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Obesity is a major and rapidly growing health problem in the developed world. It is estimated that one third of the adults in the US are overweight (Body Mass Index [BMI] between 25 and 29 kg/m2), >30% are obese (BMI > 30 kg/m2), and 5% suffer from morbid obesity (BMI > 40). Obesity has important impacts on physical and psychological health; it is associated with the development and /or aggravation of cardiovascular diseases, diabetes mellitus, sleep apnea, some forms of cancer, depression, and impairment of the quality of life. Moreover, obese patients increase their risk of death by 50-100% compared with normal weight individuals.
Dietary and behavioral approaches to treat obesity were found to have limited success among the morbidly obese. Currently bariatric surgery is the most effective therapy for these patients. The two procedures most commonly performed are the Laparoscopic Adjustable Gastric Band and Laparoscopic Roux-en-Y Gastric Bypass. However, super-obese patients usually have a higher incidence of co-existing medical problems, and are more likely to develop short and long-term complications after bariatric surgery. This has led to the development of surgical techniques designed to provide adequate excess weight loss with the least possible morbidity.
Sleeve Gastrectomy involves removing the fundus and greater curvature portion of the stomach leaving only a lesser curvature tube and a stomach that is approximately the size and shape of a banana.
There are several mechanisms contributing to the weight loss with Sleeve Gastrectomy; removing 80-90% of the stomach and leaving behind only a sleeve restricts the amount of the food that can be ingested and gives the sensation of fullness with minimal oral intake. Hormonal change represented by the decrease in the Ghrelin level due to resection of the fundus may be another factor for the weight loss, as well as the accelerated gastric emptying, and the behavioral modification of the patients.
The majority of weight loss Sleeve Gastrectomies performed today use a laparoscopic technique, which is considered minimally invasive. Laparoscopic surgery usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures.
The length of time of the surgery varies. One study found that the average operative time was 1.5 to 3.5 hours and the average hospital stay was 2 to 5 days. Patients usually return to normal activities in 2 weeks and are fully recovered in 3 weeks.
Sleeve Gastrectomy has many potential advantages. Preservation of gastric function including the pylorus eliminates dumping, and the procedure is purely restrictive and in contrast with the malabsorptive procedures as Roux-en-Y Gastric Bypass, does not result in malabsorption. Moreover, Sleeve Gastrectomy usually can be performed laparoscopically even in the super-obese patients, and does not require implantation of any artificial device or adjustments as the Laparoscopic Adjustable Gastric Band. It can also be performed in patients with disorders which preclude intestinal bypass e.g. anemia or Crohn's disease.
Alternative to a Roux-en-Y Gastric Bypass Sleeve Gastrectomy is a reasonable alternative to a Roux-en-Y Gastric Bypass for a number of reasons: Because there is no intestinal bypass, there is no risk of malabsorptive complications such as vitamin, mineral and protein deficiency. There is no risk of marginal ulcer which occurs in over 2% of Roux-en-Y Gastric Bypass patients. The pylorus is preserved so dumping syndrome does not occur. There is no intestinal obstruction since there is no intestinal bypass. It is relatively easy to modify to an alternative procedure should weight loss be inadequate. Weight loss is superior to Laparoscopic Gastric Banding and comparable to Gastric Bypass. Shorter operative time and recovery.
Most recent reports showed that Sleeve Gastrectomy as nearly as effective as Gastric Bypass in reducing co-morbidities associated with obesity:
Type 2 Diabetes
High Blood Pressure
Obstructive Sleep Apnea
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