Sleeve stomach

With procedures like that Sleeve stomach obesity surgery limits the maximum possible food intake of severely overweight patients between 18 and 65 years of age who can demonstrate either a BMI over 40 or a BMI over 35 and secondary diseases such as diabetes.

Before the procedure, the patients must demonstrate in a consultation that they have already exhausted all conventional methods of weight loss without success and that they are not suffering from addiction problems or psychoses. During the one-hour, restrictive and minimally invasive procedure, the doctor removes a large part of the stomach and only leaves a tubular part of the stomach, which helps the patient to lose weight with only limited food intake.

What is the gastric sleeve?

The sleeve stomach is an operative measure in bariatric surgery that is intended to help people who are very overweight to lose weight by limiting their maximum food intake to a minimum.

The sleeve stomach is an operative measure in bariatric surgery that is intended to help people who are very overweight to lose weight by limiting their maximum food intake to a minimum.

The procedure is one of the four recognized standard techniques in the field of bariatric surgery and is often combined with one of the three other surgical options. Gastric sleeve operations are minimally invasive operations that belong to the restrictive procedures of bariatric surgery. In this case, restrictive means that the maximum possible food intake is minimized by reducing the stomach volume. The sleeve stomach has become extremely important in the 21st century and, according to statistics, was even able to overtake gastric bypass in 2012.

The intervention suggests a 70 to 80 percent reduction in obesity and minimizes the risk of obesity-related complications. As a rule, the general well-being of the patient also increases after the operation.

Function, effect & goals

The goal of a gastric sleeve is to limit the stomach volume. The smaller the stomach's capacity, the less food the patient can ingest. As a result, he is less hungry and will be able to reduce his weight more easily as a result. Ultimately, the sleeve stomach regulates not only food intake but also the risk of secondary diseases in people who are extremely overweight. Often the procedure takes place in combination with another obesity surgical measure.

The gastric sleeve surgery in the form of a revision surgery after a gastric band has been implanted is particularly common. Apart from this, the sleeve stomach is also known as the first procedure of the two-step method, which is supplemented after around two years by a biliopancreatic diversion according to Scopinaro. This supplement combines the limitation of the maximum possible food intake with a restriction of the nutrient intake.

The doctor places the patient under general anesthesia to perform a gastric sleeve surgery and then operates in a minimally invasive manner. To do this, he cuts the stomach off at the great curvature with an ultrasound dissector. This incision is made just below the esophagus, where the stomach can be separated from the network connecting it to the spleen. Along a calibration tube on the minor curvature, the doctor removes a large part of the stomach with staple cutting instruments and sutures the tubular remainder of the organ laparoscopically.

In this way, the doctor reduces the stomach volume by around 80, sometimes even 90 percent. The operation takes about an hour in total, with the doctor usually checking the tightness of the remaining stomach before completing the procedure.

Risks, side effects & dangers

Obesity surgical interventions such as the sleeve stomach are preceded by a well-founded consultation in specially set up consultation centers. In this consultation, the respective benefits and risks of the operation for the patient are clarified. For overweight people, an operation is generally associated with higher risks than for people of normal weight.

However, minimally invasive techniques keep the risk to a minimum. The complication rate with gastric sleeve is therefore only one percent. In the previous consultation, the patient must prove, despite these meanwhile acceptable risks, that all conventional methods of weight loss have already been exhausted without success. A body mass index over 40 is also a prerequisite for the operation. Alternatively, a BMI over 35 in combination with obesity-related diseases such as diabetes is sufficient.

The extreme overweight must also have existed for at least three years, whereby the patient should have a biological age between 18 and 65 years. Apart from that, the procedure does not take place on people with psychoses or addictions. Even after the procedure, the patient is supported by an advisory specialist who gives him instructions on how to slowly rebuild the diet. For example, substitution therapies with vitamin B12 are generally and permanently indicated after gastric resections. Health insurance companies only cover the costs of a sleeve stomach in individual cases.

The patient must be able to explain the necessity of the operation in a credible and convincing manner if he does not want to or cannot bear the costs himself. The gastric sleeve does not require intestinal diversion, which makes the procedure suitable for people with inflammatory bowel diseases such as Crohn's disease. In contrast to most other obesity surgeries, the gastric sleeve retains its ability to absorb medication in the gastrointestinal tract.

The loss of the removed part of the stomach is, however, irreversible, so that the procedure must be carefully considered for this reason alone. Patients are always admitted to the hospital for surgery and stay in the clinic for around two to four days. After the operation, bleeding, thrombosis or leaks in the sutures sometimes occur, which can necessitate a longer hospital stay.