Advantages of Sleeve Gastrectomy

Sleeve Gastrectomy  is an operation that outer part of the stomach is removed vertically and your stomach volume is reduced.  Sleeve gastrectomy reduces only the volume of  your stomach.  No intervention is applied onto your intestines or another part of your digestive system.  Meals that you eat are absorbed from your digestive system normally.

What is Pylorus Muscle?

Pylorus is a muscle which exists on exit of our stomach.  While our stomach grinds foods for digestion, it provides controlled passage of foods into the small intestine.

Pylorus muscle is important in metabolic surgery operations.  Pylorus muscle is deactivated in most of obesity surgery operations.  In this case, severe nausea, vomiting and syncope as a result of blood pressure decrease are seen after carbohydrate foods in particular. This is called Dumping Syndrome.  Dumping Syndrome is common in bypass operations and Biliopancreatic Diversion operations.  In fact, these problems are very less in operations where pylorus muscle is preserved.

Furthermore, pylorus muscle prevents gastric irritation of stomach by reflux of bile content in small intestine.

This normal anatomy is not disrupted in sleeve gastrectomy operation and pylorus is preserved.  Sleeve gastrectomy may easily be converted into intestinal bypass operations which preserve pylorus muscle such as Duodenojejunal Bypass, Duodenal Switch and SADI-S.

Operations Where Pylorus Muscle is Preserved – Switch Operations

Preservation of Pylorus muscle is called duodenal switch in bypass operations.  The most known of these operations are three;

• Biliopancreatic Diversion with Duodenal Switch
• SADI-S
• Duodenojejunal Bypass with Sleeve Gastrectomy
• SIPPS
• lleal interposition with Diverted Sleeve Gastrectomy

The pylorus muscle is preserved and functional in all these  operations.  Dumping syndrome is very rare after these operations.

Another common point of these operations is that sleeve gastrectomy is performed in all these operations.  In other words, sleeve gastrectomy is an integral part of these operations.

First Stage Operation (Patients With High BMI)

Sleeve Gastrectomy operation is preferred for patients with very high body mass index.  The purpose for this is necessity to keep operation periods shorter for super obese patients.  An eager attemp to apply a major surgery to these patients in one session prolongs operation periods. Sleeve gastrectomy is an easy applicable surgical technique when compared with other complex operations.  The operation may be completed within reasonable periods even for super obese patients with BMI > 50 kg/m².

Sleeve Gastrectomy is an efficient choice for super obesity to have significant weight loss as a first step surgical option for Duodenal Switch.  The intestinal diversion may be performed after this weight loss is achieved.

First Choice Operation (For Patients with Lower BMI)

Sleeve gastrectomy has gained significant popularity among patients and bariatric surgeons. It has become the most prefered surgery for treatment of obesity in the last decade in all over the world in all BMI ranges.

Gastric Band is also a common method for the patients with lower BMI.  Gastric band application is very easy surgically.  The procedure lasts shorter than other gastric bypass operations.  Anatomy does not change.  However, long term surgical problems may be much and it may cause very severe complications.  It may not be possible to apply correction operations in a single session.  Because gastric band which is a plastic foreign body may adhere on stomach and organs with high bleeding risk such as liver and spleen.   Surgical removal may be very difficult and risky which can not be compared with placement.  Therefore, we may need to wait for a couple of months for tissue recovery and healing when we remove the gastric band.  Reconstruction operation may be left to a third session.

The gastric band should be adjusted by a doctor frequently.  Infections of the adjustment port which is placed into the subcutaneous fatty tissue and connected to the gastric band  by entering into the abdominal wall are common.  In this case, both port and gastric band should be removed.

Because of the above, sleeve gastrectomy is a reliable and practical alternative which does not have long term problems for patients who do not want to have gastric band operations.

The Only Stomach Reduction Operation With Hormonal Effect

Ghrelin hormone is secreted from the outer part of the stomach called fundus.  This hormone is responsible for feeling of hunger. This hormone is one of the most important causes of obesity.  Level of hunger hormone Ghrelin decreases by sleeve gastrectomy and this causes weight loss stronger and more permanent than gastric band.

Laparoscopic Sleeve Gastrectomy reduces gastric volume by 80 to 90%.  Because of reduction on the gastric volume, meal portions are restricted and a severe calorie restriction appears.  Normally, sense of hunger is expected to be much by such calorie restriction; however patients who have sleeve gastrectomy get full fast and satiety is preserved longer.  The cause of this effect is removal of cells secreting hunger hormone (ghrelin) in fundus part of the stomach.  Reduction of hunger hormone (ghrelin) level prolongs preserving sense of fullness.

Advantages of Sleeve Gastrectomy

• Gastric volume reduces but stomach functions normally.  Everything can be eaten, but they may be consumed in small portions.
• The area secreting hunger hormone (Ghrelin) is resected.  Decrease of hunger hormone is the most important factor for preserving the weight loss.  Reduction of ghrelin level is responsible from longer fullness sense.
• Because pylorus muscle is preserved and operates actively, Dumping Syndrome is prevented.  Dumping Syndrome is generally observed after gastric bypass operations.  When very dense foods are eaten, nausea, vomiting and syncope attacks appear.  It is not seen in sleeve gastrectomy.
• Ulcer formation is almost not seen.
• Because small intestine bypass is not performed, dumping syndrome, intestinal obstructions, severe ulcers, anemia, vitamin and mineral deficiencies, osteoporosis and nutritional disorders and diarrhea are not seen after sleeve gastrectomy operation.
• It is the first choice option in extremely fat (super obese with BMI >50 kg/m2) patients.  When patients loose weight significantly with sleeve gastrectomy, complementary actual duedonal switch operations are performed after 6 to 12 months.  It is not necessary to perform a second operation onto many patients immediately.
• It is an operation which is started to be preferred most as actual treatment option for patients under super obesity limit with lower body mass index (BMI 30 to 50 kg/m2).
• It is the first choice for patients who hesitate from obligations brought by gastric bypass operations.
• It is the first choice for cases of suspicion of cirrhosis or Non Alcoholic Steatohepatitis (NASH) or Non Alcoholic Fatty Liver Diseases (NAFLD) which are onset for cirrhosis.
• It is more effective than gastric band for patients who hesitate from placement of a foreign body into the abdomen and related problems.
• By easy and fast application through laparoscopy, it provides shorter operation period and rapid recovery for patients who experience severe heart and lung problems because of excessive obesity.