sleeve gastrectomy

A new comer to weight loss surgery – the sleeve gastrectomy

The sleeve gastrectomy is the UK’s latest addition to the surgical fight against obesity, adding to the increasing menu of options offered today.  Early data from studies indicates that this new comer offers the promise of excellent weight loss outcomes and lower risks1.

sleeve

Click the link below for an animated demo of the surgical procedure for a sleeve gastrectomy:

https://www.youtube.com/watch?v=la8qN2bbVe8

It is an increasingly popular procedure2 which divides the stomach vertically from top to bottom, and leaves a banana shaped stomach along the inside curve (lesser curvature).  It reduces the stomach size by about 75%, so I am told.  The pyloric valve, or door at the bottom of the stomach, remains untouched.   This is an important difference between this and the by pass operation, because it helps to retain control of food passage into the small bowel.  Weight loss occurs because of the restriction on how much can be eaten.

tape mesure

The procedure offers a lot more than just novelty:

  • Initial results show impressive improvements in weight loss and associated health problems, including glycemic control for those with diabestes1.
  • There is lower risk of nutritional deficiencies due to the lack of malabsorption mechanisms.
  • Stomach function and control of gastric emptying is unaltered, reducing the likely hood of unpleasant side effects
  • There is no risk of erosion, slippage or infection of foreign parts that can occur with gastric banding.

A big drawback for any fresh approach is that long term evidence is limited.  Unfortunately, until this is available, the procedure carries an element of uncertainty.  One concern is that that the remaining stomach pouch could stretch over time and possibly compromise weight loss outcomes.  Therefore, to minimize this risk of pouch dilation, those having the procedure are asked to carefully follow some guiding dietary principles:

Texture and consistency – most people are asked to change the consistency of the food they eat for about 6 weeks following the operation, although advice does vary around the country.  Slowly progressing from liquids, to pureed , then soft and finally solids allows the stomach staple line to settle.  Encouraging a slow steady pace of texture change is also thought to help avoid vomiting associated with poor texture tolerance in the early days.

Portion size – the main concern around sleeve gastrectomy surgery is that the stomach might stretch if portions are too large.  People therefore need to readjust and reduce portion sizes accordingly.  Initially swelling and discomfort will restrict intake.  However, ensuring overconsumption does not stretch the pouch in the long term will depend upon a few things:

-people have a clear idea of what is the new, acceptable portion size

-people are able to recognize the feeling of satiety.

– an element of self control and motivation

Concentrating on slowing the pace of eating and mindfulness are techniques to help achieve this.

Food pattern – it is not unusual for the desire for food and drink to diminish or even disappear altogether following a sleeve gastrectomy.  This can make it a real challenge to establish a healthy food pattern, particularly if a person’s psyche is overwhelmingly driven to achieve weight loss.  Appetite will return.   A strong emphasis on avoiding meal skipping and encouraging small and often, healthy food choices is needed to promote long term portion control and weight Pen, Diary and Glassesloss maintenance 3

Nutritional Supplements –Most agree that Vitamin B12, calcium, vitamin D,  iron  and a general vitamin supplement are minimum requirements following a sleeve gastrectomy4.  Centres  around the UK vary on how nutritional supplements are prescribed.  Deciding the best course of action is best determined through a regular review of your blood tests5.  Make sure you get yours!

The promising sleeve gastrectomy, might be the latest addition to the bariatric family of surgical options for weight loss, but ultimately its success depends on very well established weight loss principles – healthy food choices, regular eating, permanent lifestyle changes and the motivation to make sure this happens.

 

References

  1. Schauler et al.    Bariatric surgery versus intensive medical therapy in obese patients with diabetes, New England Journal Medicine, 366(17),1567-1576.
  2. National Bariatric Surgery Register, 2010
  3. Wing,   Successful weight loss maintenance.  Annual review of Nutrition, 21, 323-341.
  4. British Obesity Metabolic and Surgery Society, 2014. BOMSS Guidelines on peri-operative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery.

The Endocrine Society 2010.  Endocrine and nutritional management of the post bariatric surgery patient.  An endocrine Society Clinical Practice Guidelin

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