Certain people suffer from heavy obesity. Many of them unsuccessfully struggle for overweight reduction by means of conservative methods (diet, behavioral support, medicaments) and very often achieve the so called yo yo effect. The sleeve gastrectomy is for those patients.
Sleeve Gastrectomy is a surgical removal of major curve of the stomach including a zone of production of so-called “hungry hormones”. The rest of the stomach is in shape of a sleeve or a tube. These procedures force the patient to reduce the amount of received food and therefore to even loose weight without feeling too hungry. Hormones that stimulate appetite are produced in the removed part of the stomach (hungry hormone Ghrelin). The patient does not feel terrible hunger during the reduction diet. This type of surgery belongs to the group of Restrictive Bariatric Procedures (reducing the volume of received food).
The surgery is mainly suitable for clients that are excessively overweight (BMI is greater than 35 kg/m2) and that have already tried to reduce their overweight with other treatment procedures. Some patients suffer from associated diseases caused especially by high overweight.
The whole major curve of the stomach is laparoscopically cut off in stomach tube through special combined devices and then it is removed from the abdomen. The rest part of the stomach has a small volume (80-180ml) and a shape of a sleeve.
Especially patients with high level of overweight (BMI > 40kg/m2) which failed in conservative treatment are indicated for surgical treatment of morbid obesity. Eventually patients with overweight of high level (BMI > 35 kg/m2) that is associated with severe circulatory, metabolic and moving complications. The indication of surgical treatment is made on the base of detailed clinic and laboratory examination together by internal specialist for obesity, psychologist and surgeon that specializes on bariatric surgery.
It is necessary to perform a special internal, psychological examination and examination of obesity before the surgery. After the whole evaluation of results a suitable type of surgical procedure is decided together with the patient.
The surgery is performed under general anesthesia, almost always laparoscopically, e.g. with the help of special surgical devices and small TV camera through only approximately 1-2 cm wide needle insertion into the abdominal wall. It is not always possible to perform the surgery this way. In case of adhesions in the abdominal cavity or because of other reasons, it is sometimes necessary to start a classic surgery during the laparoscopic procedure, which means by the incision through abdominal wall. The final effect of the surgical procedure is the same though. No extraneous item stays in the body after the surgery.
The surgery is performed under general anesthesia. It is necessary to count with stay in hospital for several days after the surgery.
A walk around the bed is possible already the first day after the laparoscopic surgery. In case of no complications during the surgery the client can go home after 4-5 days after the surgery. The incapacity to work depends on the character of the job, it is usually 10-14 days. After the surgery performed with “classic” incision the client stays in the hospital around a week and the incapacity to work takes around 14-21 days.
With the help of special combined devices (through laparoscopic surgery) the whole big curve of the stomach is cut off. This reduces the volume of the stomach, its final shape is in shape of a sleeve. The reduction of the volume of the stomach results in the reduction of the amount of received food.
If the client maintains the diet program prescribed by the physician, he/she looses weight and therefore the whole health state of the patient is improved.
The diet program after the surgery is one of the most important conditions for good weight loss and for avoiding the complications of method failure or even risk to heath state! It is possible and very appropriate to start with adequate exercise approximately two weeks after the surgery, which helps to loose weight.
The essential change is in drinkable regime. It is not allowed to drink after a meal only between each food intake. It is though necessary to drink at least 2 liters a day, always in between the meals.
The patient can eat only liquid food during first days after the surgery. It prevents damage of the suture line of the stomach wall by excessive expanding of the rest of the stomach. The patient can switch from mixed food to normal, diverse, diet and rational food after another two weeks. The patient has to limit the calories intake himself/herself, otherwise he/she never reaches the desired weight reduction.
It is very important that the patient bites thoroughly the food before every swallow, much more than he/she was used to before the surgery. It is recommended to avoid raw, unpeeled fruit and vegetable or insufficiently prepared meet. It is necessary to keep classic food layout:
breakfast, snack, lunch, snack, dinner. The amount that is possible to eat at once is substantially lower than before the surgery. The food has to remain reducing with low content of fat and sufficient intake of proteins and vitamins.
In case of repeating overeating and nonobservance of directions the stomach sleeve expands and stops to function. The patient can thus start to gain weight again!