not possible on a high-calorie food or liquid diet. Therefore, strict adherence to the recommended diet is essential for adequate weight loss. Good nutritional counseling , even accompanying after the procedure, is strongly recommended for the patient.
The sleeve gastrectomy method is a non-reversible surgery in which the stomach is permanently removed. Due to the suture on the sleeve gastrectomy, complications such as leakage or fistula formation are possible. Sleeve gastrectomy is not suitable for overweight people with severe heartburn.