History of the Gastric Sleeve
Sleeve gastrectomy or gastric sleeve for weight loss evolved out of the earliest stomach reduction procedures targeted for obese patients along with observations from anti-reflux surgeries. Doug Hess performed the first open sleeve gastrectomy in Bowling Green, OH in March 1988 as part of what is now called a duodenal switch procedure. Dr. Hess used sleeve gastrectomy as the original restrictive component in the duodenal switch.
The late Dr. Lawrence L. Tretbar noted that sleeve gastrectomy evolved from fundoplication, a procedure where the top part of the stomach is folded and sewn around a muscular valve at the bottom of the esophagus to help eliminate acid reflux. In the case of sleeve gastrectomy, fundoplication is extended to create a tubular stomach that achieves weight loss.
Dr. Hess modified the extended tubular stomach concept to produce a longitudinal or vertical gastrectomy, which left the first portion of the duodenum intact. This advancement helped eliminate dumping symptoms and marginal ulcers often present in an earlier procedure called the Scopinaro bilopancreatic diversion.
In 1999, the first laparoscopic approach to the duodenal switch was developed on a pig by deCsepel, Jossart, and Gagner. Gagner proceeded with the laparoscopic duodenal switch on humans but noted a high complication rate in patients with higher body mass index (BMI). He subsequently used laparoscopic sleeve gastrectomy first as an initial stage for duodenal switch. From 2001 to 2003, seven patients with an excessively high BMI underwent a first-stage sleeve gastrectomy with a subsequent Roux-en-Y gastric bypass. Average excessive weight loss was 33%, which allowed for a safer second stage. These preliminary results rapidly popularized the procedure as a safer laparoscopic option for higher BMI patients.
Sleeve Gastrectomy Surgery Overview
Restrictive operations like sleeve gastrectomy make the stomach smaller to help you lose weight. With a smaller stomach, you will feel full much quicker. This means that you will need to make significant lifelong changes in how you eat, including selecting different foods and reducing portion size.
This surgery is performed laparascopically by making several small incisions and using small instruments and a camera to guide the surgeon or via an open procedure, where the abdomen is cut open. More than half of the stomach is removed, leaving a thin vertical sleeve about the size of a banana, closed via surgical staples. The procedure may not be reversed.
Post-Surgery Considerations
Patients have belly pain and may need pain medicine for the first week following surgery. The incision may be tender and sore.
In addition to feeling full more quickly, you may experience dumping syndrome. This occurs when the food you eat empties into the small intestine too quickly. Dumping syndrome can cause diarrhea, make you nauseated and feel faint, while making it more difficult to get the nutrition you need.
If you had open surgery, avoid heavy lifting or strenuous exercise during recovery so you can heal. You’ll be able to return to work and your normal routine within four to six weeks. If you have the more common laparoscopic procedure, recovery time is quicker.
Sleeve Gastrectomy Diet
You’ll receive specific dietary instructions following surgery. During the first month, you’ll only be able to eat small amounts of soft foods and liquids during recovery. Sipping water throughout the day is essential to avoid becoming dehydrated. Irregular bowel movements are common right after surgery. Avoid constipation and straining with bowel movements.
Patients are able to lowly add solid foods into their diets. Chew your food well and stop eating when feeling full, which happens quickly. If you do not chew your food well or stop eating soon enough, you may feel discomfort or nausea and may vomit. Avoid sodas or high-calorie fruit juices as you may not lose weight. Continual overeating will cause the stomach to stretch, diminishing the benefits of the surgery.
Your doctor will may recommend a dietitian to help plan healthy meals that provide enough protein, vitamins, and minerals while you are losing weight. Even with a healthy diet, you will need vitamin and mineral supplements for the rest of your life.
Am I a Candidate?
Bariatric surgery is suitable for people who are severely obese and unable to lose weight through diet, exercise, or medicine.
We prescribe weight reduction surgery when your BMI or 40 or higher or if your BMI is at least 35 and you have a metabolic condition such as diabetes or high blood pressure related to your weight.
Surgery for weight reduction is not an instant fix but rather a tool to take off pounds. Eating a healthy diet and getting regular exercise are key elements that will help you reach your target weight and avoid regarding excessive pounds.
Sleeve Gastrectomy Results
Research indicates that sleeve gastrectomy patients usually lose more than half of their excess weight. Success is higher for those who are realistic about their expectations, keep regular medical appointments, follow the recommended diet and increase physical activity.
