Gastric sleeve surgery, medically known as Sleeve Gastrectomy (SG), stands at the forefront of modern weight loss solutions, offering a beacon of hope for adults grappling with obesity. This procedure is not just another surgical intervention; it represents a pivotal turning point in the journey towards a healthier, more vibrant life.

The essence of gastric sleeve surgery lies in its simplicity and effectiveness. By surgically reducing the stomach's size, the procedure fosters significant weight loss by limiting food intake and altering digestive processes. It’s not merely about shrinking the stomach; it’s a strategic move to reset the body's approach to hunger and fullness, essentially reprogramming the appetite.

What sets gastric sleeve surgery apart is its dual impact – physical and psychological. Physically, it curtails the ability to consume large quantities of food, while psychologically, it diminishes the constant battle with hunger, a formidable challenge for anyone trying to lose weight.

Gastric sleeve surgery is more than a medical procedure; it's a stepping stone towards a new lease on life, enabling individuals to reclaim their health and vitality. As we explore this option together, remember that this journey is about transformation, empowerment, and, most importantly, hope for a healthier future.

• Definition and How it Works:

The Laparoscopic Sleeve Gastrectomy (LSG), often called the "sleeve," involves removing approximately 80% of the stomach, resulting in a stomach size and shape similar to a banana (figure). This surgery reduces the stomach's capacity to hold food and liquids, thus decreasing the amount of food (and calories) consumed. It also affects hunger hormone production, leading to decreased hunger and increased fullness​​.

• Science Behind the Surgery:

LSG is a restrictive procedure that provides increased satiety and decreased appetite by limiting the stomach's size. It leads to earlier stomach distension during eating, which signals the brain to feel full. The surgery also decreases levels of the hunger hormone Ghrelin​​.

Gastric sleeve surgery can be performed using two advanced surgical methods: laparoscopic and robotic. Both techniques are minimally invasive, yet Dr. El Djouzi, in keeping with the latest technological advancements, predominantly endorses the robotic approach in recent years. This preference stems from the enhanced precision and improved outcomes associated with robotic surgeries.

Both laparoscopic and robotic surgeries utilize small incisions, typically four (click to see photos), each no larger than a keyhole. These incisions, known as trocar sites, are strategically placed to allow access to the abdominal cavity. The minimal invasiveness of these incisions leads to significantly less postoperative pain and a faster recovery, a major advantage over traditional open surgeries.

One of the key elements in both laparoscopic and robotic surgeries is the creation of a pneumoperitoneum. This is a surgical technique where the abdominal cavity is insufflated with carbon dioxide gas. This gas creates a working space by gently lifting the abdominal wall away from the internal organs. The pneumoperitoneum provides a clear view and more room to maneuver surgical instruments, making the procedure safer and more precise.

In the specific context of gastric sleeve surgery, whether performed laparoscopically or robotically, the procedure involves meticulous steps. First, the surgeon elevates the liver to gain a clear view of the stomach. Then, the greater curvature of the stomach is carefully dissected. The precision of robotic arms or laparoscopic instruments is crucial here, as they allow for delicate and accurate separation of the stomach from surrounding tissues. Following the dissection, a significant portion of the stomach, about 80%, is resected using a surgical stapler. This stapler not only cuts but also seals the stomach, creating the 'sleeve.'

After the resection, a critical step is the testing of the remaining stomach for any complication. This is done performing an upper gastrointestinal endoscopy.

The robotic approach, as endorsed by Dr. El Djouzi, further enhances these steps with its superior 3D visualization and greater range of motion of the surgical instruments. The robotic system provides unmatched precision, significantly reducing the risks associated with manual procedures.

In summary, the adoption of laparoscopic and robotic techniques in gastric sleeve surgery has revolutionized the field. These approaches minimize surgical trauma, reduce pain and scarring, and facilitate a quicker return to daily activities. The focus on using the latest technologies like robotic surgery reflects a commitment to providing patients with the safest, most effective surgical options available. As a result, patients undergoing gastric sleeve surgery can expect a smoother procedure with optimal outcomes.

The recovery process following Vertical Sleeve Gastrectomy (VSG) surgery is a crucial phase where patients adapt to new physical changes and lifestyle habits. A smooth and successful recovery hinges on understanding and adhering to the guidelines laid out by the surgical team led by Dr. El Djouzi.

1. Immediate Post-Surgery Recovery

• Hospital Stay: Typically, patients remain in the hospital for 1 to 2 nights. During this time, the medical team closely monitors vital signs and manages any discomfort. Pain is generally minimal and effectively managed with medication.

• Pain Management: While some pain and discomfort are expected, most patients find they only need prescribed pain medications for a couple of days before switching to Tylenol as needed.

• Beginning to Move: Early mobilization is encouraged to reduce the risk of blood clots and to improve bowel function. Patients are advised to start walking as soon as they feel able after surgery.

2. Early Weeks of Recovery

• Dietary Changes: The post-surgery diet starts with liquids, then progresses to pureed foods, and eventually to soft foods. Adhering to these dietary stages is critical for allowing the gastrointestinal tract to heal properly.

• Managing Side Effects: Side effects like nausea, vomiting, or constipation can occur but are typically temporary. Staying hydrated and following dietary guidelines helps in managing these symptoms.

3. Long-Term Recovery

• Adjusting to New Eating Habits: Patients learn to adjust to smaller portion sizes and a nutritionally balanced diet over time. Eating slowly and chewing food thoroughly is essential.

• Incorporating Exercise: Regular exercise becomes a crucial part of the recovery process, typically starting 6 weeks post-surgery. Dr. El Djouzi recommends a combination of cardio and resistance workouts for optimal results.

• Regular Medical Follow-Ups: Follow-up appointments are essential for monitoring weight loss and overall health, as well as addressing any concerns or challenges.

4. Mental and Emotional Adaptation

• Psychological Adjustment: Recovery also involves adapting mentally and emotionally. Mood swings, changes in self-esteem, or body image issues are not uncommon. Seeking support from mental health professionals or support groups is advisable.

5. Returning to Daily Activities

• Gradual Return to Normal Activities: Normal activities can usually be resumed within a couple of weeks. Dr. El Djouzi advises avoiding lifting or pushing anything heavier than 10 lbs for the first two weeks, then gradually increasing activity. Walking and driving are generally feasible as soon as the patient feels comfortable and is off prescribed pain medications.

6. Long-Term Dietary and Lifestyle Changes

• Maintaining a Balanced Diet and Regular Exercise: Long-term success post-VSG surgery is heavily dependent on maintaining dietary and lifestyle changes, including a balanced diet and regular exercise.

7. Tips for a Smooth Recovery

• Stay Hydrated: Aim for at least 64 ounces of fluid per day to avoid dehydration.

• Avoid High Sugar and Fat Foods: To prevent dumping syndrome and other complications.

• Favor proteins: Start with the protein portion as it is the most important part of the meal. It allows faster healing.

• Take Bariatric Multivitamins and Supplements: These are crucial to prevent nutritional deficiencies due to the altered digestive system.

In summary, the recovery process after VSG surgery is a comprehensive journey involving physical, dietary, and lifestyle adjustments. With diligent care, adherence to medical advice, and supportive measures, patients can effectively navigate this phase, setting the stage for a healthier and more active life following surgery.

1. Weight Loss and Health Improvements

Gastric sleeve surgery is more than just a procedure; it is a transformative journey with profound long-term benefits, particularly in terms of weight loss and health improvements. Patients who undergo this surgery can anticipate not only a significant reduction in body weight but also substantial improvements in various obesity-related health conditions.

2. Excess Weight Loss (EWL)

• Extent of Weight Loss: : Gastric sleeve surgery is a remarkable tool for significant weight loss, offering hope for those battling obesity. Most patients undergoing this procedure can expect to lose about 60% of their excess weight. It's important to understand that this figure is an average; some individuals might lose slightly less, while others could see even more dramatic results. In fact, some studies have reported an excess weight loss of up to 83% within 6 to 36 months after the surgery. Dr. El Djouzi has observed that highly committed patients have achieved extraordinary success, with some losing all of their excess weight. For example, a patient weighing 300 pounds could potentially slim down to an ideal body weight of 150 pounds. This significant level of weight reduction underscores the effectiveness of gastric sleeve surgery in combating obesity, not just in shedding pounds but in fostering a healthier, more active lifestyle.

• Sustained Weight Loss: Unlike many traditional weight loss methods where the weight can be regained, the results of gastric sleeve surgery are typically long-lasting. This is largely due to the permanent reduction of the stomach's size, leading to a sustained decrease in calorie intake.

3. Improvement of Obesity-Related Conditions

• Diabetes: One of the most remarkable benefits of gastric sleeve surgery is its impact on Type 2 Diabetes. Many patients experience a significant improvement in their blood sugar levels, and in some cases, there is a complete remission of the disease. This improvement can reduce the need for diabetes medications and lower the risk of diabetes-related complications.

• Hypertension: High blood pressure, or hypertension, is another condition that sees substantial improvement post-surgery. The weight loss achieved can lead to lower blood pressure levels, reducing the risk of heart disease and stroke.

• Sleep Apnea: Obesity is a major contributor to sleep apnea, a condition characterized by disrupted breathing during sleep. Post-surgery weight loss has been shown to alleviate the symptoms of sleep apnea significantly, leading to better quality sleep and reduced risk of associated health issues like heart disease.

• Additional Benefits: Other obesity-related conditions like joint pain, cholesterol levels, and risk of certain cancers also show improvement. Patients often report an overall enhancement in the quality of life, including increased mobility, better self-esteem, and a more active lifestyle.

4. Psychological Impact

• Mental Health: The surgery’s impact transcends physical health. Many patients experience a boost in mental health, marked by increased confidence and a more positive outlook on life. The weight loss and improved health status can significantly impact one’s mental well-being, reducing symptoms of depression and anxiety that are often associated with obesity.

Conclusion

The long-term benefits of gastric sleeve surgery extend far beyond mere weight loss. This procedure is a life-changing event that brings about substantial improvements in both physical and mental health. By reducing the burden of obesity-related diseases and enhancing overall well-being, gastric sleeve surgery opens a new chapter in patients' lives, filled with healthier, happier days. It's an investment in a future where health risks are minimized, and quality of life is maximized.

After gastric sleeve surgery, patients embark on a journey that requires significant lifestyle changes, particularly in terms of post-operative management and dietary habits. These changes are crucial for ensuring the success and safety of the surgery.

• Dietary Instructions: Before leaving the hospital, patients receive comprehensive dietary guidance from a bariatric dietitian. This instruction is crucial because after the surgery, the stomach can only tolerate a very limited amount of food, and the types of food that can be consumed will change dramatically. Initially, the diet is liquid-based and gradually progresses to pureed foods, and then to more solid foods over a few weeks. Our dietitians provide detailed advice on how to meet nutritional needs with these dietary restrictions.

• Regular Follow-Ups: Regular follow-up appointments are a key part of the post-surgery journey. These appointments are used to monitor the patient's weight loss progress, ensure that the patient is adapting well to the new diet, and check for any nutrient deficiencies. After gastric sleeve surgery, patients are in need to take bariatric multivitamins and mineral supplements, as their reduced stomach size can affect the body's ability to absorb certain nutrients.

• Nutritional Monitoring: Our dietitians and medical team will closely monitor the patient's nutritional intake to ensure that they are getting enough protein, vitamins, and minerals. This is essential to prevent malnutrition and other complications. Patients are often advised to eat small, frequent meals and to chew their food thoroughly.

• Long-Term Dietary Changes: The lifestyle changes following gastric sleeve surgery are not just for the short term. Patients need to adopt a new approach to eating for the rest of their lives. This includes eating smaller portions, focusing on high-protein foods, avoiding high-calorie liquids and foods, and chewing food thoroughly. Patients are also advised to avoid drinking fluids while eating, as this can lead to discomfort and reduce the effectiveness of the surgery.

• Physical Activity: Increasing physical activity is another important aspect of post-operative lifestyle change. Regular exercise helps to boost weight loss, improve cardiovascular health, and enhance overall well-being.

In summary, the post-operative phase following gastric sleeve surgery involves a comprehensive management plan that includes medical tests, dietary changes, regular monitoring, and an increase in physical activity. Adhering to these changes is vital for achieving the best outcomes and maintaining long-term health and weight loss.

Undergoing gastric sleeve surgery, like any major surgical procedure, involves certain risks and potential complications. It's important for patients to be aware of these risks to make informed decisions about their healthcare.

1. Incidence of Complications: The range of complications following Laparoscopic Sleeve Gastrectomy (LSG) varies, with reported incidences between 0-24%. This range indicates that while some patients may experience no complications at all, others may face significant challenges.

2. Major Complications: Among the more serious complications that can occur are:

• Leaks: One of the most concerning complications is a leak from the staple line of the stomach. If the sealed edge of the stomach, where it has been cut and stapled, doesn't heal properly, digestive fluids and food can leak into the abdominal cavity, leading to infection and other serious complications.

• Suture Line Hemorrhage: This refers to bleeding along the line where the stomach has been stapled. It can be a serious issue, leading to a need for additional interventions to stop the bleeding and possible blood transfusion.

• Organ Injury: During the procedure, there's a risk of injury to surrounding organs, such as the intestines or liver. This can happen due to the surgical instruments used or the physical changes in the abdominal cavity during the operation.

• Mortality Rate: The overall risk of death from gastric sleeve surgery is relatively low, estimated at around 0.39%. However, it's crucial to understand that this risk, while very small, is significant and should be considered when deciding on surgery.

3. Long-Term Complications: In addition to immediate post-surgical risks, there are potential long-term complications that patients should be aware of, such as:

• Nutritional Deficiencies: Due to the reduced size of the stomach and changes in the absorption of nutrients, patients may be at risk of deficiencies in vitamins and minerals, necessitating lifelong supplementation.

• Gastroesophageal Reflux Disease (GERD): Some patients may experience an increase in acid reflux following surgery.

• Weight Regain: Although gastric sleeve surgery is an effective tool for weight loss, some patients may regain weight over time if they do not adhere to the recommended lifestyle changes.

Risk Mitigation: To minimize these risks, it's important for patients to choose experienced surgeons, follow all pre- and post-operative instructions carefully, and commit to long-term follow-up care. Regular monitoring and adherence to dietary guidelines are crucial for preventing and addressing complications effectively.

In conclusion, while gastric sleeve surgery offers substantial benefits in terms of weight loss and improvement in obesity-related health conditions, it's important for patients to be fully aware of the potential risks and complications associated with the procedure. Understanding these risks can help in making an informed decision and preparing for a successful recovery and long-term health management.