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Gastric Sleeve

Gastric sleeve Bariatric surgery is also called sleeve gastrectomy. This has become a popular choice when you wish to overcome obesity levels. It is a straight forward surgery that avoids complications which can arise in other Bariatric surgery such as lap band or gastric bypass.

If we look at how Bariatric surgery has evolved, gastric sleeve gastrectomy has become an established procedure like the other restrictive surgeries since the year 2010. Since they are established procedures with effective results as well as low risk of complications, most insurance companies provide coverage for such restrictive surgery. It is also a surgery that does not require long term maintenance as found in gastric band surgery. Today sleeve gastrectomy procedure is covered by insurance since effective results are seen in obesity patients and rates of complication are low.

Who is eligible for sleeve gastrectomy?

Those who are considered morbidly obese or have a body mass index over 40 and higher can be recommended for the surgery. One of the main benefits of this surgery is that obese patients lose significant feeling of hunger after undergoing such a surgery. They need to maintain a certain diet plan and the loss of hunger also helps them to consume a small amount of food. Hence weight loss is effectively achieved.

Benefits of gastric sleeve surgery for patients are:

  • It helps to reduce hunger as the hormone responsible for inducing hunger, ghrelin, is reduced by removing a certain portion of the stomach.
  • Operation time is short compared to gastric bypass surgery.
  • Intestines do not need to be re routed.
  • There is no dumping syndrome.
  • Pylorus is kept intact, which helps to ensure that sugar digesting time remains the same.
  • There are no adjustments required after the operation procedure is over, as in gastric band procedures where one has to get regular check up to ensure that the lap band is in place.
  • There are no foreign objects inserted in the body as in gastric band procedure.
  • Weight loss happens gradually over a period of 18 months since the procedure.
In many cases, surgeons prefer to perform sleeve gastrectomy over other restrictive Bariatric surgery such as gastric band. That is because of certain advantages that this kind of procedure offers over others, such as gastric bypass or gastric band. In the latter cases there is a foreign object that is inserted inside the abdominal cavity and inserted bands or staples can loosen up or leak into the system. In case of sleeve gastrectomy the procedure does not require any further monitoring of your body after the procedure is completed.

Weight loss is also achieved, which is the main target of such a restrictive surgery. Again the main advantage of the surgery is that hunger is effectively reduced by this procedure for which people automatically reduce the intake of food. In case of the procedure such as in gastric band hunger pangs remain the same for which there can be excessive intake of food which leads to adverse results on health.

What to expect on the day of surgery?

For those who choose to undergo such a surgery, they can feel apprehensive, but everything would go well since it is now an established procedure. Many patients who come to our clinic in Estonia have been satisfied with the results of such an operation conducted by our experienced Bariatric surgeons.

Usually surgeries are conducted in the morning, but depend on the schedule of the surgeon and the hospital. Before the surgery patients are told to follow the pre op diet 2 weeks prior. The night before the surgery one is asked not to eat beyond midnight. This is critical for the system needs to be clear when surgery is undergone. In certain cases, people vomit during the procedure and all contents of the stomach regurgitates and block the airways. People are also advised not to take any medication for a certain number of hours prior to the surgery.

Patients are anesthetized before the surgery. They are asked to walk a few steps after 5 hours have passed after the surgery. This helps to ensure blood circulation and also alleviate certain body aches that are associated with the surgery. There is a certain amount of pain involved in gastric sleeve surgery, which is not too bad for some. Pain medication is administered as required and most people are required to stay one or two days in the hospital. During this period people are keeping on liquid diet. They also monitor the bowel movement which is difficult on the initial days. Pain medication is provided as per the level of discomfort and drugs prescribed to help deal with acidity as well as heartburn which are common after such procedure.

What is involved in the surgery?

The procedure is usually conducted in various stages. Since people who undergo such an operation have a high body mass index keeping them under anesthesia for a long time can lead to lung or heart problems. In certain cases the surgeons take a two-stage approach. They might perform the gastrectomy as a decision that is taken during the operation. In other cases they might perform gastric bypass as the second stage of the operation.

If there is extensive scarring or the liver is larger than gastric bypass is usually not done. When sleeve gastrectomy is the main laparoscopic procedure being done small incisions are made in the abdomen. About 75% of the stomach is reduced by removal and a narrow tube or sleeve is left. Intestine is not bypassed or removed in this surgery. The total procedure takes about an hour or more.

Diet and activity after surgery

Diet chart is made for the patient, which usually comprises of liquid and mashed semi solid food for the first few days after they are released from hospital. Patients are encouraged to walk and they can do so frequently so that the healing process is fast. They are advised not to lift heavy objects which can put pressure on the surgical stitches. The surgical area will remain sore and some pain would be felt from time to time as one recovering after the surgery. They are also advised not to bathe fully or to sit in a hot tub, but taking a shower is usually ok.

Those who undergo such a surgery typically feel fatigued for the first few weeks after the surgery since the food intake reduces through reduced hunger. Usually people are able to start usual activities for their life within a period of 2 to 4 weeks.

In case one experiences the following symptoms they need to seek medical assistance:

  • Rising fever with chills.
  • Redness or warmth as well as pus rising from the incision site.
  • Nauseous feeling.
  • Not being able to swallow fluids.
  • Diet to be followed after surgery

    In the first few weeks following surgery the diet chart usually comprises of:

    • Clear liquids such as decaf tea, broth and water.
    • The second week one should follow a liquid diet and supplement with protein shakes.
    • Third week it is time to resort to soft, pureed food such as cottage cheese, soups and scrambled eggs.
    • On the 4th week one can start on soft food such as cereal, mashed potatoes, boiled chicken and fish.
    • Beyond this stage patients can start consuming other food items in small amounts.
    They are advised to have small meals throughout the day, chew their food slowly. They are advised to make their food dense in nutrition and healthy as well as balanced. They are also advised to take vitamin supplements and other supplements that are given to Bariatric surgery patients.

    Those who wish to undergo Bariatric restrictive surgery need to visit physician who are experienced in this domain. You should see a primary caring doctor who is helping an obese patient to lose weight. They will propose the surgery when less intrusive methods do not work. Primary care physicians usually help obese patients to lose weight by controlling the diet and establishing an exercise regime. For those who have a body mass index of 40 and over are considered morbidly obese. For such individuals Bariatric restrictive surgeries are recommended.

    At our clinic in Estonia we have several experienced Bariatric surgeons who have performed such surgery on several patients. Many people have been satisfied with the results of this surgery and they have been able to resume normal life activities within few weeks’ time.

    Differences between gastric sleeve and other procedures

    The differences between sleeve gastrectomy and other Bariatric restrictive surgeries like gastric band and gastric bypass at the following:

    • In sleeve gastrectomy the stomach is reduced to a sleeve like portion whereas in gastric band a lap band is introduced to restrict a portion of the stomach; gastric bypass portion of the stomach is blocked off as well as part of the small intestine.
    • In sleeve gastrectomy hunger inducing hormone release is reduced which leads to absence of hunger feeling; in gastric band procedure certain digestive juices are bypassed; in case of gastric band the digestive juices and hormones are left untouched.
    • In case of sleeve gastrectomy there is no foreign object that is introduced in the body, whereas in gastric band as well as in gastric bypass there is the danger of the band on the staples getting misplaced and leaking into the system. The above information will help one to take the right decision when it comes to Bariatric weight loss procedures.

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