Gastrectomy is the restrictive part of the more extensive mixed
restrictive and malabsorptive operation, the Duodenal Switch. The
Duodenal Switch and similar operations which include Sleeve Gastrectomy
have been performed since the 1970's. Over the last 5-7 years, Sleeve
Gastrectomy has been offered as a stand alone procedure to morbidly
obese individuals. In June, 2007, American Society of Metabolic
and Bariatric Surgery recognized Sleeve Gastrectomy as a form of
weight loss procedure based on scientific data that demonstrated
durable 5 year weight loss. The obesity-related medical problems
that may be improved or cured with the Sleeve Gastrectomy operation
include diabetes mellitus of the adult onset type (so-called insulin
resistant), hypertension, high cholesterol, arthritis, venous stasis
disease, bladder incontinence, liver disease, certain types of headaches,
heartburn, sleep apnea and many other disorders. Furthermore, this
operation has resulted in marked improvements in quality of life.
In Sleeve Gastrectomy, the surgeon removes approximately 85 percent
of the stomach so the stomach takes the shape of a tube or "sleeve".
The part of the stomach that is most susceptible to stretching and
relaxing is removed. The removal of the majority of the stomach
also results in the virtual elimination of hormone Ghrelin. Ghrelin
is responsible for stimulating the appetite and has been found to
increase the appetite before eating and to decrease it afterward.
In laboratory tests, humans who were injected with ghrelin reported
an increase in hunger. In addition, research seems to demonstrate
that ghrelin suppresses the utilization of fat in the adipose tissue.
In essence, ghrelin appears to be at least partially responsible
for letting the body know when it is hungry and for keeping the
body informed about the energy balance of the brain and the body.
Sleeve Gastrectomy preserves stomach's normal outlet valve, the
pylorus, and the nerves to the stomach with idea of preserving the
functions of the stomach while reducing the volume. There is no
intestinal bypass or malabsorption with this procedure, only the
Sleeve Gastrectomy achieves restriction without the use of foreign
body as in the Adjustable Gastric Banding operation and thus no
adjustment is required. Long term complications of the adjustable
band such as for port problems, erosions and slippage are also eliminated.
It does not involve any bypass of intestinal tract and thus patients
avoid the complications of intestinal bypass such as dumping syndrome,
intestinal obstruction, anemia, osteoporosis, vitamin deficiency
and protein deficiency. If weight loss is inadequate, the option
to convert the operation to Gastric Bypass remains available. Scientific
studies available to date document weight loss of 60-65 % of excess
body at three years following the Sleeve Gastrectomy. Long tern
weight loss results following the Sleeve Gastrectomy are unknown.
As with all weight loss operations, success does require adherence
to a simple and straightforward life style changes.