Gastric sleeve is a type of bariatric surgery for patients who are obese and their weight poses a significant risk to their health. It is also known as sleeve gastrectomy or vertical sleeve gastrectomy. This procedure reduces the amount of food a person can physically eat and fit inside their stomach. After the surgery, a person can expect to lose anywhere from fifty to ninety pounds in twelve months.
Sleeve gastrectomy is performed using laparoscopy in which several small incisions on the stomach, the laparoscope, and other instruments required for the surgery are inserted. The surgery removed most of the stomach and reshaped the stomach into a narrow tube known as a sleeve. Unlike other bariatric operations, the small intestine is not operated upon.
However, this surgery is only reserved for people for whom dietary changes and food regulations do not significantly affect their weight. Gastric sleeve surgery is performed in patients with class 2 diabetes with a body mass index of between 35 to 40. This surgery can also help in other accompanying ailments caused due to obesity, like sleep apnea, high blood pressure, cardiovascular diseases, or diabetes.
A gastric sleeve is usually the last resort as it does carry some risks like any other surgery. Some common ones include bleeding, infection, blood clots, and breathing problems from general anesthesia. Moreover, after the surgery, the body loses its ability to absorb nutrients like calcium, vitamin B12, vitamin D, etc. Gastric problems, heartburn, excessive burping after gastric sleeve, and acid reflux are also common complications noticed with this procedure.
A person needs to start preparing months before the actual surgery takes place. Bariatric surgeries are not recommended for people abusing drugs or alcohol as they might not be able to commit to permanent changes to their diets for the rest of their lives. Before the surgery, a patient enrolls in an education program to prepare for the surgery and for life after it.
Several physical tests need to take place before the surgery commences. The person might also be told to reduce weight before the surgery as this decreases the liver’s size, significantly reducing the risk. Patients who smoke must stop months before the surgery, and pain medications like ibuprofen, crocin, aspirin, or any blood thinning medications must be stopped.
How Does The Surgery Take Place?
This surgery is performed under general anesthesia, which makes the person lose consciousness. Several small incisions are made on the stomach through which the laparoscopy is inserted through the upper abdomen. Other tools required for the surgery are also inserted through other incisions made on the abdomen. After this, a tube is inserted that is passed down to the stomach, and a laparoscopic stapler is used to resize and create the sleeve. The remaining portion of the stomach is pulled out through one of the earlier incisions.
Due to the surgery’s laparoscopic nature, patients can usually leave the hospital during the day of the surgery itself. The recovery period after the surgery is quite long as a liquid diet needs to be maintained for the first couple of weeks and then switched to pureed and solid foods afterward.
Eating regular solid food before letting the body get used to the new sleeve leads to vomiting, nausea, and stomach pain. It’s advised to chew the food properly before swallowing to ensure no large chunks are swallowed by mistake. After the surgery, regular blood tests are mandatory to ensure the patient has no deficiencies.
Anastomotic leaking happens when food and other digestive fluids leak into the abdominal cavity due to complications after the surgery. Around 1.5 to 6% of bariatric patients face anastomotic leaks, which can vary depending on the type of bariatric surgery performed. The symptoms of this leak begin to surface after only three days of the surgery.
Some symptoms include increased heart rate, fever, abdominal or stomach pain, shoulder pain, decreased blood pressure, and reduced urine output.
Anastomotic leaking is also more common in people who are obese, and the heavier a person is, the more at risk they are of developing the leak.
A CT scan is used to diagnose an anastomotic leak and involves swallowing a dye to see if it is leaking into the abdominal cavity or not. Even if a leak is not detected, the doctor might still recommend an emergency operation just to be safe. If a leak is detected, antibiotics are given through an intravenous line, and the patient is operated upon to drain the fluid surrounding the abdominal cavity and repair the anastomosis. A tube might be inserted connecting directly to the small intestine to supply food until the leak heals properly.
Anastomotic leaks are not to be taken lightly and can be life-threatening due to the risk of infection and internal bleeding. Moreover, if undetected for a long time, they can also lead to ulcers, internal scarring, and a reduction in the anastomosis’s size, also known as a stricture. Some other risks include pneumonia and fistula, a drainage tract that develops between the gastric sleeve and stomach due to leaking.
Anastomotic leaks are life-threatening complications that must be addressed as quickly as possible. Some common symptoms to look out for after the surgery are an increased heart rate of about 120 beats per minute or more, high fever, dizziness, and abdominal and shoulder pain.
Other indicators of a leak might be revealed from blood work as an increased count of white blood cells, and C-reactive proteins are noticed in patients with anastomotic leaks. This is due to the fact that the body is actively trying to fight the infection.