Our Team @ Instituto Bariátrico | Dr. Luis A. Betances P., CEO, General, Laparoscopic & Bariatric Surgeon, Santo Domingo, Dominican Republic

Dr. Luis A. Betances

Bariatric Surgeon

Sleeve gastrectomy

Sleeve Gastrectomy Procedure: A Comprehensive Overview

Sleeve gastrectomy, also known as vertical sleeve gastrectomy (VSG), is one of the most popular bariatric surgical procedures for weight loss. Initially developed as the first stage of a two-step procedure for high-risk patients, it has evolved into a standalone surgery due to its simplicity, effectiveness, and low complication rates. This surgery is widely performed worldwide to treat obesity and obesity-related conditions.


What Is Sleeve Gastrectomy?

Sleeve gastrectomy involves the surgical removal of approximately 75–80% of the stomach, leaving behind a narrow, tube-like structure resembling a sleeve. This smaller stomach not only restricts the amount of food that can be consumed but also reduces hunger by decreasing levels of ghrelin, a hormone responsible for appetite regulation.

The procedure is typically performed laparoscopically, which involves small incisions and the use of specialized instruments, resulting in reduced recovery time and fewer complications compared to open surgery.


How the Procedure Works

  1. Preparation: The patient is placed under general anesthesia, and the surgeon creates small incisions in the abdomen for inserting laparoscopic tools.
  2. Stomach Resection: The surgeon divides and removes the majority of the stomach, creating a small, tubular stomach pouch.
  3. Stapling: The remaining portion of the stomach is stapled closed, and the integrity of the staple line is tested for leaks.
  4. Completion: The incisions are closed, and the patient is moved to recovery.

The entire surgery usually takes 60–90 minutes and requires a hospital stay of 1–2 days.


Who Is Eligible for Sleeve Gastrectomy?

Patients may qualify for sleeve gastrectomy if they:

  • Have a Body Mass Index (BMI) of 40 or greater.
  • Have a BMI of 35–40 with obesity-related conditions such as type 2 diabetes, hypertension, or sleep apnea.
  • Have not succeeded in losing weight through diet, exercise, or medical therapy.

It’s essential to undergo a thorough evaluation by a bariatric specialist to ensure the procedure is appropriate for the individual’s health needs and goals.


Benefits of Sleeve Gastrectomy

  1. Significant Weight Loss: Patients typically lose 50–70% of their excess weight within the first two years.
  2. Improvement in Comorbidities: Many obesity-related conditions, such as diabetes, high blood pressure, and joint pain, show marked improvement or complete resolution after the procedure.
  3. Preservation of Digestive Function: Unlike other bariatric surgeries, sleeve gastrectomy does not involve intestinal rerouting, preserving normal nutrient absorption.
  4. Reduction in Hunger: Lower ghrelin levels lead to reduced appetite and improved portion control.
  5. Simplicity and Safety: The procedure is technically straightforward, with fewer complications than more complex surgeries like gastric bypass.

Risks and Complications

As with any surgical procedure, sleeve gastrectomy carries potential risks, including:

  • Staple Line Leaks: A rare but serious complication requiring immediate attention.
  • Bleeding and Infection: Common risks associated with any surgery.
  • Nutritional Deficiencies: Reduced food intake may lead to deficiencies in vitamins and minerals, necessitating lifelong supplementation.
  • Acid Reflux: Some patients experience worsened or new onset gastroesophageal reflux disease (GERD).

Close monitoring and adherence to postoperative care guidelines are critical to minimizing these risks.


Postoperative Care

Successful outcomes depend on a patient’s commitment to long-term lifestyle changes, which include:

  • Dietary Adjustments: A progressive diet starting with liquids and advancing to solid foods helps the stomach heal.
  • Regular Exercise: Incorporating physical activity promotes weight loss and overall health.
  • Follow-Up Visits: Regular check-ins with healthcare providers ensure proper recovery and monitor for potential complications.
  • Vitamin and Mineral Supplementation: Daily supplements are required to prevent deficiencies.

Advantages of Sleeve Gastrectomy

  • Effective Weight Loss: Achieves significant and sustainable weight reduction.
  • Improved Comorbidities: Helps resolve or manage obesity-related health issues.
  • Reduced Hunger: Suppresses appetite due to lower ghrelin production.
  • No Intestinal Bypass: Preserves normal nutrient absorption.
  • Minimally Invasive: Performed laparoscopically, leading to quicker recovery and fewer complications.

Sleeve gastrectomy is an excellent option for patients seeking a safe, effective, and straightforward surgical solution to obesity, providing lasting benefits for those committed to a healthier lifestyle.

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Procedures
Mini gastric bypass
Roux-en-Y gastric bypass, RYGB
Gastric Sleeve Plication
Biliopancreatic diversion
Intragastric balloon

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Dr. Luis A. Betances, cirujano bariátrico | Medii

Dr. Luis A. Betances

Bariatric Surgeon

Instituto Bariátrico Dr. Luis A. Betances | Medii
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