Coastal Center for Obesity : Weight Loss Surgery : Sleeve Gastroplasty

Weight Loss Surgery

Sleeve Gastroplasty

Overview

The procedure was originally conceived of in England and has been further developed and utilized in the U.S, Germany and Belgium. The technique is an improvement over earlier gastroplasty procedures which included placement of foreign bodies, and left the excess stomach intact. It was originally used for very high BMI patients (~ 500 lbs.) to try to reduce the overall risk of surgery. It was then followed by a second surgery when the patient had lost enough weight to safely go through a second procedure like the Gastric Bypass.

The new procedure was started in England about 5 years ago as a stand alone procedure for patients of BMI’s of 35-45. It proved to be quite safe and effective even at 5 years post op.

U.S. studies have been very impressive; in one study of almost 100 very high risk, very high BMI patients there were no deaths, and only 1 leak, and 1 pulmonary embolus.

Dr. Owens has used this procedure for high risk, high BMI patients with good results.
It can be considered by patients who are:

Concerned about bowel obstructions and leaks that may occur with Gastric Bypass due to the re-arrangement of the anatomy required.
Concerned about the dietary changes and vitamin supplements required by Gastric Bypass
Concerned about the foreign body introduced with the Lap Band placement
Concerned about the need for follow up, fills required with the Lap Band

It should also be considered for patients weighing over 500 lbs, patients with existing anemia, Crohn’s disease, or other conditions that make them too high risk for Bypass procedures.

How does Sleeve Gastroplasty work?

This procedure works by restricting food intake without any bypass of the intestines or malabsorption. The stomach is restricted by dividing it vertically, creating a small vertical stomach pouch shaped like a banana. The new stomach pouch measures 2-5 ounces. The remaining part of the stomach is removed. The portion of the stomach that is removed is thought to be responsible for secreting Ghrelin, the hormone that is responsible for appetite and hunger. By removing this portion of the stomach, the appetite hormone is reduced to almost nothing, usually causing a loss of appetite.
The removed part of the stomach is also the portion thought to “stretch” the most. The new stomach pouch holds only small amounts of food, causing the patient to feel full.
The nerves to the stomach remain in tact, preserving the functions of the stomach while reducing the volume it can hold.

Benefits / Risks comparison to Gastric Bypass/ Lap Band

Sleeve Gastroplasty vs. Gastric Bypass:

Weight loss amount/ speed expected to be similar
Appetite suppression similar, and thought to be longer lasting
No dumping. Most foods can be consumed, but in small portions.
Safer: minimizes risk of ulcers, bowel obstructions, leaks at new connections.
Safer for high BMI, or other high risk patients

Sleeve Gastroplasty vs. Lap Band:

Faster weight loss
More appetite control
Less follow up required – no fills.
Safety: Does involve stapling, therefore leaks and other related complications can occur.
Eliminates potential for erosion or slips.
Not reversible/ adjustable