Menu 0

Sleeve Gastrectomy

 

Laparoscopic/Robotic sleeve gastrectomy which is also known as vertical sleeve gastrectomy is a procedure in which about 70 to 80% of the stomach is removed leaving a narrow gastric tube or "sleeve" through which food passes. The removed part of the stomach includes fundus, this upper outer part is important as it releases hormone Ghrelin. This hormone is termed as ‘hunger hormone’ because it stimulates appetite, increases food intake and promotes fat storage. No intestines are removed or bypassed during Sleeve Gastrectomy so that malabsorption is minimal. Due to this small stomach tube, the amount of food ingested is restricted and a person can take small amount of food at a time thereby the amount of calories consumed is restricted which results in weight loss.

Having said that, it is not only the restriction that causes the weight loss but many a metabolic change also occur due to rapid transit of the food in the intestines, releasing intestinal hormones that cause these effects. Thus, Sleeve Gastrectomy is no longer considered purely a restrictive surgery but also a metabolic surgery.

Though, Sleeve Gastrectomy was originally used as a first step procedure for a more definitive gastric bypass in super obese, it is now also used as a single stage procedure with excellent results across the globe. In patients with Reflux Disease and Diabetes the results may be inferior to the Gastric Bypass but the excess weight loss of both the procedures may be comparable in a select subgroup of patients.

It is a simple procedure and the patients may be able to leave the hospital in one day or even the same day in selected cases.

 

Nutritional guidelines after bariatric surgery:

After all Bariatric and Metabolic procedures, the rationale of nutritional care is two-fold. Firstly, sufficient energy and nutrients helps in supporting tissue healing after surgery and the preservation of lean body mass during the period of extreme weight loss.

Secondly, the foods and beverages consumed after surgery should decrease reflux, cause early satiety, while maximizing the weight loss and, ultimately, weight maintenance.

After bariatric surgery the diet progresses in 4 phases, starting from clear liquids, then pureed, afterwards slow progression from soft to normal diet.

Patients are advised to avoid 5 “S” i.e. Sugar, Spirits, Straw, Soda and Smoking, not only until the desired weight loss is achieved but also as directed by the bariatric Surgeon/Nutritionist. (Ideally Lifelong!!)

Sugar and spirits are avoided to prevent dumping and also to aid weight loss.

Straw and soda may cause bloating and patients may suffer with abdominal discomfort, pain or feeling of fullness.

Smoking is prohibited for good respiratory functions and to prevent stomal ulcerations.

Basic Rules:

  • Eat frequent and small meals.
  • Chew well and eat slowly.
  • Eat your proteins first.

Avoid drinking liquids along and for 30 minutes before and after meals as drinking beverages along with meals can cause early satiety and may hinder adequate protein intake.

Listen to your body – each patient may have different capacity and appetite to eat; one should listen to his/ her signals from body as to when to stop eating.

ASMBS Supplement Recommendations to prevent Micronutrient Deficiency after bariatric surgery

  • All patients should take at least 12 mg vitamin B1 daily to maintain blood levels and prevent its deficiency.
  • All post-WLS patients should take 350–500 mg vitamin B12 supplementation daily.
  • Post-WLS patients should take 400–800 mg oral folate daily from their multivitamin.
  • Women of childbearing age should take 800–1000 mg oral folate daily.
  • Post-WLS patients should receive at least 18 mg of iron from their multivitamin.
  • Menstruating females and patients who have undergone RYGB, SG,MGB or BPD/DS should take at least 45–60 mg of elemental iron daily (cumulatively, including iron from all vitamin and mineral supplements)
  • The appropriate dose of daily calcium from all sources varies by surgical procedure:

    MGB, BPD/DS: 1800–2400 mg/d
    LAGB, SG, RYGB: 1200–1500 mg/d.
  • The recommended preventative dose of vitamin D in post-WLS patients should be based on serum vitamin D levels: Recommended vitamin D3 dose is 3000 IU daily, until blood levels of 25(OH)D are greater than sufficient (30 ng/mL)
  • Post-WLS patients should take vitamins A, E, and K, with dosage based on type of procedure:

    LAGB:     Vitamin A 5000 IU/d and vitamin K 90–120 ug/d.
    RYGB and SG: Vitamin A 5000–10,000 IU/d and vitamin K 90–120 ug/d
    LAGB, SG, RYGB, BPD/DS: Vitamin E 15 mg/d
    DS: Vitamin A (10,000 IU/d) and vitamin K (300 mg/d)
  • All post-WLS patients should take > RDA zinc, with dosage based on type of procedure:

    MGB, BPD/DS: Multivitamin with minerals containing 200% of the RDA (16–22 mg/d)
    RYGB: Multivitamin with minerals containing 100–200% of the RDA (8–22 mg/d)
    SG/LAGB: Multivitamin with minerals containing 100% of the RDA (8–11 mg/d)
  • All post-WLS patients should take > RDA copper as part of routine multivitamin and mineral supplementation, with dosage based on type of procedure:

    MGB, BPD/DS or RYGB: 200% of the RDA (2 mg/d)
    SG or LAGB: 100% of the RDA (1 mg/d)
    SG: Sleeve Gastrectomy
    RYGB: Roux-en-Y- Gastric Bypass
    MGB: Mini Gastric Bypass
    OAGB: One anastomosis Gastric Bypass
    BPD/DS: Bilio-Pancreatic Diversion with Duodenal Switch
    LAGB: Laparoscopic Adjustable Gastric Band