Dr Govind Krishna is a General & Upper

Gastrointestinal Surgeon providing

consultative and surgical services to

patients in south West Sydney.



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Dr Krishna Sleeve Gastrectomy Gastric Sleeve pdf-image

What is a Sleeve Gastrectomy (Gastric Sleeve) and what are the advantages
of this type of obesity surgery?

The Sleeve Gastrectomy which is often referred to as a gastric sleeve is a surgical weight-loss procedure in which most of the stomach is excised and discarded and the final stomach is about 25% of its original size. Because the stomach has been removed, this procedure is  not reversible.

As with other bariatric operations, Sleeve Gastrectomy Surgery is performed laparoscopically (keyhole surgery). Small incisions are created in the abdominal wall to allow small instruments to be passed into the abdominal cavity, guided by a special surgical telescope with a video camera, in order to perform the operation. Sleeve gastrectomy involves converting the stomach into a long thin tube.  This is done by stapling the stomach along its entire length and then removing approximately 75% of it. This procedure will generally require an inpatient hospital stay of one to two days.

This operation reduces the capacity of the stomach thus restricting the amount of food that can be eaten

Also, the removal of the outer part of the stomach removes the main site of production of the hunger hormone Grehlin. This leads to a loss of appetite and reduced hunger even though the patient is eating less.

The sleeve procedure generates good weight loss during the first year after the procedure. In most instances patients tend to lose between  50% and 75% of their excess weight during that time.

Generally there is no more weight loss after that and there could be some weight gain in due course as the procedure is not adjustable like the lap-band and the tube of stomach is likely to stretch over time.

Sleeve Gastrectomy surgery must be followed by a step by step diet that first involves a 2-week liquid diet immediately post-surgery, followed by a soft moist diet for a further 2-week and then a long term protein rich, low calorie healthy diet.

Most patients will achieve effective weight loss and experience improvement in many obesity-related health conditions.

Patients can still eat normal food.

Sleeve Gastrectomy is a good option for the super obese. Not only can it be used as the only weight loss operation, but also as a first stage to a gastric bypass or other obesity surgery.

What are the disadvantages of a Sleeve Gastrectomy (Gastric Sleeve)?

The procedure is more invasive than lap band surgery involving cutting and stapling of the stomach is required. In some instances, this can lead to early complications like leaks and bleeding from the staple line. Although leaks are rare (1-2%) they are serious complications.

As the procedure is more invasive there is a higher upfront surgical risk.

The procedure is non-reversible. If a patient is unhappy with the lifestyle change of has side effects from the surgery – it cannot be changed.

There is a paucity of long-term clinical outcomes studies as it is a relatively new procedure.

There can be concerns about stomach tube dilatation long term.

Sleeve gastrectomy compared to gastric banding

In a sleeve gastrectomy the whole gastric tube fills when eating so patients feel naturally full rather than the feeling of obstruction experienced with a gastric band.  Sleeve gastrectomy patients are able to tolerate a greater range of food items e.g. bread, meat and fruits. Therefore sleeve gastrectomy allows patients to eat a more healthy normal day to day diet. Other advantages include more rapid weight loss, no ongoing adjustments, and a greater end weight loss.

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