Sleeve Gastrectomy

Sleeve gastrectomy (gastric sleeve surgery) is the surgical removal of about three quarters of the stomach, leaving behind a narrow, tube-shaped stomach. It is one of the most frequently performed operations worldwide among the methods of obesity surgery (bariatric surgery).

The reduced stomach allows a feeling of fullness to develop with a smaller amount of food. In addition, the removed part of the stomach is an important source of ghrelin, a hormone associated with the feeling of hunger; for this reason, a reduction in appetite is observed in many patients. The operation is not a solution on its own; it is a step of treatment that is effective together with changes in diet and lifestyle.

The decision on obesity surgery is made through an overall assessment of the patient’s general health. The generally accepted criteria are:

• A body mass index (a value calculated from height and weight) of 40 or above,
• A body mass index between 35 and 40 together with an accompanying condition such as type 2 diabetes, hypertension (high blood pressure) or sleep apnoea,
• Sufficient results not having been achieved with non-surgical methods such as diet, exercise and medication,
• No condition that prevents general anaesthesia,
• The patient being ready to follow the dietary rules after the operation and to keep to lifelong follow-up.

The suitability assessment is often a multidisciplinary process in which endocrinology, psychiatry/psychology and nutrition specialists also take part. You need to assess together with your doctor which method is suitable for you.

What preparation is done before the operation?

Before the operation, blood tests, a gastroscopy (examination of the stomach with a camera passed through the mouth), an abdominal ultrasound, and cardiology and anaesthesia assessments are carried out. If you smoke, you are advised to stop; smoking has a negative effect on wound healing and lung health. In some patients, a special diet programme lasting a few weeks is followed before the operation to shrink the liver and allow the operation to be performed more safely.

The operation is performed under general anaesthesia and mostly by the laparoscopic (keyhole) method, through a few small incisions in the abdomen. With the help of a camera and special instruments, the stomach is divided along its length with stapling and cutting devices called staplers; most of the stomach is removed, leaving a narrow, tube-shaped stomach.

Although the duration varies from patient to patient, the procedure generally takes around 1–2 hours. The integrity of the staple line may be tested during the operation. Rarely, because of technical difficulties, it may be necessary to switch from the keyhole method to open surgery; this is a decision taken for the patient’s safety.

As with any surgical procedure, this operation has risks. Your doctor will explain the risks specific to your situation in detail before the operation.

• Bleeding, wound infection and problems related to anaesthesia,
• Blood clot formation in the leg veins (deep vein thrombosis) and the clot travelling to the lungs (embolism),
• Leak along the staple line (stomach contents seeping into the abdominal cavity) — this is rare but serious and may require additional treatment,
• Narrowing of the sleeve stomach,
• Onset of reflux (heartburn) symptoms or worsening of existing symptoms,
• In the long term, vitamin and mineral deficiencies and gallstone formation,
• Some weight regain over time.

If symptoms such as fever, severe abdominal pain, palpitations or shortness of breath appear after the operation, it is important to contact your doctor or the nearest healthcare facility without delay.

The hospital stay is usually a few days. Getting up and walking early after the operation is important for preventing blood clots.

What is eating like after the operation?

Eating progresses in defined stages: first clear fluids, then thick fluids, puréed foods, soft foods and finally a diet of normal consistency. The length of each stage is set by your doctor and your dietitian. Eating small portions slowly, chewing mouthfuls well, drinking fluids at times separate from meals and taking in enough protein are the basic rules of this period.

Why is follow-up lifelong?

Because the stomach is smaller, the intake of some vitamins and minerals (such as B12, iron, vitamin D and calcium) may decrease. For this reason, the supplements your doctor recommends need to be taken regularly and blood tests need to be done at set intervals. Obesity is a chronic disease; regular check-ups with the doctor and dietitian after the operation continue for life. This follow-up supports both the early detection of nutritional deficiencies and lasting results.