Sleeve Gastrectomy (gastric sleeve)

What is sleeve gastrectomy?  

Sleeve gastrectomy or gastric sleeve surgery is a bariatric surgery procedure that is performed to assist you to lose weight.

During a sleeve gastrectomy procedure, your surgeon removes most of your stomach, about 80%.

The surgeon retains a sleeve-like tube that takes the shape and size of a banana. There are no alterations on your small intestine in a gastric sleeve surgery.

The procedure helps to limit the food intake. A gastric sleeve further reduces the quantity of the hunger hormone Ghrelin that is produced in the stomach. That means a reduction in food cravings and appetite. 

Why you might need a sleeve gastrectomy?

Your surgeon may recommend a gastrectomy if you are severely obese. Your healthcare provider may also advise you to undergo gastric sleeve surgery if:

• The BMI or body mass index is above 40

• Your BMI ranges between 35 and 40, but you also have a preexisting health condition like heart disease, sleep apnea, or type 2 diabetes

• You have tried to shed excess weight with exercise and reduced food intake and are still obese

• Your surgeon will only recommend surgery after other non-surgical alternatives to weight loss have failed

Sleeve gastrectomy will improve your overall health and reduce blood pressure, type 2 diabetes, and sleep apnea problems.    

Gastric sleeve surgery techniques

Your primary healthcare provider will either recommend the traditional open-sleeve gastrectomy or laparoscopic sleeve gastrectomy.

In open gastric sleeve surgery, your surgeon makes a large incision to allow him/her to see the digestive and stomach tract.

If you have a very high BMI, abdominal fat could hinder your surgeon from seeing or accessing the surgical field. For that reason, your surgeon will recommend open gastric sleeve surgery.

Other reasons your surgeon may prefer open gastric sleeve surgery to laparoscopic surgery are:

• If you have certain medical conditions that increase the risk of laparoscopic surgery

• In case of pronounced scar tissue (likely because of a previous abdominal surgery) making it hard for your surgeon to view or access the surgical area

Laparoscopic sleeve gastrectomy is a minimally invasive procedure where the surgeon makes small incisions in your abdomen and guides surgical instruments that include a miniature camera into the abdomen.

The miniature camera is connected to a television monitor. This allows the surgeon to administer the surgery with high precision and accuracy.     

Preparing for a sleeve gastrectomy

Before a sleeve gastrectomy, your primary care provider will assess your overall health to determine whether you meet the general requirements for this procedure. You need to meet the following requirements before the procedure:

You must be under the class III obesity category – That means you should have a BMI of 40 and above. With a BMI of 35, you could be considered for gastric sleeve surgery, as long as you have a preexisting related disease such as Type 2 diabetes or high blood pressure.

Other weight loss programs have failed – Most insurance companies will require that you undergo a medically supervised program to lose weight for between three and six months. Only then can they approve the surgical cover.

The healthcare provider must ascertain you are fully prepared for sleeve gastrectomy both mentally and physically. This will involve several meetings with medical specialists, including psychologists and dieticians for screening and counseling.

Once you have passed the screening and counseling process successfully, you will be taken through a liquid diet program for about two weeks.

You will receive particular guidelines on the liquid diet and need to follow them carefully.

The aim of the liquid diet is to help you lose fat in the liver and abdomen. It minimizes the risks during surgery.

Your healthcare provider will ask you to fast for about 12 hours before a sleeve gastrectomy. This ensures you have an empty stomach during surgery.

Any liquid or food in your stomach during the procedure may trigger nasty or fatal side effects.

Your healthcare provider will also order the following tests before the sleeve gastrectomy:

• Electrocardiogram (ECG)

• Liver and calcium function tests

• Tests to determine folate, thiamine, and B12 levels

• Thyroid function tests

If you are taking any immunosuppressant medication, alcohol, or smoking cigarettes, you will be asked to stop.

During a sleeve gastrectomy  

Gastric sleeve surgery is administered via open surgery or laparoscopic surgery. 

Regardless of the technique chosen, you will receive general anesthesia that puts you to sleep during surgery.

If you are undergoing open gastric sleeve surgery, your surgeon makes a large incision in your abdomen about 10 inches long. 

For a laparoscopic procedure, the surgeon makes several incisions in your upper abdomen. He will then insert the small surgical instruments through these incisions.

The surgeon staples the upper section of your stomach using surgical staples. The surgeon will remove the curved larger partitions of your stomach. 

A sleeve gastrectomy takes about one or two hours to administer.

You will wake up in a recovery room with the surgical team on standby. The surgical team will check your vitals through a screen and monitor your progress to make sure you do not suffer any complications.  

After a sleeve gastrectomy  

After the procedure, your dieticians will give you specific dietary guidelines for the next 1 week.

You will need to take noncarbonated, sugar-free liquids. After seven days, your dietician will advise you to reintroduce pureed foods into your diet for the next few weeks.

By the fourth week post-surgery, you should be able to start taking solid foods. 

Your doctor may prescribe vitamins and calcium supplements for the rest of your life. 

You will have scheduled post-surgical appointments with your surgeon to monitor your progress and overall health for the first few months, post-surgery.

Your surgeon may order blood tests, laboratory work, and other exams as part of the medical checkup. 

A dietician will give you nutritional advice on dietary modifications so that you remain fit and healthy.

Benefits of gastric sleeve surgery 

A sleeve gastrectomy procedure retains the functions of your stomach while still permitting normal digestion.

Other types of bariatric surgery like gastric bypass surgery hinder the absorption of calories, affect nerves, and change the stomach openings.

During sleeve gastrectomy, your surgeon removes about 80% of your stomach. This interferes with hormone production. You will experience fewer hunger pangs because of the limited amounts of the “hunger hormone” Ghrelin. 

Gastric sleeve surgery has fewer risks compared with other welt loss procedures. For example, gastric bypass surgery puts you at risk of developing stomach ulcers while lap band surgery comes with band complications. Such risks are absent in a sleeve gastrectomy. 

Also, sleeve gastrectomy does not change the intestinal tract. This minimizes the risk of intestinal obstruction, vitamin deficiencies, and other complications associated with gastric bypass surgery.  

Risks/Complications

A sleeve gastrectomy may manifest with the following risks in the short term:

• Infection

• Blood clots

• Breathing problems

• Bleeding

• Leaks from the incision site

• Adverse reactions to the anesthesia

Sleeve gastrectomy may also present longer-term risks, such as:

• Malnutrition

• Hernia

• Vomiting

• Obstruction to the gastrointestinal tract

• Hypoglycemia

Cost of sleeve gastrectomy in India  

The price of sleeve gastrectomy surgery in India ranges from Rs. 2,00,000 to Rs. 5,00,000.  

The table below summarizes the cost of laparoscopic sleeve gastrectomy in selected Indian cities:

Variations in the cost of sleeve gastrectomy surgery in India could be attributed to the following factors: 

Types of hospital

Government hospitals charge less for sleeve gastrectomy surgery compared to private clinics. 

Facility accreditation

If a healthcare facility has received the relevant accreditation, it is likely to charge more for a surgical service. 

Hospital brand and reputation

Reputable hospitals in India that offer sleeve gastrectomy surgery have built a name for themselves, both locally and internationally. They can afford to charge a premium price for their services.

Type of surgery

Laparoscopic sleeve gastrectomy surgery is more expensive than open sleeve gastrectomy surgery because of the state-of-the-art equipment and other technologies invested in it.

Type of sedation or anesthesia

This will impact the overall cost of surgery.

Surgeon’s expertise, skills, and qualifications

A highly skilled and qualified surgeon will charge a premium price for sleeve gastrectomy surgery.

Diagnostic tests

Any diagnostic test done before sleeve gastrectomy surgery affects the cost of the procedure.

Patient’s room

The kind of room that a patient chooses for their recuperation will also affect the overall cost of surgery.

Deluxe rooms are more expensive than shared rooms.

In the table below, I summarize the average cost of sleeve gastrectomy in leading countries that offer the procedure compared to that of India:

Sleeve gastrectomy surgery in India is highly affordable compared with other countries.

India also provides quality care in sleeve gastrectomy surgeries making the country a popular medical tourism destination of choice.

The following factors have played a key role in ensuring India continues to offer cost-effective sleeve gastrectomy surgeries:

Economies of scale

The high population in India has led to a significant rise in demand for bariatric surgeries. There are many hospitals and specialized centers that offer high-quality, affordable sleeve gastrostomies.  India enjoys economies of scale that permit in price reduction while the quality of treatment remains high.

Government effort

The Indian government has been actively involved in promoting medical tourism in the country. Some initiatives by the Indian government include giving tax benefits to international patients and easing visa processing.

Affordable labor costs and infrastructure

Labor cost in India is lower than in Western countries. That means hospitals have reduced operating costs which is reflected in affordable sleeve gastrectomy surgeries.

State-of-the-art medical facilities

India offers affordable sleeve gastrectomy surgeries. The country has not compromised on the cost of healthcare. Indian hospitals and clinics that offer sleeve gastrostomies have invested in advanced medical facilities. The surgeons are also highly skilled.

References

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