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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.