Known formally as Sleeve Gastrectomy
The Sleeve Gastrectomy is now the most commonly performed Bariatric Surgery and brings an excellent balance of long term sustained weight loss, together with a great quality of life.
The procedure is performed using a few small laparoscopic (keyhole) incisions, and creates a long narrow stomach which is smaller in volume 200-300 mL instead of the usual 1000-1300 mL. The excess portion of stomach is permanently removed. The food passes through the smaller stomach similarly to the originally sized one, entering the small intestine via the normal end of the stomach.
The procedure is successful due to several effective mechanisms all working together. Firstly, patients are now very satisfied with a much smaller portion of food and feel full earlier. Secondly, the hunger drive is diminished for at least 9-12 months due to the removal of the top portion of the stomach (fundus) which produces a lot of the hormones that normally drive hunger (Ghrelin amongst others). The ability to absorb nutrients is essentially unchanged, although a few patients may have low vitamin B12 or low Iron levels long term.
- Excellent weight loss success and long-term maintenance.
- Ability to tolerate a normal range of food choices.
- Good for mild to moderately controlled Diabetes.
- Can improve fertility in women, with more likelihood of a healthy weight full term delivery than a Gastric Bypass. (please note: pregnancy is not advised in the first 6-12 months after Bariatric Surgery)
- A small number of patients may have Vitamin B12 or Iron deficiency long term.
All patients are required to commence an Optifast based diet for a period of 2-3 weeks prior to surgery. This diet induces a change to the patient's metabolism putting it into a Ketotic state, known as Ketosis. During this period the patient's diet will be restricted, with only certain additional foods allowed (your Dietitian will provide clear direction tailored to you). There are no carbohydrates, sugars, fruits or juices etc. permitted during this Optifast period.
The ketosis will result in fat stores coming out of the liver to provide the metabolic fuel your body needs. During surgery, it is necessary to retract the liver – the reduction in fat stores in the lead up to surgery allows for this to be done safely without risk of damaging or tearing the liver during the procedure.
Some patients may note that they can lose 5-10% of their body weight during this period. (It would be terrific if this were sustainable long term, but Optifast isn't sustainable over time).
Most medications can continue until the day of surgery, and they will be recommenced post-operatively under our direction. There are several blood thinners and anti-platelet agents which will need to be stopped 2-10 days prior to surgery depending on the particular medication. We will provide advice tailored to each patient. Fish Oil supplements should not be consumed within 14 days of surgery.
The small keyhole incisions are all closed with dissolving stitches which are all placed under the skin so that patients will never need to see them. We also use steristrips and waterproof dressings to ensure the skin heals in a clean and dry environment. Patients can bathe or shower with these dressings in place, however they should be patted dry afterwards.
The dressings are normally removed 10 days after surgery and the incisions should have healed nicely by then.
Most patient's post-operative discomfort has settled at the time of discharge from hospital. Some patients may however require a small amount of oral medication to help manage ongoing discomfort for a week or so. This can include Panadol, Panadeine Forte, Endone, or occasionally other medicines.
Routine medications can be recommenced as directed in the post-operative phase and any blood thinning agents that patients were previously taking will also be recommenced as directed by the medical team.
Many patients will be directed to take a PPI (Proton Pump Inhibitor) such as Nexium, Somac or Losec for a certain period after surgery to reduce stomach acid production.
Surgery will help patients to start their weight loss journey, however, in order to achieve successful long-term results - dietary and behavioural changes are necessary.
Each patient will be given specific dietary advice based on their personal requirements, but the following are very brief recommended guidelines following surgery.
- Liquid nourishment
Weeks 2 - 4
- Pureed food
Week 4 +
- Commencement of soft solid diet.
** For more dietary information, please speak with your Dietitian, who will provide you with a more comprehensive plan.
As a guide, most patients need 3 nights in hospital post-op, and depending on the work in which you are employed, anywhere from 3-14 days off work. Most patients can start walking within a few days, and more vigorous exercise can commence within 3 weeks.