Gastric Sleeve
More Information on Ghrelin, The Hunger Hormone
If you’re reading this article, you have likely spent a good amount of time researching bariatric surgery, and we commend you for that. Bariatric surgery is not a one-and-done solution to excess weight and obesity. It requires a lot of careful thought, introspection, and research into the best procedure for you. Having done at least some of that, you will have undoubtedly come across a hormone known as ghrelin. This is one of the few hormones that promote hunger rather than satiety, which is leptin‘s job. Ghrelin sprang to the forefront of bariatric surgery in the late 1990s because of the experiences we, as surgeons, saw in our patients after gastric sleeves. Amazingly, gastric sleeve patients were losing a great deal of excess body weight. However, it seemed disproportionate to the simplicity of the procedure. It turned out that the restriction-only mechanism of the gastric sleeve was not the only mechanism that worked to help patients. Soon, we realized that by removing the fundus of the stomach, the outer, curved end, and creating the sleeved shape pouch, we were also removing the primary production center of the hunger hormone in our bodies. It stands to reason that by doing this, patients lost even more weight because they had a hormonal mechanism of weight loss in addition to physical restriction.
Why Dieting Alone Simply Doesn’t Work
Have you found that what seems like endless days of dieting slowly yield fewer and fewer incremental pounds lost? Today, we will discuss why obese patients who try to embark on dietary restriction alone have difficulty maintaining their weight loss progress and often end up regaining their weight.
Restricting your caloric intake is the fastest way to lose weight, certainly at the beginning of your dietary program. Avoiding ingesting calories in the first place is far easier than burning them off later, either through exercise or resting metabolic activity. However, the human body is incredibly adaptable and will make changes to compensate for this reduced caloric intake. The body, which has considered your higher weight as normal for years, will work hard to maintain what it wrongly believes to be an equilibrium. We now know that the body develops a sort of set point. It will adjust the metabolism and how it stores fat to maintain that setpoint. Dieting alone is often insufficient to break through and continue losing weight long-term.
Why We Regain Weight Following Gastric Sleeve
Weight Loss Surgery is nearing 70 years of use, and most of those years involved malabsorptive or intestinal bypass surgeries. On the other hand, the gastric sleeve relies on restriction, a weight loss procedure with approximately half that history. Recent data has shown that sleeve gastrectomies account for more than 60% of all weight loss surgeries despite slightly less excess weight loss potential versus a bypass. 75-80% of Excess Weight Loss is typically maintained for at least five years with a bypass procedure, while 60-65% of EWL is associated with the sleeve. A relatively small number of bypass procedures may require revision for inadequate weight loss or regain of weight. In contrast, a slightly greater number of sleeve procedures may require modification or conversion.
Weight loss following a gastric sleeve is multi-factorial, and weight regain can be too.
Is The Lap-Band Still a Good Surgery?
About two decades ago, a novel bariatric procedure and device was brought to market. The adjustable gastric band, commonly referred to by its trade name, the Lap-Band, hit the market with a splash. And rightly so. This was the first device that offered significant weight loss but could also be adjusted and removed without any significant changes to the gastrointestinal tract. It was seen as an excellent alternative to the gold standard of the time – the gastric bypass.
How A Hiatal Hernia Can Affect the Gastric Sleeve
If you have researched the gastric sleeve, you will find the procedure increases the risk of new or worsened gastroesophageal reflux disease or GERD. This is one of the reasons why the gastric bypass may be the more appropriate procedure for someone with severe and uncontrolled GERD.
When we first started performing the gastric sleeve, there were a significant number of patients – somewhere around 15 to 20% – that would experience new or worsened chronic acid reflux after the procedure. Of course, back then, the fundoplication was the only viable anti-GERD surgery available. However, since the fundus of the stomach is removed from the abdomen, it cannot be performed on gastric sleeve patients. Therefore, sleeve patients with GERD issues either had to be converted to a different procedure (Duodenal Switch or Gastric Bypass) or had to manage their GERD with lifestyle changes and medication.
Why The Gastric Sleeve Can Cause Acid Reflux
When a patient comes in for a bariatric consultation wanting the gastric sleeve, we determine if they are currently suffering from moderate to severe acid reflux. This is because new or worsened acid reflux can be a side effect of the gastric sleeve procedure. While it may seem counterintuitive, after all bariatric surgery is supposed to eliminate the most common conditions associated with obesity, how the gastric sleeve changes the gastrointestinal anatomy is somewhat different from other bariatric procedures.
Can the Gastric Sleeve be Performed on an Outpatient Basis?
Let’s get right to it and say…yes! We are outfitted with the most advanced robotic surgical technology, known as the da Vinci Xi robotic surgical system – specifically created for general surgeries including bariatric surgery.
While we do perform many of our sleeves in the outpatient setting, not all weight loss surgery procedures can be handled at an ambulatory surgery center. Some patients will require an overnight hospital stay. This is especially true for patients that, either due to poor health or other reasons, have a higher risk of complications. For high-risk patients, it is important that they have access to the full breath of hospital services in case of a complication.
