The sleeve gastrectomy is rapidly emerging as a reasonable alternative to adjustable gastric banding and other stapling procedures. Its earliest development was in anti-reflux surgery, and it was originally the restrictive component of the duodenal switch. The laparoscopic approach and the evolution of a reduced pouch volume have demonstrated results comparable to other stapling procedures both with weight loss and safety.
The history of the sleeve gastrectomy is more an evolution of prior procedures than a discrete timeline of development of a single procedure. The procedure has its roots in the earliest gastroplasty procedures and as an observation from prior anti-reflux procedures. It was Doug Hess, in Bowling Green, Ohio, who performed the first open sleeve gastrectomy in March of 1988 as part of what is now known as the duodenal switch procedure. Lawrence L. Tretbar described weight loss associated with a fundoplication for reflux surgery. He described an extension of the fundoplication that created a tubular structure that achieves weight loss.
Dr. Hess used this concept of a tubular stomach and modified from an extended plication to an actual longitudinal or vertical gastrectomy. This type of gastrectomy that also left in place the first portion of the duodenum helped solve the problem of dumping symptoms and marginal ulcers seen with the Scopinaro bilopancreatic diversion. This was because an intact pylorus was left and a duodenal enteric anastomosis was performed instead of a gastro-enteric anastomosis.
In 1999, the first laparoscopic approach to the duodenal switch was developed on a porcine model by deCsepel, Jossart, and Gagner. The sleeve gastrectomy portion of the procedure was found to be feasible. Gagner proceeded with the laparoscopic duodenal switch on humans but noted a high complication rate in the higher body mass index (BMI) group. He subsequently developed the technique of staging the intestinal bypass procedure by performing the laparoscopic sleeve gastrectomy first as an initial stage. From 2001 to 2003, seven patients with a BMI of 58 to 71kg/m underwent a first stage sleeve gastrectomy with a subsequent Roux-en-Y gastric bypass. The average EWL was 37kg (33%EWL) and this allowed for a safer second stage. These preliminary results quickly popularized the procedure as a safer laparoscopic option for the higher BMI group.
Restrictive operations like sleeve gastrectomy or gastric sleeve surgery make the stomach smaller and help people lose weight. With a smaller stomach, you will feel full a lot quicker than you are used to. This means that you will need to make big lifelong changes in how you eat—including smaller portion sizes and different foods—in order to lose weight.
This surgery can be done by making a large incision in the abdomen (an open procedure) or by making several small incisions and using small instruments and a camera to guide the surgery (laparoscopic approach). More than half of your stomach is removed, leaving a thin vertical sleeve, or tube, that is about the size of a banana. Surgical staples keep your new stomach closed. Because part of your stomach has been removed, this is not reversible.
Sometimes this surgery is part of a larger approach to weight loss done in several steps. If you need to lose a lot of weight before you have duodenal switch surgery, gastric sleeve surgery may help you.
You will have some belly pain and may need pain medicine for the first week or so after surgery. The cut that the doctor makes (incision) may be tender and sore.
Because the surgery makes your stomach smaller, you will get full more quickly when you eat. Food also may empty into the small intestine too quickly. This is called dumping syndrome. It can cause diarrhea and make you feel faint, shaky, and nauseated. It also can make it hard for your body to get enough nutrition.
Depending on how the surgery was done (open or laparoscopic) you’ll have to watch your activity during recovery. If you had open surgery, it is important to avoid heavy lifting or strenuous exercise while you are recovering so that your belly can heal. In this case, you will probably be able to return to work or your normal routine in 4 to 6 weeks. The surgery is most commonly done as a laparoscopic procedure, which means the recovery time is faster.
Your doctor will give you specific instructions about what to eat after the surgery. For about the first month after surgery, your stomach can only handle small amounts of soft foods and liquids while you are healing. It is important to try to sip water throughout the day to avoid becoming dehydrated. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements.
Bit by bit, you will be able to add solid foods back into your diet. You must be careful to chew food well and to stop eating when you feel full. This can take some getting used to, because you will feel full after eating much less food than you are used to eating. If you do not chew your food well or do not stop eating soon enough, you may feel discomfort or nausea and may sometimes vomit. If you drink a lot of high-calorie liquid such as soda or fruit juice, you may not lose weight. If you continually overeat, the stomach may stretch. If your stomach stretches, you will not benefit from your surgery.
Your doctor will probably recommend that you work with a dietitian to plan healthy meals that give you enough protein, vitamins, and minerals while you are losing weight. Even with a healthy diet, you probably will need to take vitamin and mineral supplements for the rest of your life.
Weight-loss surgery is suitable for people who are severely overweight and who have not been able to lose weight with diet, exercise, or medicine.
Surgery is generally considered when your body mass index (BMI) is 40 or higher. Surgery may also be an option when your BMI is 35 or higher and you have a life-threatening or disabling problem that is related to your weight.
It is important to think of this surgery as a tool to help you lose weight. It is not an instant fix. You will still need to eat a healthy diet and get regular exercise. This will help you reach your weight goal and avoid regaining the weight you lose.
Research has shown that people who have had a sleeve gastrectomy on average lose more than half of their excess weight. Success is higher for people who are realistic about how much weight will be lost and who keep appointments with the medical team, follow the recommended eating plan, and are physically active.