Sleeve gastrectomy or vertical sleeve gastrectomy, is a surgical weight-loss procedure, typically performed laparoscopically, in which approximately 75 - 85% of the stomach is removed, along the

greater curvature The curvatures of the stomach are the long, convex, lateral surface, and the shorter, concave, medial surface of the stomach, which are referred to as the greater and lesser curvatures, respectively. The greater curvature, which begins at the ca ...

, which leaves a cylindrical, or "sleeve"-shaped stomach the size of a banana. Weight loss is affected not only through the reduction of the organ's size, but by the removal of the portion of it that produces

ghrelin Ghrelin (; or lenomorelin, INN) is a hormone primarily produced by enteroendocrine cells of the gastrointestinal tract, especially the stomach, and is often called a "hunger hormone" because it increases the drive to eat. Blood levels of ghrel ...

, the hormone that stimulates appetite. Patients can lose 50-70 percent of excess weight over the course of the two years that follow the surgery. The procedure is irreversible, though in some uncommon cases, patients can regain the lost weight, via resumption of poor dietary habits, or dilation of the stomach over time, which can require gastric sleeve revision surgery to either repair the sleeve or convert it to another type of weight loss method that may produce better results, such as a

gastric bypass Gastric bypass surgery refers to a technique in which the stomach is divided into a small upper pouch and a much larger lower "remnant" pouch, where the small intestine is rearranged to connect to both. Surgeons have developed several differen ...

duodenal switch The duodenal switch (DS) procedure, also known as a gastric reduction duodenal switch (GRDS), is a weight loss surgery procedure that is composed of a restrictive and a malabsorptive aspect. The restrictive portion of the surgery involves remo ...

. A meta-analysis of 174,772 participants published in ''

The Lancet ''The Lancet'' is a weekly peer-reviewed general medical journal, founded in England in 1823. It is one of the world's highest-impact academic journals and also one of the oldest medical journals still in publication. The journal publishes ...

'' in 2021 found that

bariatric surgery Bariatric surgery (also known as metabolic surgery or weight loss surgery) is a surgical procedure used to manage obesity and obesity-related conditions. Long term weight loss with bariatric surgery may be achieved through alteration of gut ho ...

was associated with 59% and 30% reduction in all-cause mortality among

obese Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classified as obese when ...

adults with and without

type 2 diabetes Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent ...

, respectively. This meta-analysis also found that median life-expectancy was 9.3 years longer for obese adults with diabetes who received bariatric surgery as compared to routine (non-surgical) care, whereas the life expectancy gain was 5.1 years longer for obese adults without diabetes.

Procedure

Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the

, and then later as the first part of a two-stage

operation on extremely

patients for whom the risk of performing gastric bypass surgery was deemed too great. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure. Sleeve gastrectomy is the most commonly performed bariatric surgery worldwide. In many cases, sleeve gastrectomy is as effective as gastric bypass surgery, including improvements in glucose homeostasis before substantial weight loss has occurred. This weight-loss independent benefit is related to the decrease in gastric volume, changes in gut peptides, and expression of genes involved in glucose absorption. Sleeve Gastrectomy Surgery

The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia. The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 36 and 40 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.

Use in children and adolescents

Endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders and the American Society for Metabolic and Bariatric Surgery, sleeve gastrectomy is gaining popularity in children and adolescents. Studies by Alqahtani and colleagues have found that sleeve gastrectomy causes large weight loss in children and adolescents aged 5 to 21 years. Moreover, they compared weight loss with adults and found comparable weight loss. A study published in 2016 showed that growth progresses were unaffected after sleeve gastrectomy in children younger than 14 years of age. Depression following the procedure has been noted in some individuals. Another side effect is

insomnia Insomnia, also known as sleeplessness, is a sleep disorder where people have difficulty sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low ene ...

. After this surgery many people can only sleep when they take

melatonin Melatonin, an indoleamine, is a natural compound produced by various organisms, including bacteria and eukaryotes. Its discovery in 1958 by Aaron B. Lerner and colleagues stemmed from the isolation of a substance from the pineal gland of cow ...

or sleeping medications.

Complications

Sleeve gastrectomy may cause complications; some of them are listed below: * Sleeve leaking (occurs 1 in 200 patients) *

Blood clot A thrombus ( thrombi) is a solid or semisolid aggregate from constituents of the blood (platelets, fibrin, red blood cells, white blood cells) within the circulatory system during life. A blood clot is the final product of the blood coagulatio ...

s (happens 1% of the time) * Wound infections (occurs in about 10 to 15% of post-op patients) * Strictures (occurs in 3.5% of post-op patients) * Aversion to food, and

nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat. Over 30 d ...

* Damage to the

vagus nerve The vagus nerve, also known as the tenth cranial nerve (CN X), plays a crucial role in the autonomic nervous system, which is responsible for regulating involuntary functions within the human body. This nerve carries both sensory and motor fibe ...

which will cause constant nausea *

Gastroparesis Gastroparesis (gastro- from Ancient Greek – gaster, "stomach"; and -paresis, πάρεσις – "partial paralysis") is a medical disorder of ineffective neuromuscular contractions (peristalsis) of the stomach, resulting in food and l ...

, with a delay in moving food from the stomach to the

small intestine The small intestine or small bowel is an organ (anatomy), organ in the human gastrointestinal tract, gastrointestinal tract where most of the #Absorption, absorption of nutrients from food takes place. It lies between the stomach and large intes ...

* Vomiting * Internal bleeding * Esophageal spasm/pain * Gastroesophageal Reflux Disease (GERD) * Lack of gastric

intrinsic factor Intrinsic factor (IF), also known as cobalamin binding intrinsic factor, or gastric intrinsic factor (GIF), is a glycoprotein produced by the parietal cells (in humans) or chief cells (in rodents) of the stomach. It is necessary for the absorp ...

result in

vitamin B₁₂ deficiency Vitamins are organic molecules (or a set of closely related molecules called vitamers) that are essential to an organism in small quantities for proper metabolic function. Essential nutrients cannot be synthesized in the organism in suff ...

* Depression after surgery * Reduced bone health * Weight regain

Procedure

Use in children and adolescents

Complications

References

Further reading