Gastric Sleeve / Sleeve Gastrectomy

The gastric sleeve procedure is the best "all-round" procedure for obesity with the main contraindications being severe reflux, Barrett's metaplasia of the oesophagus and significant oesophageal dysmotility.

Generally patients with a BMI >35 with comorbidities or BMI over 40 are suitable. There are certain patients with a BMI less than 35, such as those with severe obesity-related comorbidities, or a well-documented history of progressive obesity despite lifestyle modifications, who will benefit from having a sleeve gastrectomy also.

 • Surgery is performed under General Anaesthesia.
• The surgery is performed using key-hole surgery and there will usually be 5 small incisions.
• A gastroscopy is performed before surgery, usually weeks prior.
• The majority of the stomach will be removed using a surgical stapling device, calibrated around a narrow tube.

• The remnant stomach will be a narrow tube shape which is why it is called a gastric sleeve.
• Sutures are placed to anchor the oesophagus to the diaphragm hiatus, and if a hernia is present here it will also be repaired. This help to prevent reflux.
• This can sometimes cause temporary discomfort with swallowing or breathing.
• Sutures are placed to anchor the gastric sleeve to prevent twisting and reinforce the staple line.
• Pain around the wounds and shoulder tip are to be expected following surgery.
• Swallowing fluids and eventually food may feel different after surgery. 

Most patients stay in hospital for 1 or 2 nights. Pain is well controlled and most patients only need paracetamol and occasionally might need endone.

You will be on a liquid diet for 2 weeks after surgery which the dietican will go through with you prior to surgery, then provide ongoing care and follow-up to guide you through you new and modified eating plan.

Eventually, it is expected that you will be able to eat most normal foods in significantly reduced portion sizes.

A proportion of patients will suffer from intractable gastroesophageal reflux symptoms or develop gastroesophageal reflux disease (inflammation of the oesophagus from acid or transformation of the lining of the oesophagus into Barrett's metaplasia, a potentially pre-cancerous condition) and require revision surgery to Roux-en-Y Gastric Bypass. Some studies have quoted new reflux disease developing in 10 to 31.6% of patients after sleeve gastrectomy, with 5-10% requiring revision to RYGB.

Currently, less than 3-4% of Dr Wong's patients have gastroesophageal reflux symptoms with the majority being controlled with medication and less than 1% requiring revision to bypass.  This low rate is attributed to good surgical technique and patient selection.

Weight regain can occur after any bariatric procedure, not just sleeve gastrectomy. Ultimately, sleeve gastrectomy can be successful long-term in a selected group of patients, but in many patients particularly those with more severe obesity, it is simply not a strong enough a metabolic procedure to correct severe obesity long-term.  In these patients, weight-regain in almost inevitable eventually as obesity recurs.

This is potentially a problem where patients select their own procedure based on internet-research when a sleeve is not their ideal procedure, or are only offered a sleeve gastrectomy procedure because other procedures are not able to be performed by the surgeon.

Obesity is a complex, multi-factorial disease and often a good surgical procedure alone is not enough to sustain weight-loss long-term. For this reason, Dr Wong's multidisciplinary bariatric care program is designed to address as many non-surgical factors to assist in the long-term maintenance of weight-loss.

The RYGB is a stronger metabolic procedure than the sleeve gastrectomy and is performed for patients who have a BMI >35 with comorbidities, or BMI >40. If patients have a higher BMI, poorly controlled Type 2 Diabetes or other poorly-controlled weight-related comorbidities - RYGB can be a more effective procedure than sleeve gastrectomy.

Indications for RYGB are similar to that for OAGB-MGB, and is the main preferred surgery for patients with Gastroesophageal Reflux Disease.

Some patients will be suitable for both forms of gastric bypass.  The majority of these patients will be recommended the OAGB over RYGB, which has additional risks that do not really exist with OAGB.  These include GJ anastomosis stricture, kinked small bowel at the small-bowel anastomosis, JJ intussusception, internal hernia, non-specific LUQ abdominal pain and also that weight-loss tends to be not quite as good as OAGB-MGB.

A full discussion will be had with Dr Wong during your consultation for your understanding.

• Surgery is performed under General Anaesthesia.  

• The surgery is performed using key-hole surgery and there will usually be 5 small incisions.  

• A gastroscopy is performed before surgery, usually weeks prior.  

• The majority of the stomach will be partitioned and bypassed using a surgical stapling device.

• The part of the stomach that food goes into will be a short and narrow tube calibrated around the same calibration tube used for sleeve and OAGB.  

• 50-100cm of small intestine is bypassed which amplifies the gut hormone effects to food.  

• The small intestine is joined onto the narrow gastric pouch by suturing using key-hole surgery.

• A 100cm Roux-limb to divert bile is created and surgical stapler used to create a join between the small intestine to complete the bile and pancreas juice diversion.

• Defects in the fat or mesentery of the intestine are sutured closed with permanent sutures to prevent internal hernias.

• Leak test is performed to ensure that there is no leak.

• Pain around the wounds and shoulder tip are to be expected following surgery.  

• Some patients will have pain in the left upper abdomen which can persist for weeks.

• Swallowing fluids and eventually food may feel different after surgery. 

Most patients stay in hospital for 1 or 2 nights. Pain is well controlled and most patients only need paracetamol and occasionally might need endone. Pain in the upper left hand side of the abdomen is more common with this surgery.

You will be on a liquid diet for 2 weeks after surgery which the dietican will go through with you prior to surgery, then provide ongoing care and follow-up to guide you through you new and modified eating plan. Eventually, it is expected that you will be able to eat more normal consistency foods.  

Many Roux-en-Y Bypass patients will have gastrointestinal symptoms of bloating, diarrhoea, abdominal distention and discomfort that may or may not be looked to particular foods.  

There may also be particular foods that feel very heavy or may feel like they get stuck when you eat them.  Your portion sizes will be significantly reduced, with a meal being approximately the size of the palm of your hand..

Sugary foods or too much carbohydrate may cause diarrhoea (dumping) or lower blood sugars (post-prandial hypoglycaemia).