Sleeve gastrectomy

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Mechanism of action

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There are several mechanisms of action that explain the weight loss after a sleeve gastrectomy:

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• Due to a smaller stomach volume, a feeling of satiety is obtained more quickly.

• Accelerated gastric emptying causes an increase in 'incretin' hormones , which in turn cause a feeling of satiety. It are also these 'incretin' hormones that have a direct beneficial effect on type 2 diabetes through better control of the sugar metabolism.

• The 'Ghrelin' hormone is produced in the part of the stomach that is removed during the operation. This hormone is known as an 'orexigenic' hormone or a hormone that stimulates appetite. Because this segment of stomach is removed, the appetite is reduced.

• The operation also changes the distribution and concentration of a number of gut bacteria (microbiome) , which in themselves also play a role in weight loss.

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weight loss

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Long-term results show that after a sleeve gastrectomy, an average weight loss of between 50% and 65% of the overweight (%EWL*) is achieved.

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Exactly how much weight is lost after surgery varies from person to person and depends on gender, age, weight before surgery and the degree of follow-up after surgery. From experience it is clear that better follow-up leads to better motivation and better results in the long term. In particular, the extent to which the dietary recommendations are met and the degree of physical activity determine the degree of success.

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The greatest weight loss occurs in the first 12 to 18 months after the procedure. This is usually followed by a slight weight gain of a few kg, which stabilizes again. Especially in this period (after the so-called 'white bread or honeymoon' months) good follow-up is of great importance.

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* %EWL = % Excess Weight Loss = weight loss/(starting weight – ideal weight calculated on a BMI of 25))

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Possible complications

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In the short term , the following complications can occur:

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• Infection of the wound/wound abscess.

• Leakage or bleeding at the staple line where the stomach was transsected.

• Blood clot in the legs and/or lungs (Deep venous thrombosis/Pulmonary embolism)

 

In the long term , the following complications can occur:

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• Reflux

• Hair loss (this is temporary due to the rapid weight loss and is reversible)

• Fatigue (mainly in the period with the most weight loss)

• Incisional hernia (less risk due to the use of the laparoscopic technique)

• Vitamin deficiencies that require additional supplements.

• Dumping Syndrome

 

It should also be taken into account that in female patients, birth controle pills may be less effective after the procedure due to an altered drug absorption. This should be discussed with your gynaecologist .

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Furthermore, pregnancy within 18 months after the procedure is also strongly discouraged. Because of the rapid weight loss ('catabolic' state = the body is braking down its overall mas) the body is not in an optimal state to to be able to form an embryo or fetus at the same time.

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The sleeve gastrectomy is an irreversible procedure.

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Hospital stay

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The first day after the operation a light diet will be initiated and early mobilization is stimulated in order to avoid respiratory complications and to prevent potential blood clots in the legs and/or lungs.  Adequate pain medication is provided. During the hospitalization, the dietitian will provide all the necessary nutritional advice for the first weeks after the operation. When the blood tests and clinical examination are reassuring, most patients can be discharged the second day after surgery. A first wound check with the general practitioner is scheduled after one week. The wounds are sutured with a self-dissolving suture, located within the wound itself, so no stitches need to be removed.

 

When discharged from the hospital, a prescription for the following medication is provided:

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• Daily injections with blood thinners (LMWHs) to prevent blood clots in the legs and/or lungs for 30 days after the procedure.

• A proton pump inhibitor (PPIs) to protect the anastomosis or stapler line against stomach ulcers. This should be continued for 12 months postoperatively.

• Pain medication

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Nutritional advice and physical activity

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The dietician will explain in detail the diet that has to be followed both before the procedure as well as during the hospitalization. An overview of the various postoperative diet phases can be found here.

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In the first weeks it is recommended to stay mobile: walk around sufficiently and resume daily physical activities as much as possible within the limits of potential pain. Heavy exertion should be avoided intially until after the first consultation with the surgeon, 3 weeks after the procedure.

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Alarm Symptoms

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In the case of the following symptoms, you are requested to contact the general practitioner or our department or, if necessary, to go to the emergency department:

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• Severe abdominal pain

• Fever

• Vomiting blood or blood in stool/black stool

• Inability to take in food.

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Follow-up

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After the operation, follow-up is organised with various members of the multidisciplinary team as well as by your general practitioner. Furthermore, lifelong multivitamine supplements need to be taken. In the first year after the operation, a blood test is also performed at regular intervals to detect any deficiencies in minerals and vitamins. Afterwards, an annual bloodtest is required. 

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