- 1 kg = 2.2 pounds
- 1 foot = 0.305 meters
- 1 inch = 0.0254 meters
Restrictive Procedures - Gastric Sleeve Surgery
This is a relatively new procedure that has had minimal exposure in the bariatric surgery field. This procedure was discovered inadvertently in the United States of America as a result of complications faced when a clinically obese patient underwent surgery. The patient's surgery was suspended leaving the formed gastric sleeve intact. A few months passed and the patient had lost a considerable amount of weight, and after that it was no longer necessary to complete the bypass surgery.
Gastric sleeve surgery became common in treating morbidly obese patients (BMI of over 50) as a result of this one particular surgery This new procedure not only minimizes post operative risks but also decreases any technical risks that could crop up during surgery.
The greatest fear faced by obese patients are the fistulas that may potentially bring symptoms that could complicate the patient's ability to carry out daily activities, thus this procedure is and should only be conducted by highly qualified surgical teams that have previously performed at least 500 other surgeries in the same bariatric field; the exposure of the surgeons to other methods and techniques will considerably minimize the risk to the patient.
This technique induces weight loss through the restriction of food consumption. This procedure encompasses the reduction and or removal of 70% to 80% of the stomach, resulting in the formation of a "sleeve or tube".
This surgery is also an option for patients who are overweight (specifically individuals with a body mass index of 35 to 40), as surgery to restrict the intake of food is considered a better option than installing a prosthesis (gastric band).
The Gastric banding demands the patient to abide strictly to a regime regarding eating habits such as; chewing foods properly, types of food and length of the diet, physical exercise, and the adjusting of the band through endoscopic controls. At the moment, gastric sleeve surgery presents an interesting alternative to gastric band surgery.
Expected Weight Loss
This procedure has tremendously decreased the risk of weight loss surgeries for this specific group of patients, (morbid obesity) even when the risk of two surgeries is added.
The majority of the patients can expect the loss from the 60% to the 80% of their excess body weight in a period from 8 to 12 months, with the gastric sleeve surgery alone. It may not be necessary to perform a second procedure to arrive at the ideal weight In patients where this can be used as a first procedure, therefore, the second procedure can vary according to the degree of weight loss, typically within 6 to 18 months from the first surgery.
How is it carried out?
It is a procedure that consists of removing from 70 to the 80% of the patient's stomach diminishing its capacity. The stomach is sealed closed with staples guaranteeing a waterproof seal, we need to keep in mind that obese patients need to fill their stomachs to create or stimulate a message that lets him know that enough food has been consumed. By cutting the two thirds of the stomach, the patient will have the sensation of being full with very little amount of food. This as consequence brings a weight reduction during 8 to 12 months.
And if after that period of time the patient has reduced weight considerably but not sufficiently, he can return to the operating room and complete the gastric bypass, now in better health and able to resist a more prolonged period in the operating room.
On the other hand, if the patient has lost sufficient weight and now is close to his ideal weight then no other procedure will be needed by the patient. And in that case, this procedure will compete with the gastric band, in the sense that it is a matter of a purely restrictive procedure but without foreign bodies, without calibrations and without being controlled by the surgeon.
This does not only work as a restrictive mechanism since in this surgery the hormone that regulates the appetite, Ghrelin, that is in greater production in the gastric bottom, diminishes notoriously, as a result the patient doesn't have so much appetite, (compulsion for eating).
The advantages of this surgery are:
That is carried out through a Laparoscopic procedure.
It alters in no way the stomach physiology and is a procedure that can be carried out in patients with a BMI of 35 to 40.
The patient can eat everything but in small quantities and without the sensation of choking since there is not anastomosis (unions), only the natural sphincters remaining.
We do not carry out this surgery, in super obese patients since we consider, by the experience of the group, in carrying out surgeries of by pass as first instance.
To summarize :
The procedure is performed by means of a Laparoscopy.
Does not require detachment and reattachment.
Is technically a simpler operation than the gastric bypass or the duodenal switch.
It eliminates a portion of the stomach (gastric bottom) that produces the hormone that stimulates hunger, (Ghrelin).
It does not present any type of fast emptying because it preserves the pilorus.
It reduces ulcerate formation to a minimum.
It prevents intestinal obstructions, anemia, osteoporosis and the lack of proteins.
It is an operation that requires of 2 days of hospitalization, and in 5 to 7 days the person can be reinstated to his habitual lifestyle.
Postoperative Care
The patient can leave the hospital a couple of days after the surgery. The draining pipe will be able to be removed by then too. The patient will have to remain in a liquid diet for 2 weeks, in a semi liquid diet for 1 week, followed by a diet of purées for 3 weeks. If there are no complications the patient will be able to move on to a regular diet. Sweets, alcohol and carbonated drinks must be avoid. The patient will be able to exercise from the third week after the surgery.
Risks
You should keep in mind that any surgery can have complications, and this is a surgery that does not escape to these risks. The rare specific complications, that will be mentioned at the moment of the reported consent, besides, should realize carefully all the benefits against the risks of this surgery.
You should consider any another weight loss alternative available and evaluate if you are a viable candidate for the gastric banding surgery, usually if you have 45 kilograms excess weight or more, or if it is impossible to lose weight and to maintain it at any rate. If you do not have surgery you will probably continue gaining weight and creating new complications originated from the obesity, which could seriously affect your health and shorten your life expectancy.
The decision have surgery cannot be taken on the spur of the moment because this will bring a permanent life change. The changes that the surgery will bring to your life are generally positive, but all the implications that the surgery entails must be considered.
Indications
Gastric Sleeve surgery is not for you if:
If you present inflammatory illness or some condition of the gastrointestinal tract, like ulcerate, severe esophagitis or Crohn illness.
If you have severe heart problems or some lungs disease that makes you not viable candidate for this surgery.
If you have some other disease that make you a not viable candidate for the surgery.
If you have a problem that could cause bleeding in the esophagus or in the stomach. That would include also esophageal or gastric varices (a dilated vein). It might also be something like a congenital illness, or intestinal telangiectasia (enlargement of a small vein in the intestines).
If you have portal Hypertension.
If you have an abnormal esophagus, stomach or intestines, (whether because of a congenital problem or acquired).
If you have any lesions caused by any surgery whether gastric or of another kind.
If you have Cirrhosis.
If you have Chronic Pancreatitis.
If you are pregnant.
If you have alcohol or drugs addictions.
If you are less than 15 years old.
If you have an infection anywhere that could contaminate the surgical area.
If you have been in a long chronic steroids treatment.
If you are allergic to any of the materials utilized in this procedure.
If you can’t or dont want tpo obey the diet rules that this procedure requires.
If you are allergic to any of the materials utilized in this procedure.
If you cannot tolerate the pain originated by any implant.
If you or someone in your family suffers of any illness in the connective immune system. Such as Sistemic Lupus Erythematosus or scleroderma.
To Consider
The risk of postoperative complications is in the range of 3 to 5%. This includes infections, pneumonia or bleedings. The patients with severe excess weight run a greater risk to have complication.
The risk of loss of life is, according to the literature, of 0.3%.
To conclude, we have adapted the Gastric Sleeve procedure for patients that suitably comply with a range of personal responsibilities such as adaptation to a new life system to optimize and ensure that the weight loss be progressive, rich in proteins and with the adequate caloric increment that will not adversely affect the goal.
When patients do not comply adequately with all these restrictions if for instance they consume food that is rich in calories, abundant liquids, or inappropriate diets, the failure of the Sleeve is obvious, and these may be patients that can be better candidates for the Gastric By - pass protocol, a more radical surgery.
Diet Instructions
Important Instructions to Follow:
Eat small amounts: Since the capacity of the stomach has diminished, we have to protect two diet aspects: an important protean value, and eat an amount of food such to not cause that the sleeve is prematurely dilated; this means to eat a piece of toast, 100 grams of chicken, or fish for lunch or supper; some fruit or liquids between meals. In general follow the nutrition plans that our group of nutrition experts prescribes that ranges from the 800 to 1500 calories approximately.
Food intake: You must eat very slowly and chew your food to mush to achieve three effects: the first one is a progressive and slow emptying of the new stomach, second is to achieve a change in the diet habits, and third to avoid an abrupt distension of the band. With this we will achieve a gastric emptying without putting undue stress on the inadequately peristalsis of the Sleeve and obtaining unwanted effects such as an increase of acids, reflux, or postprandial pain, (after eating).
Liquids and Solids: As previously mentioned, it is very important that the patient should not eat solids along with liquids, since this mixture could originate pain, nausea, uncomfortable belches, and faster dilation of the Sleeve.
Postprandial rest: Gastric Sleeve surgery requires the patient to always remain in a semi seated position after consuming food. It is recommended that the patient does not lie dawn, as the gastroesophagic reflux would increase considerably, adversely affecting the dynamics and physiology that we expect.
Diet division: Due to the stomach reduction, the sanitary- dietary change, the eating patterns, the restrictions of solids and liquid and others, we suggest that the diet be divided into not less than 5 small meals a day.
Dangerous Food:Any excess, be it carbohydrates, fats, or fast food will undoubtedly go against the caloric restriction that we indicate, which will be reflected, in a little or minimal weight loss after this procedure.
General Considerations
I have been performing Gastric Sleeve Surgery in Peru since May 2006, experience that I have dedicated for the most part to in patients that need a restrictive surgery, with a weight greater than those needing Gastric Banding.
I use this surgery in patients with an BMI not higher than 40, and not in super obese patients as is the case of the "Double Surgery"; for these patients I prefer to perform a malabsorptive procedure.
As with gastric banding, the Gastric Sleeve Surgery implies a diet that must be progressively regulated for an adequate healing of the Sleeve; this is a diet that goes from 800 calories to as many calories as the patient need; the protean requirements are also calculated for each patient.
As is the case for every Surgery, the related medical problems (Hypertension, Diabetes, Arthralgia, and others) will improve. Any surgery performed by expert hands is not so complex and the possibility of complications is much smaller than the gastric By - Pass procedures. We are performing this procedure with a clinic stay of no longer than 2 days.
We believe that it is an interesting surgical alternative and that it is in a phase of high expectative in the medical world.
En español 
What is obesity?
It is a procedure that consists of removing from 70 to the 80% of the patient's stomach diminishing its capacity. The stomach is sealed closed with staples guaranteeing a waterproof seal, we need to keep in mind that obese patients need to fill their stomachs to create or stimulate a message that lets him know that enough food has been consumed. By cutting the two thirds of the stomach, the patient will have the sensation of being full with very little amount of food. This as consequence brings a weight reduction during 8 to 12 months. 
