SLEEVE GASTRECTOMY( SG)

SLEEVE GASTRECTOMY( SG)

WHAT IS SLEEVE GASTRECTOMY (SG)?

Sleeve gastrectomy is the most commonly done bariatric surgery worldwide. Up to 80% of stomach is removed using staplers to form a vertical sleeve. Capacity of resulting sleeve is 60 to 120 ml.

HOW DOES GASTRIC SLEEVE SURGERY WORK?

Ghrelin, a hunger hormone, is produced in fundus of stomach. As fundus is completely removed in sleeve gastrectomy, appetite comes down. There will be rapid stomach emptying, so undigested food reaches end of small intestine rapidly resulting in increase of GLP1 & Peptide YY (Satiety hormones). There will be more than 200 hormone changes after surgery. There will be more than 200 hormonal changes after surgery. Removal of body of stomach alters several genes involved in energy balance. These hormonal and genetic changes reduce appetite, increase energy expenditure and reset the ‘fat mass’ to a lower level, resulting in long lasting and effective weight loss. Same hormonal changes are responsible for long lasting type 2 diabetes remission. Ghrelin acts against insulin. As levels of this hormone come down, insulin resistance comes down. Since GLP 1 hormone is increased, insulin production increases and insulin resistance comes down. Role of restriction of food is secondary, in inducing weight loss or diabetes remission.

WHAT ARE THE ADVANTAGES OF GASTRIC SLEEVE SURGERY?

It is a very simple and safe surgery. Complications are very low. Compared to diversion procedures risk of vitamin and mineral deficiencies is very low.

WHAT ARE THE LIMITATIONS OF GASTRIC SLEEVE SURGERY?

Hormonal changes after gastric sleeve surgery are less compared to diversion procedures. Chances of long-term weight regain and recurrence of diabetes are very high after gastric sleeve. This is not necessarily a failure of surgery but mainly related to not following a healthy diet and exercise after surgery. These patients may need revision bariatric/ metabolic surgery to induce further hormonal changes necessary for weight loss and diabetes remission. The incidence of reflux of acid into the esophagus is high after sleeve gastrectomy.