Sleeve Gastrectomy

1. What is it? Any common name for this procedure?

A Sleeve Gastrectomy is a surgical weight-loss procedure in which approximately 80% of the stomach is removed, leaving a narrow, tube-like "sleeve" about the size and shape of a banana. Unlike a bypass, this procedure does not involve rerouting the intestines; it works primarily through restriction (smaller stomach capacity) and hormonal shifts.

Common Names:

• Gastric Sleeve
• VSG (Vertical Sleeve Gastrectomy)
• The "Sleeve"

2. Common Indications: When is it Recommended?

The sleeve is currently the most performed bariatric procedure worldwide due to its balance of safety and effectiveness. It is often recommended for:

• High-Risk Patients: Those with complex medical histories who may not tolerate the longer operative time of a bypass.
• Medication Users: Patients who must continue taking certain medications (like NSAIDs or steroids) that are dangerous after a gastric bypass.
• Severe Obesity: Often used as the first step in a "two-stage" surgical plan for patients with a very high $BMI$ (e.g., $>60$).
• Anatomical Concerns: Patients with extensive abdominal scarring or intestinal issues that make a bypass difficult.

3. List of Associated Diseases and Conditions

The "Sleeve" is highly effective at treating the complications of obesity:

• Class II and III Obesity.
• Type 2 Diabetes: Significant improvement or remission due to the removal of the part of the stomach that produces hunger-regulating hormones.
• Obstructive Sleep Apnea (OSA).
• PCOS (Polycystic Ovary Syndrome): Weight loss often restores regular ovulation and improves fertility.
• Non-Alcoholic Fatty Liver Disease (NAFLD).

4. List of Screening Tests and Assessment Tools

Pre-surgical preparation involves a "deep dive" into your physical and mental health:

• Upper Endoscopy (EGD): To check for a Hiatal Hernia or severe Acid Reflux (GERD). If severe reflux is found, a bypass may be a better option than a sleeve.
• Abdominal Ultrasound: To check for gallstones, which are common in patients with obesity and may be removed during the same surgery.
• Hormone Panel: Testing $A1c$, thyroid levels, and cortisol to rule out endocrine causes of weight gain.
• Psychological Clearance: Assessing "emotional eating" patterns and ensuring a solid support system is in place.

5. Am I Eligible for This Evaluation?

Current 2026 guidelines for the Gastric Sleeve include:

1. BMI Threshold: $BMI \geq 35$, or $BMI \geq 30$ with a related health condition like high blood pressure or diabetes.
2. Age: Typically performed on adults, but increasingly used for adolescents with severe obesity and metabolic disease.
3. Reflux Status: Candidates should not have uncontrolled, severe gastroesophageal reflux disease (GERD), as the sleeve can sometimes worsen these symptoms.
4. Lifestyle Readiness: Willingness to move from "grazing" or large meals to small, nutrient-dense portions.

6. Pre and Post Care

Pre-Care (The Preparation):

• Liver Shrinkage Diet: 2 weeks of high-protein, very low-carb intake to reduce the size of the liver, which sits directly over the stomach.
• Smoking Cessation: You must be 100% nicotine-free; smoking significantly increases the risk of the "staple line" not healing correctly (leaks).

Post-Care (The Recovery):

• The "Hunger Reset": Because the portion of the stomach that produces Ghrelin (the hunger hormone) is removed, many patients feel very little hunger for the first 6–12 months.
• Staged Diet: 1 week clear liquids $\rightarrow$ 1 week full liquids $\rightarrow$ 2 weeks pureed $\rightarrow$ Soft foods.
• Vitamin Support: While malabsorption is less of a concern than with a bypass, daily bariatric multivitamins and Calcium are still required for life.

7. Days Required for Hospitalization

• Surgical Duration: 60 to 90 minutes.
• In-Hospital Stay: 1 to 2 Days. Most patients stay one night to ensure they can stay hydrated and that their pain is well-managed.
• Return to Activity: Most patients are back to work within 2 weeks and can begin heavy lifting/exercise after 6 weeks.
• Hospitalization: 1–2 Days.

8. Benefits of Sleeve Gastrectomy

• No Intestinal Rerouting: The natural path of digestion remains unchanged, reducing the risk of "dumping syndrome" or bowel obstructions.
• Hormonal Weight Loss: It’s not just a "smaller pouch"; the dramatic drop in Ghrelin helps quiet "food noise" in the brain.
• Rapid Recovery: Laparoscopic or robotic techniques mean tiny incisions and a faster return to daily life.
• High Success Rate: Patients typically lose 50% to 70% of their excess body weight within the first year.