Gastric Sleeve Q&A with Dr. Ballard

Q: Why is the gastric sleeve so popular?

About a decade and a half ago, the gastric bypass was the most popular bariatric procedure in the United States, the Lap-Band® was just being introduced and the gastric sleeve was still the first part of a two-part procedure known as a duodenal switch. In fact, back then, the gastric sleeve, as a standalone procedure, was considered experimental. Over time, after we would perform the gastric sleeve, we noticed that many patients were losing a significant amount of weight and were very happy. We were often able to avoid the additional surgical risk and some of the main drawback to the duodenal switch by stopping with the sleeve. This eventually caught on and patients and surgeons now often prefer the gastric sleeve to other surgeries.

Q: What’s the difference between a gastric sleeve and a sleeve gastrectomy?

There is no difference between a gastric sleeve and a sleeve gastrectomy. They are two different terms to describing the same procedure.

Q: How long does a sleeve gastrectomy take?

The sleeve typically takes about 45 minutes to 1 hour and 15 minutes depending on the patient’s health circumstance. Patients with significant scar tissue from prior surgery may require conversion to open surgery, which will take longer to perform. While robotic surgery may take slightly longer under anesthesia than traditional laparoscopy, there is no measurable difference in outcomes as a result of procedure time alone.

Q: How do you measure how much stomach to cut out?

During the gastric sleeve, we insert a long thin tube known as a Bougie down the esophagus and into the stomach. The diameter of this device (measured with a number followed by French – i.e. 42-French or 32-French) regulates how much stomach to cut away and results in very precise sizing of the new stomach pouch, which is approximately 20% of the original stomach size.

Q: How long do I have to be in the hospital after a gastric sleeve?

In theory, the gastric sleeve can be performed on an outpatient basis safely and effectively. However, we prefer to have our patients spend two nights in the hospital for observation before discharging them. Speak to your surgeon about how long they expect you to be in the hospital based on you expected recovery and general health.

Q: Do you revise the gastric sleeve if I don’t lose weight?

The truth is that most patients do very well for a long time after the gastric sleeve and we don’t do a whole lot of sleeve revisions. It is worth noting however that the gastric sleeve, while not reversible can be revised either by creating a gastric bypass, duodenal switch, or, less commonly, a re-sleeve.

If you received the procedure many years ago, before gastric sleeve technique was standardized, you may qualify for a revision. If you experience very severe reflux after gastric sleeve, we may choose to revise it to a gastric bypass.

Q: Will I be able to keep the weight off after gastric sleeve?

We have a great deal of five- and 10-year data on the gastric sleeve and it shows excellent weight loss potential as well as weight maintenance in the long term. In fact, over the long term, patients can expect to maintain weight loss similar to that of a gastric bypass. Of course, a lot of this depends on the patient sticking to their postoperative diet and exercise plan.

Q: Is the gastric sleeve better than the gastric bypass?

The gastric sleeve and gastric bypass are two different procedures. The gastric sleeve uses only restriction for weight loss while the gastric bypass adds a malabsorptive (intestinal bypass) component. Certainly, the gastric bypass comes with more postoperative considerations including limited food consumption, higher risk of nutritional deficiencies and more, however they are both very effective and safe procedures. For those with severe and uncontrolled acid reflux or type-2 diabetes, the gastric bypass may be a better option.

Q: Can gastric sleeve cause acid reflux? What are my options?

The short answer is yes, the gastric sleeve can cause acid reflux in a subset of patients and we discuss how in the blog post linked below. We have been able to reduce this risk by aggressively screening for and correcting Hiatal hernias – but the risk is still there. Patients who develop severe reflux after the gastric sleeve, which fortunately is not a large contingent of patients, may benefit from the LINX Reflux Management System or a conversion to gastric bypass. A fundoplication is not possible after gastric sleeve.

Read: How We Manage Reflux after a Gastric Sleeve

Q: Any final thoughts?

As with any surgery, it is important that you choose experience. Having an experienced bariatric surgeon allows you to make the best and most informed decision on the procedure that is right for you. With that being said, no two patients are the same and will benefit from different procedures. Be sure to give your surgeon a full medical history so that they can help you determine the right step forward whether it is a gastric sleeve or otherwise. Most importantly, remember that the complications of living with severe obesity are often far worse than the risks associated with the gastric sleeve or any other weight loss surgery procedure we offer.

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