Sleeve Gastrectomy

Also referred to as ‘Gastric Sleeve’, Sleeve gastrectomy’s main idea is to create a small stomach pouch shaped like a narrow sleeve and remove the remaining bigger portion; which produces the hormone responsible for appetite, so after the sleeve procedure hunger is greatly diminished. Favourably, all the functions of the stomach remain intact, only its volume is reduced. The Sleeve operation has become the best obesity surgery in the world recently because of its safety and ease as well as no change in the internal anatomy or digestive function.

How does sleeve gastrectomy work?

Gastric sleeve belongs to a group of obesity surgeries that reduce the size of the stomach (restrictive bariatric surgeries), and hence reduce the capacity of food, which leads to a rapid sense of satiety with the least amount of food possible. The resected stomach contains the cells that secrete the hormone responsible for hunger. With the eradication of this expanding part, the hormone secretion is reduced and hunger is also reduced.

 

What to expect after Sleeve Operation?

Following surgery, you will not be able to eat as much food as you can now and you may put off a compelling amount of weight, which would enhance your overall health and your quality of life, and thus, increasing your life expectancy. Other conditions that relate to or are affected by obesity may be mitigated as well, such as diabetes mellitus, hypertension and sleep-apnea. You will feel a nourishing sense of pride in your appearance and the encouragement to always stay in shape and in good health.

 

What is the expected amount of weight loss after gastric sleeve?

Weight loss varies from one patient to another depending on several factors, the most important of which is adherence to dietary instructions and sports; Weight loss is approximately 70 to 100% of the extra weight.

Expected weight loss after the process is as follows:

• • After the first 45 days 10-25%
• • Month 3: 30% loss
• • Month 6: loss of about 50-60%
• • Month 9-12: Losing up to 100% extra weight

Can obesity return after Sleeve Gastrectomy?

Sleeve gastrectomy will very much ease your way to your ideal weight. Yet, to maintain the result of the procedure you should know that sleeve gastrectomy is the gateway to your new life, but the biggest role in maintaining the harmony of your body lies with you. You will be easily tempted to change your lifestyle and adopt healthy eating habits like avoiding excessive sugars, fats, soda drinks and high-calorie juices. Daily sports practice should be adopted as a continuous lifestyle in order to keep your body healthy forever.

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Who should do Sleeve Gastrectomy ?

• Obesity cases with BMI 30 with an obesity related comorbidity, like diabetes.
• Obesity cases with 35 BMI.
• Obesity in children.
• Obesity-related health conditions such as: high blood pressure, high cholesterol, diabetes, sleep apnea, delayed childbearing in both sexes, which is usually in women due to polycystic ovaries and men because of poor sperm quality, which usually occurs in patients who are obese.
• Suitable for patients with metabolic syndrome, obesity, diabetes and hypertension.
• Preferred in cases of women with obesity and suffering from heavy bleeding during the menstrual cycle.
• Obese postmenopausal women to avoid osteoporosis due to lack of effect on calcium absorption.

The patient must not be neither addicted to eating sweets

nor suffer from GERD severe and recurrent GERD.

 

Why Sleeve Gastrectomy ?

Sleeve Gastrectomy, one of the simplest operations in bariatric surgeries with the lowest complication rate among other obesity surgeries, is less hunger and faster satiation (feeling of fullness) has the following merits:

• Sleeve Gastrectomy is a safe and radical solution to obesity and its risks with 99.9% success rate with 80% to 100% of excess weight loss, which is the highest percentage of weight loss among bariatric surgeries, after which most patients feel a significant improvement in their quality of life.
• Sleeve Gastrectomy gives you a healthy balanced eating that is enough for the body with no deprivation of eating.
• It is conducted for all ages from 10 to 70 years.
• Sleeve Gastrectomy neither affects the digestive function in terms of digestion and absorption nor the internal anatomy of the body, and hence you don't have to take vitamins beyond the first 6 months.
• Significant improvement in the condition of 55 obesity-related health conditions, such as:

1) Diabetes Mellitus.

2) High blood pressure.
3) High Cholesterol in blood.

4) Osteoarthritis.

5) Sleep apnea.

6) Increases fertility in both men and women for childbearing

7) Improves sexual ability for the better.

• Sleeve Gastrectomy increases the basal metabolic rate through the secretion of GLP1, which stimulates the secretion of insulin and therefore treats or improves diabetes (depending on type, severity and duration of diabetes).
• Sleeve Gastrectomy has no side effects in the future, a fact proven through a few decades.
• Sleeve Gastrectomy does not implant external tools in body, which prevents complications of possible rejection of the body to external objects as occurs in the balloon and gastric Lap-band.
• The incomplete resection of the stomach keeps the absorption process reducing the chances of impact on the absorption of iron, as happens in surgeries that affect the absorption, so the patient does not suffer from iron deficiency anaemia.
• The lack of effect of surgery on the absorption of calcium reduces the risk of osteoporosis, especially at the age of menopause and aging.
• Reduce the amount of gastric acid secreted in the stomach, which reduces the risk of infectious ulcers and duodenal ulcers.
• Sleeve Gastrectomy does not include intestinal cutting and reconnection or a change in the order of the digestive system and therefore does not suffer from dumping syndrome (rapid emptying) or intestinal disorders or problems of malabsorption of food.
• Short operative time, takes 20 to 40 minutes.

How to get ready for Sleeve Gastrectomy?

After you go through your preliminary consultation with our nutritionist and our psychiatrist together with our surgeons, and you still remain a potential candidate for surgery, you will be asked to undertake a series of diagnostic work-up and consultations to make sure that you will be safe in and out of surgery. The surgical team will go over with you -in detail- the tests and consultations you will need to do prior to surgery. The sequence will be as follows:

• Booking a clinic appointment or contacting us online.
• Visiting us at the clinic;
• You will be informed about different procedures and you will be counselled about the procedure recommended for you.
• You will be asked about your medical history, the medications you regularly takes, any known food or medication allergies if any; you will also be instructed to stop taking blood thinners such as aspirin or other medicines that may cause bleeding during the procedure.
• You will be requested to do some tests and medical tests and having them sent to us prior to your surgery date setting.
• Starting on a liver shrinkage diet, this has to be a few days before the day of surgery.
• Start taking antacid 5 days prior to surgery to prepare your stomach for safe and fast healing.

 

 

What instructions do I have to follow the day after surgery?

You will go home the morning after surgery, follow a liquid diet for the first two weeks, followed by soft foods afterwards. You will be prescribed medications to regularly take during the first week. Maximally, a week after the procedure, you should be back to non-strenuous physical activity and work.

 

What are the steps to take after Sleeve Gastrectomy ?

1. Before discharge:

• • The patient remains in the hospital after the operation for a night under observation.
• • The patient is encouraged to move two hours after the operation, to speed up the hospitalization.
• • Start drinking liquids 12 hours after surgery.

2. After discharge from hospital (at home):

Since surgery is laparoscopic, the duration of recovery after surgery is short, unlike conventional surgery. In general, the patient needs to stay a day in the hospital and can return to work within two to three days.

• • There are some steps to follow after returning home, such as walking for half an hour a day for a month.
• • Avoid effort and large activities as well as lifting heavy objects.
• • Avoid smoking for at least two weeks.
• • Avoid drinking alcohol for at least a month.

3. Follow up appointments:

• •Your first follow up visit will be a week after surgery day.
• •Your second follow up visit shall be after 6 weeks from surgery day.
• •You are inquired to visit the clinic monthly afterwards.
• •You are inquired to send your updates with your questions online to us and you shall have your queries answered instantly.

 

Who should not undertake gastric sleeve?

• • If the patient’s health condition does not qualify him for surgery.
• • If the patient is pregnant.
• • If the patient is addicted to alcohol or drugs.
• • If the patient has an untreated stomach ulcer.
• • The patient suffers from Barrett’s syndrome, long standing severe reflux.
• • The patient suffers from ‘achalasia’ narrowing of the oesophagus.
• • Diaphragmatic hernias of large size or severe oesophageal reflux.

 

What tools are used in Sleeve Gastrectomy ?

The latest surgical staplers made of titanium are used in the gastric sleeve, where the stomach is stapled with three rows of staples on each side to ensure the highest degree of safety and is performed by laparoscopic surgery without surgical openings.

Will I follow a specific diet plan after the operation?

There are no prohibitions on the menu after the operation except during the first 45 days of the operation where you will be given a diet that starts with fluids and gradually increases until it reaches normal eating with regards to healthy eating habits. Yet you will have to elevate your life-style to a more of a healthy one.

 

Will I have to take medicines for a lifetime? 

No lifetime medication is required. You will only boost your body nourishment through the highest weight loss phase (during the 1^st 6 months).

What are the possible risks of bariatric surgeries?

Contours team is dedicated to providing you with all the information you may need in order to make a well-informed decision regarding whether Sleeve Gastrectomy -or any another procedure- is best move for you. Like any surgery, there are possible risks and complications that might take place in a sleeve gastrectomy. Even though these problems rarely occur, we are keen that you become informed and aware of them upfront.

Each surgery has risks, whether small, such as tonsillectomy, normal delivery or as large as laparoscopic obesity surgery 

Repeated vomiting : owing to the removal of excess part of the stomach, which leads to the small size of the stomach and the amounts of food are greater than the ability of the stomach to receive food.

• Can avoid this problem through the choice of the appropriate experienced surgeon.

 

Dehydration;

• Can avoid this problem through drinking about 2-3 litres of fluid per day during the first few months of weight loss after gastric sleeve. It may be difficult to drink this amount of fluid in the first few weeks after surgery, but these initial difficulties are overcome by adding flavours to the water..

Constipation: Which happens as a result to dehydration

• Can avoid this problem through

1. Plenty of fluids intake .
2. Walking exercise for 30 minutes daily during the first 45 days after surgery.

 

Postoperative bleeding (1_2%)

• This is avoided by performing a proper surgery with a highly skilled surgeon along with close post-operative monitoring to rapidly catch on any signs of bleeding for the earliest intervention

 

Stomach leakage 0.01 %

Rare, yet, must apply all measure for prevention

Leakeage is a lack of healing which could be caused by:

1.Improper surgery.

2.Improper tools/ consumables.

3.Failure to adhere to the doctor's instructions before and after surgery.

4.Impaired ability of tissues to heal which could be discovered by pre-operative investigation.

• This is avoided by dealing with the surgeon you trust the most to fulfil the following:

1. Mastering of bariatric surgery and have performed a credible number of surgeries.
2. Single use equipment policy.
3. Proper follow-up system.
4. Proper pre-operative preparation.

 

Hair loss.        

• This can be avoided through the following:

1.Appropriate nutritional plan and follow up through our nutrition consultant.

2.Multivatmin supplement through the first six months if needed.

3.Follow up investigations every 3 months including hair growth indices.

4.Hair endorsement therapy through contours derma care clinic.

Not losing weight in a satisfactory manner.

• This is caused by

1. Choosing the less appropriate type of bariatric surgery.
2. Not following the bariatric team instructions.
3. Choosing a less qualified surgeon who could inappropriately cut the stomach.

Which is called Insufficient removal, which leads to re-expansion of the stomach and the continued secretion of hormone ghrelin, which loses surgery required, this is one of the most important reasons for the failure of sleeve gastrectomy surgery.

• In order to avoid this, the patient must follow the team’s instructions, attend their regular follow-up visits and choose an experienced surgeon and the appropriate bariatric surgery in the first place.

 

Stretch marks and redundant skin

• This can be avoided through

1. Drinking excessively.
2. Exercising, by walking 30 minutes daily up till the first 45 days, then practicing regular swimming/ cross fit/ zomba classes……
3. Plastic surgery: only if the patient did not exercise,the patient might resort to plastic surgery to remove excess skin and solve the problem.

Gallstones urinary tract stones: owing to dehydration on the long term

• This can be avoided with plenty of fluids intake.

Pulmonary Embolism:  very rare with most surgeries including gastric sleeve, yet must be protected against.

• Measures taken to avoid pulmonary embolism:

1. Plenty of fluids are to be taken in the preparatory diet before surgery.
2. Operative time is reduced to 30-45 mins.
3. Elastic stocking are worn during and shortly after surgery.
4. The patient is instructed to move two hours after surgery.
5. Plenty of fluids are to be taken in the instructed diet after surgery.
6. Blood thinners are given up till 10-days after surgery.