İbrahim Karataş | Sleeve Gastrectomy

Sleeve Gastrectomy

Sleeve gastrectomy is a type of partial gastrectomy operation in which a large part of the greater curvature of the stomach is removed and a tube shape is given to the stomach. It is a volume limiter method. It is used as a first base operation for losing the surplus weight before the harder and complex surgeries such as gastric bypass, biliopancreatic diversion for those with very high BMI (>60 kg/m2 ). However, when it has been observed that it has a high efficiency on losing weight and metabolic outcomes just by itself, it is also started to be performed as primer surgery. Today, it is preferred increasingly for its technical convenience and good metabolic outcomes.

ADVANTAGES

It is a safe and easy operation. In addition to its restrictive effect, it also reduces appetite by reducing orexigenic hormone levels such as ghrelin. Dumping syndrome does not occur because the pylorus is intact. The risk of malnutrition is low. It is preferred in super obese patients with high surgical risk or those with Crohn’s disease.

Laparoscopic Adjustable gastric band

It has been used as a restrictive method since 2001 in the USA with FDA approval. An inflatable silicone band is wrapped around the stomach, 3 cm below the esophago-gastric junction and a 25-30 cm reservoir is created proximally. At the other end of the tape, there is a port placed under the skin. The caliber of the gastric opening can be changed by filling and emptying with serum. With the feeling of satiety, the patient’s calorie intake decreases by 1000-1200 kcal.

Roux en- Y Gastric Bypass ( RYGB )

In RYGB, a section is made in the upper part of the stomach and thus, a small gastric pouch between 10 and 30 ml in size is created. This gastric pouch bypasses the rest of the stomach, duodenum and a small part of the jejunum. In the second National Bariatric Surgery (NBSR) report, excessive weight loss 1 year after gastric bypass was 68.7%, and excessive weight loss within 3 years after surgery was 65.4%.

Mini gastric bypass

Mini gastric bypass (MGB) is a procedure recently increasingly used in some centers. Although mini gastric bypass is the easiest technique since it involves less anastomosis and the anastomosis is performed distal to the long gastric pouch, it is recommended to be performed by trained surgeons in experienced centers. Restricted stomach volume reduces the amount of meals and it is an easy technique to practice and learn.

Biliopancreatic diversion ± duodenal switch

Biliopancreatic diversion (BPD) can be performed with or without a duodenal switch (DS). In biliopancreatic diversion, a long enteric leg gastroileostomy and a short common canal are created together with distal gastric resection. It provides maximum weight loss in the long term with minimal dietary restrictions. It is the most effective technique in the recovery of T2DM, HT and dyslipidemia.

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