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 Gastric Sleeve Resection
The Sleeve Gastrectomy (also know as Gastric Sleeve Resection) is a minimally invasive laparoscopic weight loss surgery option is rapidly emerging as a great alternative for patients.
How the Sleeve works:
 Laparoscopic Gastric Sleeve Resection (LGSR or “Sleeve”) is a gastric restrictive operation. It simply makes a narrow tube out of the stomach (the “Sleeve”) which markedly decreases the amount of food that it takes to feel full. It is a type of longitudinal or vertical gastroplasty. It is called a Sleeve “Resection” because approximately 2/3 of the stomach is removed. In addition to significantly decreasing the size of the stomach. A very small meal will provide a full feeling. Removing most of the stomach decreases the main hunger hormone called Ghrelin. Ghrelin is made in the stomach and has been directly related to feeling hungry. 1 To put it simply: less stomach, less ghrelin. Less ghrelin, less hunger. Gastric Sleeve Resection is done laparoscopically (small incisions and TV cameras and is considered "minimally invasive"Surgery. Read about laparoscopic surgery by clicking here.
History
Laparoscopic Gastric Sleeve Resection is an evolution of previous weight loss surgeries and stomach operations. It was done first as an open operation as a part of the malabsorptive duodenal switch (see our page on malabsorptive procedures). The laparoscopic approach to duodenal switch (and the Sleeve part of the operation) was developed in pigs in 1999 and the first human laparoscopic procedures followed.
Staged Procedures and the Gastric Sleeve Resection
Staged procedures (see diagrams below)
Duodenal Switch
(second stage) |
Gastric Bypass
(second stage)
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A staged procedure was developed so that the gastric sleeve part of the operation was done first and the duodenal switch operation (the bowel part) was done at a many month interval (Gagner 2003). The first staged laparoscopic Gastric Sleeve Resections that included the Roux en Y gastric bypass (RYGB) as the second stage were done during this time. The two staged procedures were initially done in super obese patients to decrease the risk of doing the duodenal switch and the RYGB as one big operation. It is recognized that the second stage of the two stage operation may not be necessary in all patients. 2 The two stage procedure option is still an excellent opportunity for high body mass (> 50 BMI patients and especially for > 55 BMI). |
Gastric Sleeve as a Stand Alone Procedure for BMI 35 to 49 (and >49)
It was realized that the initial operation of the staged procedure (the Gastric Sleeve) worked very well. Gastric Sleeve resection was then tried and shown successful as a stand alone procedure in lower body mass index patients (BMI 35 to 49). Worldwide experience is increasing, demonstrating the effectiveness, the durability and the safety of the Laparoscopic Gastric Sleeve Resection. The American Society for Metabolic and Bariatric Surgery has approved the Sleeve Resection as a primary and a staged procedure. The ASMBS recognizes the value of the gastric Sleeve as the first stage before RYGB and duodenal switch in high body mass index patients. 3
The Results of Gastric Sleeve Resection
The percentage of Excess Body Weight Loss with the stand alone procedure in intermediate studies (3 to 4 years) ranges from 35 to 69 % with an average of 55%. Long term results can be expected from the Sleeve; one of the best long term series available, analyzing the results patients receiving only sleeve gastrectomy, 3-year =77.5% and 6+ year = 53.3%. 4 The reported major complication rates are comparable or less than the RYGB. The major complications of Gastric Sleeve are related to the pouch and the staple lines. Reported leak rates were 2.2%, bleeding rates 1.2%, and stricture rates 0.63%. 30 day mortality rate is reported as 0.19%. 5 A long term concern may be gastroesophageal reflux disease in up to 21%, but this might be reduced by repairing hiatal hernia at the time of the first surgery. 6
Why Might a Patient Choose a Gastric Sleeve Resection?
- Safety. High body mass index patients (BMI greater than 50) and high risk patients may benefit from the relative safety and decreased operative time of the Sleeve as a primary procedure, with the option of getting a second stage operation if necessary. The fact is that all laparoscopic weight loss surgical procedures are safe.
- Predictable Weight loss. Patients with BMIs from 35 to 49 will achieve average weight loss with the Sleeve (estimated 50 to 55%), approaching the RYGB (estimated 55 to 65%), yet better than the Gastric Band (40 to 50%). Weight loss with the Sleeve and the RYGB is much more predictable than gastric bands. 7 Weight loss is more variable with the gastric bands.
- Rate of Weight Loss. The rate of weight loss with the Sleeve is between that of RYGB, where the weight loss with gastric banding is most often long and slow.
- Less Radical. Sleeve resection does not radically reconfigure the small intestine, as in the RYGB, which may be unacceptable for some patients.
- No mechanical device to fail. Sleeve resection does not use an implantable device, such as Gastric Banding, which may be unacceptable for some patients. Gastric Bands can be plagued by short and long term mechanical complications (such as slip and erosion).
- Acceptably low complication rate. Complications of Sleeve Resection such as leak, bleeding, stricture and death are similar or less than RYGB. Life threatening complications are significantly less with Gastric banding procedures.
- Marginal ulcer is minimized. Sleeve resection does not have the risk of marginal ulcer which can be troublesome problem with RYGB.
- No gastric band fills. Fills are expensive, inconvenient and variable.
Also understand about the Gastric Sleeve resection:
- Need for Vitamin supplementation. Although with the Sleeve the food goes through it’s natural course, there are still significant vitamin deficiencies that may occur without ongoing lifetime vitamin supplementation, such as iron deficiency, calcium deficiency, B12 deficiency and others. (Similar to RYGB).
- Diabetes type II patients are advised that the best procedure is RYGB, due to the known metabolic / hormonal changes that occur with bypassing the first part of the small intestine. Diabetes has been proven to get better with the weight loss and calorie restriction achieved with the Sleeve and the gastric band, however there are definite theoretical advantages to the RYGB in the remission of diabetes type II. However, there are data that suggest the diabetes resolution rates are similar with RYGB and Sleeve (81.2% and 80.9% respectively, which both were better than the band, 60.8%). 8
- Irreversibility. Note that once the part of the stomach is removed in gastric sleeve resection. This obviously is not reversible. Both gastric bypass and the gastric banding procedures can be conceptually reversed. Reversing the gastric bypass is possible, but it is a relatively difficult and risky procedure to sew the stomach back together and reroute the intestine.
- Issues that are less well studied but should be discussed with your surgeon with the Sleeve (which should be discussed in all the gastric restrictive procedures) include:
- gastroesophageal reflux (heartburn) both in the short term and long term.
- difficulty with nausea
- potential long term dilation of the gastric pouch
- long term weight loss maintenance
This website can help you learn more about the gastric sleeve resection.
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1 “Weight Loss, Appetite Supression, … after RYGB and Sleeve Gastrectomy”Karamanakos et. al. / Annals of Surgery, Vol 247, Number 3, March 2008, 401-407.
2 “The History of Sleeve Gastrectomy” GH Jossart, G Anthone, Bariatric Times (2010: 7 (2): 9-10.
3 Updated Position Statement on Sleeve Gastrectomy…/ Surgery for Obesity and Related Diseases 6 (2020) 1-5.
4 Long-term Results of Laparoscopic Sleeve Gastrectomy for Obesity, Himpens, Jacques MD Annals of Surgery: August 2010 - Volume 252 - Issue 2 - pp 319-324.
5 S.A. Brethauer et al. / Surgery for Obesity and Related Diseases 5 (2009) 469-475.
6 Himpins
7 Fermelia, personal summary.
8 Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Abbatini F,.Surg Endosc. 2010 May;24(5):1005-10. Epub 2009 Oct 29. |
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