– Most commonly performed bariatric surgery worldwide for the treatment of severe obesity and severe diabetes.  

– Procedure:

1. Performed by robotic or laparoscopic method (By putting small holes over the tummy) using advanced high quality imported laparoscopic equipment and instruments.
2. Up to 80% of the stomach is removed using high quality staplers and stapler guns to form a vertical sleeve.
3. When the stomach is divided using staplers, it is stapled in three rows, sealed and cut simultaneously.
4. The percentage of the removed stomach is relative but the capacity of the remaining gastric sleeve is 60 to 100 ml.
5. A loose ring is placed around upper part of sleeve, with the intention of creating long term restriction.

– In India and Asia,

1. Individuals suffering from severe obesity with the body mass index is ≥ 32.5 kg/m² with co-morbid medical conditions such as type 2 diabetes.
2. Individuals suffering from severe obesity with the body mass index is ≥ 37.5 kg/m² even without any co-morbid medical conditions.

– In Western countries

1. Individuals suffering from severe obesity with the body mass index is ≥ 35 kg/m² with co-morbid medical conditions such as type 2 diabetes.
2. Individuals suffering from severe obesity with the body mass index is ≥ 40 kg/m² even without any co-morbid medical conditions.

– Sleeve gastrectomy is ideal for individuals with excess weight burden of 20 to 30 kg with or without mild diabetes or co-morbid conditions.

– Sleeve gastrectomy is considered in teenagers and in females planning for pregnancy in future.

– Weight loss is mainly due to physiological changes altering body energy balance.

– Because of these changes

1. Appetite (Hunger) is reduced.
2. Metabolic rate is increased.
3. Energy expenditure is increased.
4. ‘Fat mass’ is reset to a lower level.
5. Fat starts melting as body doesn’t want to store large quantity of fat.
6. You don’t eat large quantity of food as you start hating unhealthy foods.

– Role of food restriction and malabsorption is secondary.

– Same physiological changes are responsible for type 2 diabetes remission.

1. Insulin resistance is reduced.
2. Insulin production is optimised to control blood sugars.

– Creating too tight sleeve with the expectation that it will provide more weight loss and more diabetes remission is wrong.

– Too tight sleeve will increase the risk of complications such as leak and vomitings, but will not provide additional weight loss.

– I prefer creating lax sleeve so that weight loss and diabetes remission will be sufficient, at the same time complications are very rare.

– Since weight loss and diabetes remission are mainly related to physiological changes and role of restriction or malabsorption is secondary, placing a ring around gastric sleeve doesn’t offer any extra advantage in terms of weight loss, diabetes remission, prevention of weight regain or diabetes recurrence.

– Average excess weight loss is ~ 50 to 60%.

– Some may lose above average, even 100% of the excess weight loss but that number is less.

– For Example – If you are 50 kg excess weight, you lose approximately 25 to 30 kg on average. Some may lose all the extra 50 kg but that number is less.

– Generally if your weight burden is less, you lose more percentage of excess weight and if your weight burden is more you lose less percentage of excess weight.

– Total weight loss percentage is ~ 20 to 25%.

– Average diabetes remission ~ 50 to 60%.

– It is necessary to follow lifestyle modifications to improve weight loss and diabetes remission and to prevent weight regain and diabetes recurrence.

– Very simple and safe surgery.

– Results in long lasting weight loss.

– Results in long lasting diabetes remission.

– Complications are very low.

– Compared to diversion procedures risk of vitamin and mineral deficiencies is very low.

– Dumping syndrome is rare.

– Physiological changes are less in sleeve gastrectomy compared to the diversion surgeries.

– Weight loss is less effective after gastric sleeve compared to the diversion procedures.

– Diabetes remission is less after sleeve gastrectomy compared to the diversion procedures.

– Weight regain  after gastric sleeve is very high.

– Some may lose below average. Inadequate weight loss ~ 20%. They may lose only 5 to 10 kg and stop losing further.

– Average weight regain ~ 30 to 40% especially if lifestyle modifications are not followed.

– Diabetes recurrence after sleeve gastrectomy is very high ~ 40 to 50%.

– Placing a band may at most postpone weight regain or diabetes remission but can’t prevent them.

– Incidence of reflux of acid into esophagus is high after gastric sleeve.

– If anyone regains weight or if diabetes recurs after sleeve gastrectomy, revision to loop duodenal switch or duodenal switch re-induce significant weight loss and diabetes remission.

– It is very very safe procedure.

– It is a life saving surgery.

– Severe obesity and severe diabetes are dangerous.

– Bariatric and Metabolic surgeries are very safe.

– Complications are very rare. Even if they occur, they can be rectified.

– Band related complications such as band slippage, and band erosion are rare.