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Weight Loss Surgery

Sleeve Gastrectomy

Overview

Sleeve Gastrectomy Weight Loss SurgeryThe 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 7 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 7 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.

The Inverted Sleeve Gastrectomy by Dr. Owens

After several sleeve gastrectomy procedures, Dr. Owens perfected the procedure by making an inverted corner at the gastroesophageal junction. This improvement was found to reduce the likelyhood of leakage and heartburn incidences. This gastric sleeve improvement was published in the official Journal of the American Society of Metabolic and Bariatric Surgery and can be further studied here

 

How does Sleeve Gastrectomy work?

Restricts food intake without the bypass of the intestines. 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.

Gastric Sleeve explained by Dr. Owens

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Benefits / Risks comparison to Gastric Bypass/ Lap Band

Sleeve Gastrectomy 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.
  • Potentially safer: minimizes leaks at new connections, long term complications, risk of ulcers, bowel obstructions.
  • Potentially safer for high BMI, or other high risk patients
  • No Iron Deficiency

Sleeve Gastrectomy 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