Sleeve gastrectomy (damage - advantages - eating system) 2020 | Prof. Mahmoud Zakaria Elganzoury| The greatest obesity surgeon in Egypt
Sleeve gastrectomy

Sleeve gastrectomy

The gastric sleeve operation reduces the amount of food you eat by reducing the size of the stomach by removing part of the stomach, making the stomach roughly the size and shape of a small banana (50 -100 cc), which leads to a feeling of fullness after eating a small amount of food much less than before the sleeve. In addition, in sleeve gastrectomy operation we remove the part of the stomach that produces the ghrelin hormone (the hunger hormone) that is responsible for making you feel hungry, so you will not want to eat too much food.

What is the gastric sleeve operation?

It is a procedure in which the stomach is resected by using a laparoscope to treat obesity and its complications.

The gastric sleeve operation is performed laparoscopically through 3 small holes (less than 1 cm) in the abdomen, and the laparoscopic holes are closed cosmetically without stitches.

 Patients need hospitalization (admission) for a period of 24 hours only after the laparoscopic gastrectomy. The staplers used for gastric cutting are titanium staples, which is an inert metal that does not interact with the stomach tissue and has no negative effect. We use the most recent staplers and laparoscopy. 

 Laparoscopic gastrectomy does not require vitamins and life-long medical care like other operations.

It can be performed for the elderly, children, and adolescents, as it does not affect the absorption of nutrients.

The gastric sleeve operation is the most common operation in the world for the treatment of obesity, as it is the first choice among obesity surgeries in all the countries of the world.

Sleeve -gastrectomy

 How is the laparoscopic sleeve gastrectomy performed?

  Removing part of the stomach reduces the level of a hormone called ghrelin, which is often referred to as the “hunger hormone“. Thus, many people find they are less hungry after gastric sleeve. Ghrelin also plays a role in determining the level of sugar in the blood, so people with type 2 diabetes often see a direct decrease in their need for diabetes medications After sleeve gastrectomy. The gastric sleeve operation leads to a complete cure of type 2 diabetes in more than 60% to 80% of cases.

What are the advantages of sleeve gastrectomy?

The path of food in the digestive system will not change after sleeve gastrectomy, and therefore there is no reduction in food absorption as in the case of gastric bypass surgery and there is no foreign body implanted around the stomach, as in the case of the adjustable gastric band operation. 

How much weight will I lose after sleeve gastrectomy?

On average, patients lose about 70 – 80 % of their excess body weight during the first year after the operation

The first month: patients lose from 10-15 kg

The first 3 months: 35 to 45% of the excess body weight

The first 6 months: 50-60% of excess weight

First-year: 70 – 80% of excess body weight loss

Most people reach their lowest weight of 12-24 months after surgery.

Does the patient get better after sleeve gastrectomy as regards obesity-related health problems?

Large clinical trials and studies have proven that sleeve gastrectomy leads to the cure or improvement of many health problems associated with obesity, such as:

Type 2 diabetes: Most studies indicated that 60-80% of patients suffering from type 2 diabetes could achieve a cure or improvement after gastric sleeve.

  1. Blood Hypertension
  2. Fatty liver disease
  3. Obstructive Sleep Apnea
  4. Cancer
  5. Polycystic ovaries and poor fertility in women.
  6. Depression and psychological problems
  7. Sterility
  8. Low testosterone in men: Sleeve gastrectomy can increase testosterone level
  9. Urine Incontinence.

When is the laparoscopic sleeve gastrectomy performed?

BMI greater than 40 Kg/m2

BMI from 35 to 39.9 Kg/m2 with one of the health problems associated with obesity such as:

  •    Hypertension
  •    Type 2 diabetes
  •    Sleep Apnea
  •    Fatty liver disease
  •    High level of blood fats

For patients with a body mass index of 30-34.9 Kg/m2 gastric sleeve surgery can be performed, if they have struggled with obesity for a long time and all other obesity treatments have failed with them, especially those with health problems related to obesity.

What are the benefits of using Laparoscopy in sleeve gastrectomy operation?

1- Reducing pain after the operation

2- Reducing the length of hospital stay

3- There are no visible wounds

4- Faster recovery and return to normal life and work than traditional open surgery.

In the beginning, the laparoscopic sleeve gastrectomy was performed for very high weights (body mass index more than 60 Kg/m2) as the first operation of a two-stage procedure, and the second stage, which is the gastric bypass operation, was performed after the patient reached an appropriate weight. The laparoscopic sleeve gastrectomy proved very successful and many of these patients reached their ideal weight and did not require gastric bypass surgery.

Is there a problem to get pregnant later after gastric sleeve surgery?

We recommend that pregnancy be at least one year after the operation so that the body can adapt to the reduction in the size of the stomach and the amount of food. Vitamins, iron, and calcium must be taken regularly after the gastric sleeve operation for a year, and pregnant women may need additional doses of iron and calcium in consultation with a nutritionist. If Pregnancy occurred under any circumstances during the first year after the operation, the pregnant woman must have a close follow-up with a nutritionist to make sure that she consumes types of foods that are rich and beneficial to the fetus. Any drugs or vitamin intake during pregnancy should be under the direct medical supervision of the gynecologist.

How is the patient prepared for the operation?

 Before surgery, you should give your doctor a list of all medications, vitamins, minerals, and herbal or nutritional supplements that you are taking. After surgery, you may have restrictions on eating, drinking, and the medications you can take.

If you take blood thinners such as Aspirin or Marivan, talk to your doctor before surgery. Since these medicines affect clotting and cause bleeding, you may need to change the routine of this medicine before the operation.

If you have diabetes, speak with your doctor for specific instructions on taking or adjusting your medication before and after surgery.

Smoking of all kinds must be stopped at least two weeks before the operation.

If you have high blood pressure, your blood pressure must be completely controlled before the operation, by regularly taking your medications and measuring blood pressure daily 1 week before the operation.

How long does the recovery take after gastric sleeve operation?

  • The operation takes about 60 minutes
  • The patient is discharged from the hospital 24 hours after the operation.
  • All patients are encouraged to walk as early as 3-4 hours after the operation.

Most patients return to work or school after the operation by one to four weeks. Fatigue is common in the first two weeks due to the decrease in calorie intake with a liquid diet phase. However, the majority of patients do not feel hungry during this phase of t diet. The energy level improves rapidly after the introduction of a soft diet, which takes about two weeks after surgery. Sometimes we allow patients to work from home 2-3 days a week after surgery.

You can start walking from 30 to 60 minutes a day after pain relief. Patients can start sports after two months of sleeve gastrectomy operation.

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