Sleeve gastrectomy

Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve or tube like structure. The procedure permanently reduces the size of the stomach, although there could be some dilatation of the stomach later on in life. The procedure is generally performed laparoscopically and is irreversible.

Procedure

Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.

Today sleeve gastrectomy is the fastest-growing weight loss surgery option in North America and Asia. In many cases, but not all, sleeve gastrectomy is as effective as gastric bypass surgery, including weight-independent benefits on glucose homeostasis. The precise mechanism that produces these benefits is not known.

The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia.^[1] The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 36-40 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.^[2]

Use in children and adolescents

Endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders^[3] and the American Society for Metabolic and Bariatric Surgery,^[4] sleeve gastrectomy is gaining popularity in children and adolescents. Studies by Alqahtani and colleagues have found that sleeve gastrectomy causes large weight loss in children and adolescents aged 5 to 21 years.^[5] Moreover, they compared weight loss with adults and found comparable weight loss.^[6] Recent reports from the group show that growth progresses unaffected after sleeve gastrectomy in children younger than 14 years of age.^[7]

Complications

Sleeve gastrectomy may cause complications; some of them are listed below:

• Sleeve leaking (occurs 1 in 200 patients)
• Blood clots (happens 1% of the time)
• Wound infections (occurs in about 10-15% of post-op patients)
• Strictures (occurs 3.5% of post-op patients)^[8]
• Aversion to food and nausea^[9]
• Damage to the vagus nerve which will cause constant nausea
• Gastroparesis, with a delay in moving food from the stomach to the small intestine
• Vomiting
• Esophageal spasm/pain
• Gastroesophageal Reflux Disease (GERD)

Costs

There are three cost categories for sleeve gastrectomy surgery: pre-op (all fees associated with preparing the patient for surgery including professional fees, lab work and testing), the surgery itself (including surgeon, surgical assistant, anesthesia and hospital fees) and post-op costs (follow-up physician office visits, vitamins and supplements).

Out of pocket costs for the sleeve gastrectomy surgery itself may be offered to the patient as a packaged price or charged separately by the surgeon's office and hospital. Packaged prices may or may not include pre-op and post-op care, depending on the surgical practice.

Average costs for sleeve gastrectomy surgery are $19,000 in the United States, although this varies widely between states; South Dakota and Texas offer the lowest average cost at about $12,000 while the most expensive surgeries are performed in Alaska (average about $58,000). In Turkey this operation costs $6,000 USD. In Jordan the total cost is around $4,000 USD, which includes all pre-surgery tests, x-ray and hospital fees. In New Zealand the cost is approximately $20,000 USD.

The procedure is covered by several insurance plans if deemed medically necessary. Coverage is required in several states due to requirements of the Affordable Care Act.^[10]

References

• Pitombo, Cid (2008). Obesity surgery: principles and practice. McGraw Hill Professional. p. 177. ISBN 0-07-149492-8. 

• Nguyen, etc all; Ninh T. Nguyen; Eric J. DeMaria; Sayeed Ikramuddin; Matthew M. Hutter (2008). The SAGES Manual: A Practical Guide to Bariatric Surgery. Springer. p. 131. ISBN 0-387-69170-7.