Restriction – eat less
Metabolic – Decreased hunger and decreased storage of extra calories as fat
The sleeve is a restrictive operation in that there is no re-routing of the intestines and it is done laparoscopically. The operation works because we permanently remove about 80% of the stomach – but we remove it lengthwise along the long axis of the stomach. When we are finished with the operation, your stomach has the appearance of a banana or a hockey stick. It is a long, tubular, and stiff stomach that does not have much capacity to hold food. It holds about 3-6 ounces of liquid.
Sleeve gastrectomy is considered a metabolic surgery because it modifies the way the body distributes energy and recalibrates the neuro-hormonal pathways that lead to obesity. So not only does the sleeve gastrectomy severely restrict the amount and quantity of food that you can eat but it also has some hormonal metabolic effects as well. There is a hormone called ghrelin that is mostly made in the fundus of your stomach. This hormone stimulates another hormone called Neuropeptide Y (NPY). Neuropeptide Y stimulates your appetite and tells your body to store energy as fat. By decreasing NPY your body will be less hungry and store less fat. When we perform the sleeve gastrectomy we are removing the main area that produces the hormone ghrelin. With less ghrelin being manufactured by your body, there is less stimulation of your appetite because there is less hormone to activate the NPY. The sleeve operation also increases GLP-1 and thus improves the body’s sensitivity to insulin and decreases the body’s tendency to store extra calories as fat.
Sleeve gastrectomy can have dramatic impacts, beyond weight loss itself, which can significantly improve the status of certain medical conditions. Sleep Apnea, hyperlipidemia, hypertension and diabetes are profoundly improved and even cured in most cases after sleeve gastrectomy. If a patient suffers from severe reflux/GERD before the procedure, this may not be a good operation to cure that medical condition. Some patients, up to 15%, will have mild reflux after the sleeve gastrectomy.
Weight loss after the sleeve gastrectomy is very similar to that of a gastric bypass, at least for the first two years. Initially it is not as rapid as the weight loss with gastric bypass but it is slow and progressive as you continue with the lifestyle changes.
Risks of Sleeve Gastrectomy
The sleeve gastrectomy has potential complications much like any other surgery. The risks are mostly related to the long staple line that is created along the length of the stomach. Specifically, bleeding and leaking are two of the more serious complications that can occur with a sleeve gastrectomy. Similar to the gastric bypass, we make every effort to minimize the risk of these complications. Our surgeons utilize state of the art equipment and a technique, including intra-operative endoscopy to ensure everything is connected and working as it should and there is no evidence of bleeding or leakage. Endoscopy involves the placement of a small fiber optic camera which allows us to see inside the “new stomach” to be sure everything looks good. We also require that the sleeve patients stay on a 3 week liquid diet after surgery.
Sleeve gastrectomy patients might have nausea after surgery. The nausea goes away usually within a couple of days but occasionally it can linger for longer. In addition, sleeve gastrectomy patients often complain of chest discomfort while drinking their liquids. We believe that this is because your body is used to having more stomach to push food and liquid into. Your body needs to adjust to the fact that your stomach is no longer there. Again, this is something that gets better in time.
Please also note that if you have GERD (acid reflux), this can get WORSE after surgery. After several weeks or months this will usually get better and hopefully resolve. For this reason, you should plan to continue taking your reflux meds after surgery for a while. Sometimes reflux is caused by eating too much food or too quickly. Often, behavioral changes will make this better.
Also as with any surgery or procedure there are risks, albeit small or severe, like allergic reactions, infections, heart attacks, pneumonia, and rarely death.