The Garrison Center is pleased to offer sleeve gastrectomy, a surgical procedure for weight loss that provides superior weight loss and low risks. Sleeve gastrectomy is also commonly called gastric sleeve and vertical sleeve gastrectomy.
The procedure is currently gaining increased use in the United States, but in fact it is not new at all; it has been used for a long time, so it has been subject to many years of observation. Initially it was used as the first phase in a two-stage procedure, biliopancreatic diversion (BPD), among patients considered 'super obese' (those with a BMI of 60 or greater). Over time, physicians observed that patients were losing weight very effectively after the first phase, sleeve gastrectomy, without undergoing the invasive second procedure. Based on these observations, increasing numbers of surgeons now advocate sleeve gastrectomy as a standalone operation.
Learn about Sleeve Gastrectomy here. Mouse over to click on 'play' button (2 minute video).
There are compelling reasons to consider sleeve gastrectomy for weight loss, says Dr. Garrison. It produces weight loss as effectively as gastric bypass, but with the low risks associated with banding procedures. “After sleeve gastrectomy, patients lose weight in two ways. One, the stomach size is restricted, so patients feel full quickly, after eating small meals. Second, the procedure has a hormonal effect: it eliminates ghrelin from the body. Without ghrelin, patients feel far less hungry.”
Sleeve gastrectomy is a very safe procedure, with risks as low as those associated with gastric banding. Moreover, elimination of type 2 diabetes in obese patients occurs immediately in many patients, thereby sparing them from the serious risks associated with diabetes complications.
How is sleeve gastrectomy performed?
During sleeve gastrectomy, several small incisions are made in the abdomen. Surgical instruments and a camera are inserted through these ports. The surgeon staples across the stomach, creating a narrow banana-shaped pouch. The excess portion of the stomach, which contains the ghrelin-producing cells, is then removed. There is no cutting or suturing of the intestines.
What are the advantages of the gastric sleeve?
Patients lose 60-70% of their excess weight over the course of the next year – a result that rivals that achieved by gastric bypass surgery.
Type 2 diabetes can be eliminated as early as within 30 days, even though weight loss occurs gradually.
Sleeve gastrectomy is performed laparoscopically. It is simpler and less invasive than gastric bypass surgery, because it does not require rerouting of the intestines. The risk associated with sleeve gastrectomy is equal to that associated with gastric banding procedures (extremely low risk). A portion of the stomach is removed, but because there is no rerouting of the intestines, there are no anastomoses (connections of the intestines) which can pose the risk of leakage.
After gastric bypass surgery, patients continue to feel hungry. After sleeve gastrectomy, however, patients do feel full, and this contributes to better weight loss. This occurs because the ghrelin-producing cells are removed during surgery; without this hormone, hunger is significantly reduced.
Sleeve gastrectomy is particularly appropriate for patients who have had prior abdominal surgeries, and who may have adhesions.
If a complication arises during surgery, surgeons can easily convert sleeve gastrectomy to a gastric bypass procedure or gastric banding, instead.
After surgery, patients do not experience protein or vitamin deficiencies, which can occur after gastric bypass surgery.
Unlike gastric banding procedures, no foreign body is implanted.
Weight loss after sleeve gastrectomy is greater than that associated with gastric banding, and it occurs more quickly.
Patients who have undergone sleeve gastrectomy may continue to take nonsteroidal anti-inflammatory drugs (NSAIDS) for arthritis or other conditions. After gastric banding or gastric bypass, these medications must be avoided.
What are the disadvantages associated with sleeve gastrectomy?
Sleeve gastrectomy is not reversible or adjustable like gastric banding procedures are.
There is a very low risk of the staple line leaking. This risk is less than 0.5-1%.
At this time, not all insurance carriers reimburse for the procedure. Oxford Health Plan (a subsidiary of United Healthcare) does reimburse for the procedure in New Jersey, New York, and Connecticut. Other carriers may provide coverage for patients who have had prior intrabdominal surgery, on a case-by-case basis.
Who may be a candidate for sleeve gastrectomy?
Initially, sleeve gastrectomy was performed among patients considered 'super obese'. Now, many bariatric surgeons, including Dr. Garrison, offer sleeve gastrectomy to many obese patients who are considering weight loss surgery. It is the operation of choice for patients who have had prior abdominal surgery, and it is highly recommended for obese patients who have type 2 diabetes.
