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Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve or tube like structure. The procedure permanently reduces the size of the stomach, although there could be some dilatation of the stomach later on in life. The procedure is generally performed laparoscopically and is irreversible.
Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. 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 36-40 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. Recent reports from the group show that growth progresses unaffected after sleeve gastrectomy in children younger than 14 years of age. Although this surgery helps immensely with losing weight the main side effect to this surgery afterwards in the depression that follows the weight loss. This may be because you are realizing that some foods may never be eaten again, or your chemical imbalance is thrown off. It could also be because of the lack of carbohydrates, which throws off the serotonin levels in your body. Another side effect is insomnia. Many people after this surgery can only sleep when they take melatonin or sleeping medications.
Sleeve gastrectomy may cause complications; some of them are listed below:
Sleeve leaking (occurs 1 in 200 patients)
Blood clots (happens 1% of the time)
Wound infections (occurs in about 10-15% of post-op patients)
^Alqahtani AR, Antonisamy B, Alamri H, Elahmedi M, Zimmerman VA (August 2012). "Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years". Annals of Surgery. 256 (2): 266-73. doi:10.1097/SLA.0b013e318251e92b. PMID22504281.
^Alqahtani A, Alamri H, Elahmedi M, Mohammed R (November 2012). "Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study". Surgical Endoscopy. 26 (11): 3094-100. doi:10.1007/s00464-012-2345-x. PMID22648112.
^Alqahtani A, Elahmedi M, Qahtani AR (February 2016). "Laparoscopic Sleeve Gastrectomy in Children Younger Than 14 Years: Refuting the Concerns". Annals of Surgery. 263 (2): 312-9. doi:10.1097/SLA.0000000000001278. PMID26496081.