Gastric Sleeve surgery is a restrictive procedure. Restriction is accomplished by surgically altering the stomach so it is smaller (15% of capacity or about 2 – 6 ounces). A large portion of the stomach is removed. It is reduced to a tube with the pylorus intact. Malabsorption is not applied so none of the intestinal tract is bypassed or altered.
Vertical Sleeve Gastrectomy
Introduced in 2005, Gastric Sleeve surgery isn’t new at all. It is actually one half of the Duodenal Switch bypass which was introduced in the late 1980’s. The bypass portion of the procedure just isn’t performed. The bypass can be performed later if the initial surgery fails to produce weight loss on its own.
When you get this procedure you lose 80 to 90 percent of your stomach. Unlike RNY surgery where the transected stomach remains in the body, this operation requires a large portion of it be removed from your body. Your stomach capacity is reduced to 2 to 6 ounces of food. But it may (in rare cases) stretch larger over time and it can only be adjusted surgically.
With Gastric Sleeve surgery you get to keep your pylorus
This is the best feature of the procedure. Some bypass surgeries remove the pylorus muscle (RNY and Bilio-pancreatic diversion). The pylorus is actually the sphincter valve where food exits the stomach. The valve stays shut for a time after a meal to allow digestive acids to mix with and pre-digest the food. Weight loss surgeries that remove the pylorus allow undigested food to enter the small intestine. This causes the ‘dumping’ syndrome that is frequently a characteristic of RNY and Bilio-pancreatic diversion bypass surgeries. Dumping is spontaneous diarrhea and large amounts of flatulence (gas). We believe keeping the pylorus is important because it is necessary for proper digestion. Weight loss surgeries that require it to be removed should be avoided. Well digested food makes protein, vitamins and minerals more absorbable and is vital for good health.
The pylorus also holds food and liquids in the stomach longer…
…causing far greater weight loss. When the pylorus is removed food exits the stomach almost immediately. Drinking will push food out of the pouch and the patient will become hungry again right away. Gastric Sleeve surgery allows the patient to drink while eating (unlike RNY and Bilio-pancreatic diversion bypass surgeries). With the pylorus intact, fluid is captured with food in the pouch causing a greater feeling of fullness while eating much less. In the event a patient is not getting enough nutrition they should not drink while eating. Patients must chew food thoroughly being careful to not overeat, especially if they drink while eating.
The downside of keeping the pylorus is it limits the patient’s ability to drink
Gastric Sleeve surgery reduces stomach volume by 85 percent greatly limiting the amount a patient can drink in one sitting. So when you drink you must sip and wait until the pylorus opens. This limited drinking can cause patients not to get enough fluids. Patients must develop a habit of taking small drinks very frequently throughout the day. In comparison, dumping has a much larger negative affect on a patient’s quality of life. Your pylorus is a good thing to keep!
Gastric Sleeve surgery issues and advantages
Some patients will develop ulcers that may require life long therapy. They may have to take acid reducers for the rest of their life (Prevacid®, Pepcid®, Zantac® etc.). The risk for ulcers with this procedure is not greater than other weight loss surgeries. All weight loss surgeries have some risk for ulcers.
Upper GI Endoscopy can be done on patients. RNY bypass surgeries cannot fully be scoped because the lower stomach has been surgically isolated and is not accessible by a scope. This makes diagnosis of lower stomach problems such as an ulcer very difficult.
Patients can take NSAIDs (non-steroidal anti-inflammatory medicines) such as aspirin, Motrin®, Naprosyn® and Viox® to name a few.
Patients can take pills in general. RNY and Bilio-pancreatic diversion bypass surgeries require the outlet or ‘stoma’ of the stomach be surgically created. If the surgeon creates it a little small, swallowing pills may be an issue. Surgeries that keep the lower stomach intact function normally and so swallowing pills is rarely an issue.
Gastric Sleeve patients can eat fruits and vegetables without bezoars
With the lower stomach left in its natural state patients typically can eat most foods including fruits and vegetables without ill effect. RNY bypass patients can have problems eating certain fruits and vegetables because they have a surgically constructed ‘stoma’ that replaces their pylorus. Blockages akin to a hair ball occur in some weight loss surgery patient’s pouch. Nausea and vomiting may result and bezoars may need to be removed via endoscopy.
Is Gastric Plication better?
Plication requires none of the stomach be removed and can be completely reversed. Gastric Sleeve can never be reversed because 85% of the stomach is removed. While this bariatric surgery is new in the United States, Plication is even newer (although it has been widely used throughout the world for over a decade).