Vertical Sleeve Gastrectomy, or otherwise known simply as the sleeve gastrectomy, is one type of surgery that falls under the category of Bariatric Surgery. Because of its drastic influence on weight loss, minimally invasive technique and impact on the quality of life, the sleeve gastrectomy is becoming one of the most common procedures performed.
The Sleeve Gastrectomy is considered a restrictive type of procedure and its main function is to allow for smaller portions of food while promoting the feeling of “fullness” faster than conservative measures. Once the procedure is performed, your stomach is the size and shape of a banana only allowing for small amounts of food to be allowed in at once.
Among the many hormones associated with hunger and satiety, Ghrelin has been the most commonly researched. Highly concentrated in the large part of the stomach (the fundus), this hormone is responsible for feeling hunger. In obese patients, this hormone is unbalanced therefore leading to constant hunger and fewer feelings of fullness. In the Sleeve Gastrectomy, the area of highly concentrated hormones is removed allowing for patients to experience fullness for a longer period of time. Decrease in this hormone will also decrease persistent hunger sensations, which will promote eating for fuel and nutrition for a healthier lifestyle.
This procedure is performed in a hospital using a laparoscopic technique. This means multiple small incisions throughout the abdomen. Using a camera as well as long-handled tools, 75% of the stomach is detached permanently and removed through one of the incisions. The patient is then left with a stomach that is as long and narrow as a banana.
Experienced Bariatric Surgeon Dr. Buchin
recommends patients have a BMI (Body Mass Index) of greater than 40 or a BMI of 35-40 with two obesity-related conditions (sleep apnea, high cholesterol, high blood pressure or Diabetes Mellitus type II) before considering this treatment. Once the procedure is performed the patient will be in the hospital for a total of two nights. A staged diet will be enforced once surgery dates are obtained. Two weeks prior to surgery a patient is placed on an all-protein shake and clear liquid diet in order to increase weight loss and put a patient’s body into a state of ketosis. This is a normal metabolic process that happens when the body does not have carbohydrates coming in for energy and is forced to get energy from fat storage. For surgery, this is especially important because fat storage is taken from the liver allowing for shrinkage in the liver. This will decrease the risk of injury to the liver as well as allow for the surgery to be safer, faster and more efficient.
Two weeks post-surgery the patient will be on a clear liquid diet with three small protein shakes a day and clear liquids in between. This will allow for proper tissue healing and nutrition in preparation for slowly introducing food back into the diet. Week three will start the soft food portion and week 6 will allow for raw fruits, vegetables, and harder proteins to be incorporated as well.
Patients are instructed on no heavy lifting greater than 20lbs after surgery, no driving for five days after surgery and are usually able to return to a sedentary type job within 1-2 weeks. Patients that partake in more rigorous work can discuss return to work options with the MD/PA on a one to one bases. Drinking from straws and drinking carbonated drinks are discouraged after surgery. Pregnancy is possible after bariatric surgery and encouraged to hold off until two years post-surgery. This will allow ample time for efficient weight loss and adjustment to the new lifestyle.