Sleeve Gastrectomy

The first strength is good early weight loss. Because of the small stomach and the low levels of ghrelin, you will eat a lot less, typically around 1000-1200 calories per day and the weight comes down. The weight loss is usually quite rapid, more rapid than after the Lap-Band. You can expect to lose around two-thirds of your excess weight, two-thirds of the excess fat in the body. This should occur within the first year. This represents an excellent outcome. It will improve your health and it will lead to major improvements physically and psychosocially.

The second strength is that it is technically quite easy to perform so you find the surgeons tend to be keen on it. It is also good for you as you tend to get over the procedure more readily than a more complex procedure such as a gastric bypass.

The third strength is that it is not so dependent on close follow-up. This is quite the opposite of the Lap-Band where close follow-up is highly desirable. This can be a very attractive feature to you, particularly if getting to a follow-up clinic can be difficult. It is also an attraction to some surgeons who are not so keen on the follow-up. At CBS, we are very keen to maintain good follow-up. We do want to keep seeing you so that we can reinforce the eating and exercise rules, check on your nutritional status and make sure you are taking a vitamin and mineral replacement. And if any problems start to arise, we can address them early rather than late. Research tells us that this approach leads to better weight loss and other outcomes.

The most important weakness is the higher surgical risk of this procedure compared to the Lap-Band procedure. In particular, we worry greatly about a leak from the staple line. This is actually quite uncommon, maybe occurring in just 1-2%. But, for that 1-2%, it is 100%. And it can be a very nasty complication which could keep you in hospital for many months and needing intensive care. It can even lead to death.

Another weakness is the possibility of weight regain. Generally all the weight loss you will have occurs during the first year or two. After that the weight tends to creep back on. There have been no reports beyond 8 years so far. We know that the weight regain is associated with enlargement of the sleeve of stomach. We believe that eating too much or too quickly drives this enlargement. We strongly advise that you always eat small amounts of good food slowly but, at the end of the day, the control of weight regain is largely up to you. It is possibly avoidable if you are careful. For those who are becoming hungry again and regaining their weight, revisional surgery needs to be considered; we can provide options for you if need be.

If you find over time that your appetite is increasing, we are not able to do anything about it. It may be due to some enlargement of the stomach or the ghrelin levels rising. With the Lap-Band, we just add more fluid to reduce the appetite. We cannot do that with the Sleeve. If the weight regain is substantial, most often we will have to discuss one of the revisional options with you.

The sleeve is not reversible. Once 80% of the stomach is removed, it is gone for good. We do not see this as necessarily a problem. After all, removal of most of the stomach is the intention of the sleeve but it does reduce our flexibility if there is weight regain or symptoms such are reflux and heartburn develop.