Sleeve Gastrectomy: Procedure, Recovery, Cost, Risk & Complication

Sleeve gastrectomy is a modern type of weight-loss surgery that involves removing fairly a large portion of the stomach, eventually restricting the amount of food that can be consumed after the surgery. Like every other metabolic surgery, it promotes weight loss by changing the hormonal signals between your stomach, brain and liver.

In this surgery, most of the stomach is removed, leaving a small sleeve-shaped pouch. The patient will not be able to have as much food as he/she was eating previously, so fewer calories will be absorbed in the body, resulting in changes in the hormonal signal that is sent between the brain and the stomach. Therefore, there will be an improvement in the metabolic syndrome, cause weight loss and also maintain overall health and well-being.

Sleeve gastrectomy is recommended in the following conditions:

• If a person is very obese and unable to lose weight through dieting or exercising
• A person who has a BMI (Body Mass Index) of 40 or more than that, meaning almost 100 pounds over the recommended weight. A normal BMI lies between 18.5 and 25.
• A high BMI along with a severe health condition like heart disease, type 2 diabetes or obstructive sleep apnea. These conditions may improve if extra weight is lost.
• In some cases, it is done on patients who are too heavy to undergo any other surgery for weight-loss safely

Pre Procedure

There are certain pre-procedure guidelines that you need to follow before undergoing a sleeve gastrectomy:

• Have a detailed discussion with your doctor regarding the whole procedure; what can you expect post-surgery and the complications that may arise
• You will have to undergo a complete physical examination and nutritional counselling
• You also have to go for a blood test, ultrasound test of the gallbladder, along with other tests so that your doctor can ensure that you are healthy enough for undergoing the surgery
• Inform your doctor regarding any medical conditions that you have, such as diabetes, heart/lung problems or high blood pressure so that they can be kept under control. Also, inform your doctor if you think you are pregnant.
• Stop smoking.
• You have to stop eating or drinking anything a few hours before the surgery. Follow the instructions carefully as provided by your doctor.

During Procedure

This surgery is performed by administering general anaesthesia to the patient. A tiny camera will be placed inside the stomach, through one of the small incisions that the surgeon makes on your belly. The camera and the other instruments that are required for performing the surgery are inserted through these tiny incisions. The camera, being connected to a monitor outside, allows the surgeon to have a view of the stomach while he is performing the surgery.

The surgeon will remove most of the stomach, and join the portions that remain with the help of surgical staples. It will change the shape of the stomach like a long, vertical tube, similar to that of a banana. The procedure does not cut or change the sphincter muscles that are responsible for allowing food to enter/leave the stomach. The camera and the other instruments are then removed and the cuts are stitched and bandaged.

Post Procedure

You may have to stay in the hospital for 2-3 days after the surgery. In the first two days, your diet will consist only of clear liquids. After that, you can go on a pureed diet. You will be given medications that will provide you relief from the pain. This surgery will bring about a great change in your lifestyle. Very small amounts of food will fill your stomach quickly. You have to eat healthy foods, control the portion sizes that you eat regularly and exercise on a daily basis. Follow the diet that your surgeon or dietician has recommended.

You will have to visit your doctor 2-3 weeks after the surgery. The wounds will be assessed and if you have any other issues, they will be discussed in this appointment.

The possible risks or complications that may be associated with sleeve gastrectomy are:

• Bleeding or infection from the incision site
• Formation of blood clots
• Problems in breathing
• Injury in the stomach, intestine or other organs in the course of the surgery
• Inflammation of the stomach lining, stomach ulcer or heartburn
• Leakage from the area where the parts of the stomach has been stapled together
• Scarring in the insides of the belly, that could eventually lead to blockage in bowel in the future
• Vomiting, if you eat more than your reduced stomach can hold
• Dumping syndrome, when food moves from the stomach to the small bowel at a very fast speed

It is very important that you monitor your diet eat carefully after undergoing a sleeve gastrectomy. Make sure that you are eating the right foods at the right time, and also prepared in the right way. Foods that can be chewed and swallowed easily must be included in your diet. There are some foods like popcorn, nuts, seeds or hard meat that are not chewed properly before swallowing; hence it is advisable to avoid them. Also, avoid having carbonated beverages that may produce gas due to the digestive enzymes. There is not much room for the expansion of gas in the reduced size of the stomach. Apart from that, exercising is also an important aspect that has to be included in your daily schedule.

The cost of sleeve gastrectomy could be around Rs. 2,50,000 – Rs. 5,00,000.