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In this procedure, a gastric portion is separated and removed along the major curvature. The size of the remaining remainder of the stomach is determined by a placeholder introduced into the stomach and is usually 100 - 125 ml. The occlusion of the stomach takes place with special titanium staples, which remain in the body after the operation. The procedure is relatively safer and leads to a good weight reduction. A big advantage of the procedure is the significantly reduced feeling of hunger and the already after a few bites onset of satiety. In type 2 diabetics, a significant improvement in the metabolic status usually occurs only a few days after the operation, which translates into a lower insulin dose or a lower requirement for oral antidiabetics.

Inpatient admission is the day before the operation. To prepare for the morning surgery, our nurses will provide you with surgical clothing. The operation takes place under general anesthesia as laparoscopy and lasts about one hour. After the operation, they may be monitored for one night in the intensive care unit. Discharge usually takes place on the 7th day. The first follow-up appointment takes place about 4-6 weeks later.

GermanMedicalGroup + 49 (7221) 39-65-785 Flugstrasse 8a
76532 Baden-Baden
Germany
Sleeve gastrectomy is an interim goal in the obesity surgery and treatment. German experts for bariatric surgery will support you 2020-03-13 Sleeve Gastrectomy
Profiles of Doctors for Sleeve Gastrectomy
Sleeve Gastrectomy
Sleeve gastrectomy

The sleeve gastrectomy is a form of stomach reduction used for obesity treatment. During the operation, a large part of the stomach is removed, so that only a tube-like remaining stomach is retained. This way the patient feels satiety much faster with small amount of food.

The gastric sleeve surgery or sleeve gastrectomy is a stomach reduction surgery used to treat obesity (adiposity). The method is based on the food restriction principle: the intervention reduces the stomach volume to the size of a small banana. As a result, the stomach is filled even with just small amounts of food. The food stretches the stomach wall, which in turn triggers the feeling of satiety.

In addition, sleeve gastrectomy appears to prompt certain hormonal processes, which restrain the appetite. There are evidences that after a sleeve gastrectomy the stomach produces lower amounts of the so-called hunger hormone "ghrelin" and thereby additionally reduces the appetite. At the same time, hunger suppressing hormones are released. These are, for example, "GLP-1" and "peptide YY".

The hormones also have favorable effect on various metabolic processes. This is why stomach reducing surgeries are more and more often called metabolic surgeries. For example, many patients have experienced clear improvement of their existing diabetes (diabetes mellitus type 2) after the surgery.

The sleeve gastrectomy is carried out more and more often worldwide. In Germany, the sleeve gastrectomy is the most frequently performed obesity surgery.

Preparation for the sleeve gastrectomy

Prior to the actual operation, it is necessary to perform certain preliminary examination. This includes an endoscopy of esophagus, stomach and duodenum (esophagogastroduodenoscopy) which is used to rule out any pathological changes such as inflammation, ulcers or tumors. A upper abdominal sonography can also be used to assess the condition of liver, gallbladder and pancreas. An ECG is also recorded and, if necessary, a pulmonary function testing (PFT) is carried out to prepare the patient for anesthesia.

A so-called protein-rich liquid phase is recommended for patients with very pronounced obesity (BMI above 40 kg/m2) and fatty liver before the sleeve gastrectomy. Depending on the hospital, it lasts for about 10 to 14 days prior to the surgery. During this time, patients should eat only liquid, protein-rich food. The goal of the liquid phase is a slight weight loss and reduction of liver fat. Detailed information about the preoperative liquid phase can be obtained directly from the treating hospital.

Sleeve gastrectomy procedure

In sleeve gastrectomy the most of the stomach is removed. Only a two to three centimeters narrow hose (sleeve stomach) with a volume of about 80 to 120 milliliters remains.

The sleeve gastrectomy is always performed under general anesthesia. However, usually there is no need for a large abdominal incision, the intervention is performed as a so-called minimally invasive operation (keyhole technique) over small cuts in the abdominal wall. The actual surgery takes a little more than an hour and is performed using following steps:

  1. After the surgical instruments and the camera are introduced into the abdominal cavity it is filled with a gas (mostly carbon dioxide) to achieve better accessibility and visibility of the abdominal organs.
  2. Now the surgeon drags a special surgical stapler along the curved bottom of the stomach (greater curvature). The stapler performs two functions: firstly, it separated the lower part of the stomach. At the same time, it places clamps along the cut, connecting the wound edges and closing the remaining gastric sleeve. Therefore a time-consuming suturing by hand is not necessary.
  3. The separated stomach part is pulled out of the abdominal cavity through one of the working channels using a so-called plastic specimen pouch. Then a coloring agent is introduced into the stomach via a gastric tube. It is used to check the tightness of the clamp seam along the cut edge. If the agent does not leak, the operation can be finished.

Laparoscopic Banded Sleeve Gastrectomy, also called tubing, is a surgical procedure that can be performed minimally invasively through (video) surgery. The procedure reduces the stomach size by about 10% of the original volume and has a limited capacity to absorb food. Patients have a feeling of fullness after eating small portions. The gastric volume is 80-120 ml according to LBSG. In the procedure, the left side of the stomach is removed by pruning and stapling. The result is a new stomach in the form of a tube about 20 cm long ("sleeve"). In the upper part of the sleeve, a silicone ring is implanted. The surgery does not divert or reconnect to the intestines and is thus less complex than gastric bypass. In addition, the pylorus is not removed, ie the muscle that regulates the gastric emptying. LBSG acts as a kind of "natural", functional gastric band; It keeps the food in the stomach for a while, so the patient feels full while the food porridge seeps through. Together with the fact that the bowel continuity is not changed, there are no complications of dumping or ulcers. The normal saturation mechanisms are restored by the operation.

Who is sleeve gastrectomy suitable for?

A sleeve gastrectomy is recommended as an effective weight reduction method in very obese people with a body mass index (BMI) of 40 kg/m². In case of comorbidities such as diabetes that can be improved by a weight loss, a sleeve gastrectomy can be performed in patients with a BMI of 35 kg/m².

The precondition is that the patient has already unsuccessfully tried to lose weight under medical supervision before (with a change of diet and lifestyle). Patients should be at least 18 and at most 65 years old.

Indications for LBSG:

  • BMI over 40 kg / m2
  • No sweet eaters
  • No "volume eaters"
  • No stress eaters
  • Approval for the follow-up program

No heartburn

  • Patients with clear contraindication to gastric bypass or LBPD
  • Patients who can be assumed that no alternative surgical procedure can initiate therapy
  • Patients whose medication requires reliable absorption in the intact intestine.

Sleeve gastrectomy as an interim goal

In the case of extremely obese people, the gastric surgery is sometimes performed as the first step for a more complex obesity surgery. If the patient has lost weight and thus has reduced their surgical risk, the second step is to perform a more effective operation, such as biliopancreatic diversion or gastric bypass. These operations not only reduce the food supply (restriction), but also hinder the food metabolism (malabsorption).

Who is sleeve gastrectomy not suitable for?

Sleeve gastrectomy cannot be performed in people whose overweight results from the consumption of soft, calorie-rich foods or liquids, for example, sweets, sweet drinks ("sweet-eater") or alcohol. Because these calorie carriers pass through the gastric sleeve unhampered (run through) without filling it and triggering a sensation of satiety In these cases, a malabsorptive procedure such as a gastric bypass is recommended. A sleeve gastrectomy is also not indicated in people with reflux. Acid reflux and heartburn can become more intense after the operation.

Effectiveness of sleeve gastrectomy

The chances of a successful weight loss after a sleeve gastrectomy are very high: First studies show that patients were able to reduce their average excessive weight by 33 to 83 per cent. Since the sleeve gastrectomy is a relatively new surgical technique, there are still no long-term results on the success of the method.

Some people experience a renewed weight gain after a few years of successful weight loss. More reliable long-term expectations offers a technique very similar to the sleeve gastrectomy called "magenstrasse and mill operation". A gastric tube is also formed in this method, similar to sleeve gastrectomy, but the remaining stomach pouch is left in the body. A study showed that this technique equivalent to the sleeve gastrectomy helps to achieve 60 percent excessive weight loss (EWL) in five years.

Advantages of sleeve gastrectomy compared to other methods

In contrast to other surgical procedures, the sleeve gastrectomy does not disturb the normal functioning of the stomach. The esophageal and pyloric sphincters of the stomach are also preserved. Therefore, after a postoperative transition to normal diet, patients can eat their usual food but in smaller quantities.

The procedure is shorter and more gentle compared with, for example, gastric bypass surgery. Sleeve gastrectomy is also much more effective than, for example, gastric banding.

Side effects

After the operation, patients should have vitamin B12 administered via injections (intramuscularly or as short infusion) for the rest of their life. Because the intestine can no longer absorb vitamin B12 in sufficient quantities. Since a large part of the stomach is removed it no longer produces sufficient amount of "intrinsic factor" – a protein that is necessary for the absorption of vitamin B12 in the intestine.

Sleeve gastrectomy is an irreversible operation even if the patient has successfully reduced their weight.

Risks and complications

As with any surgery, sleeve gastrectomy may also cause problems or complications. In addition to the typical risks of general anesthesia, these include:

  • Injury of blood vessels accompanied by bleeding or secondary bleeding
  • Injury of other organs
  • Wound healing disorders or wound infections
  • A hole in the gastric seam (seam insufficiency) causing the gastric contents to leak into the abdominal cavity with the risk of peritoneal inflammation (peritonitis)
  • (Temporal) disorders of gastrointestinal activity
  • Adhesions of the abdominal organs

Compared with other obesity surgery interventions, the sleeve gastrectomy has a lower complication rate. The individual risk depends largely on the patient's state of health.

Nutrition after the surgery

One or two weeks after a sleeve gastrectomy the patient is supposed to eat only strained or liquid food. The hospital then recommends a nutrition plan for gradual transition to a normal diet. The goal is to divide the daily amount of food into five-seven smaller meals.

Basically, a few weeks after the sleeve gastrectomy the patient is allowed to eat any food, provided it is well tolerated. However, in order to achieve effective weight loss, the patient must fundamentally and permanently change their diet and lifestyle habits. The sleeve gastrectomy is only one – albeit very effective – component of obesity therapy.

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Latest News in Sleeve Gastrectomy

Sleeve Gastrectomy against obesity

24.06.2019

More than half of all Germans are affected by obesity. Some of them are so strong that only an operative stomach reduction is possible. Due to numerous sequelae, the World Health Organization now classifies obesity as an illness. Last chance: a sleeve gastrectomy operation.

Christian Kröber has a full life. The 45-year-old loves his garden, is up and running and his two dogs keep him busy. As a caregiver for disabled children, he often goes for walks in the woods or in the swimming pool. But Christian Kröger does not feel well in his skin. With a BMI (Body Mass Index) of over 40 and 140 kilograms of body weight, he is severely limited in his activities. Because of the strong overweight, he also suffers from hypertension and has a disc disease. His biggest wish is to be able to go by bike or to tie up his shoes. As a child and a young man, the trained baker was very thin, but since he was 30 years old, he grew fatter. Neither diets nor nutritional advice helped. He lost five kilos, he had twice as much on his hips a little later. In 2017, Christian Kröber then applied for the reimbursement for a gastric reduction with a sleeve gastrectomy operation at his health insurance and a small fight for approval began. Despite psychological report, the motivation to sports and a change in diet, he received several rejections. At the end of 2018 he got the hoped-for approval and was able to undergo surgery in February of this year by Professor Frank Benedix at the University Hospital in Magdeburg.

An operation for gastric reduction is only possible if the applicant reveals his absolute willingness for a positive change in his habits and has at least two failed diets or cures behind him. According to the Federal Social Court, the cost assumption of an obesity operation by the statutory health insurance funds is only as an "ultima ratio", so if nothing else helps. Mainly because of the high follow-up costs, the health insurance companies hesitate in granting the costs. In addition, BMI must be above 40 (Grade 3 obesity) or between 35 and 40 (Grade 2 obesity) with additional conditions such as diabetes, heart disease or sleep apnea. A pregnancy or a metabolic disease must not be present. The application for reimbursement by the statutory health insurance funds must be accompanied by a medical certificate and various documents. Including certificates of participation in weight loss programs and sports courses as well as a food diary. To show serious readiness, a letter of motivation must not be missing. An operation should always be the last step!

If the criteria for obesity surgery are met, various surgical procedures are available. The gastric band, the stomach and the gastric bypass are most commonly used. In the peritoneal surgery, about three-fourths of the stomach are surgically separated, reducing the capacity of 1.5 liters to 50 to 150 milliliters. The shape of the stomach now reminds of a tube. In addition, hormone-producing cells in the stomach are removed. The hormonal changes curb the appetite and have a favorable effect on diabetes. The average weight reduction of the overweight is 50 to 60 percent. Disadvantages can be complications with leaky surgical sutures, the formation of gallstones due to too rapid weight loss and a renewed weight gain. A stomach can not be undone!

When deciding for or against sleeve gastrectomy, it is important to carefully weigh the pros and cons of surgery. It was the same with Yvonne Stadtmüller. 1.5 years ago, Professor Benedix performed a perineum surgery on the today 34-year-old. Before the procedure, she weighed 160 kilograms at a BMI of 60. She had high blood pressure, poor blood levels, and symptoms of a heart attack. So her last chance was seen in the operation. Although she survived this well, she had to be revived after the procedure. At her high body weight, the anesthesia could not be properly dosed. Yvonne Stadtmüller says: "I died for my new life." She was not allowed to eat for the first few days after the procedure. She swallowed too much air while drinking, that stretched her stomach and she was in pain. A two-week soup phase followed. For this purpose, the soup was frozen in preparation for ice cubes. Per meal Yvonne Stadtmüller managed only three thawed cubes. Then came a two-week porridge phase before finally eating half a slice of toast.

But the pounds tumbled and that was a positive vote. Yvonne Stadtmüller had to learn what she can tolerate and how much she can eat. Above all, protein is on the menu. Today, the trained automotive mechatronics technician weighs 97 kilograms and is again up and running and active. She wants to lose another 20 kilograms later this year.

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