Weight Loss Surgery - Gastric Sleeve Resection
 

This is a relatively new approach. It is the first component of the duodenal switch operation and involves removing the lateral 2/3rds of the stomach with a stapling device. It can be done laparoscopically ( keyhole surgery) but is not reversible. It basically leaves a stomach tube instead of a stomach sack.

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This is the first component of a Biliopancreatic Diversion / Duodenal Switch where the stomach is reduced in size by removing the lateral 2/3rds leaving the stomach in the shape of a tube. Sometimes it is offered to patients as part of a two stage Bypass operation particularly if they are super obese ( BMI>60) because it allows good weight loss until the patient gets down to a safe weight and the more radical bypass can then be offered laparoscopically when they are at a safer weight. The residual stomach capacity is about 200mls so a generous entree should be possible.

Issues with Tube gastrectomy

1. Stomach tube may stretch up over time leading to late weight regain. The extent of this is currently unknown

2. The amount of weight reduction is in the region of 40-60% of excess wt lost over the
first 1-2 years.

3. There is no malabsorbtion to nutrients

4. If weight is regained the second stage of Duodenal Switch or Gastric Bypass can be added laparoscopically.
 

 

 

DIETARY INSTRUCTIONS

The Gastric Sleeve Resection operation is often the first step towards intestinal bypass for high cardiopulmonary risk patients. Fortunately a majority of patients do benefit from Sleeve Resection alone.

The following 6 rules are very important eating habits:

 

1. Only eat small quantities: The capacity of the stomach has changed. Also the amount of food intake has to change. Nevertheless it is not always easy to stop eating at the right time. What do we mean, if we say small quantities? For example one slice of bread for breakfast or 2 potatoes and a small piece of fish for lunch.

2.      Chew well and swallow food only completely mashed: You need more time for chewing and also not all food is possible to chew well. The list of “unsuitable food” will show you the products which are usually not easy to chew.

3.      Never eat and drink at the same time: The reduced capacity of the stomach will no longer permit to take in both: liquid and food at the same time. The usual amount of beverage, 2-3 litre liquid per day, are desirable. It´s better to drink between or before meals.

4.      Do not lay down or rest after eating: because in a horizontal position reflux is more likely. The food also remains longer in the prestomach and leads to a very uncomfortable accumulation of mucus.

5.      Eat five times a day: This is important, because if you only eat 2-3 times a day, it is not possible to have a great variety of food. Consequently, as you can only eat small amounts, you do not get enough proteins, minerals and vitamins. In addition, when eating 5 times daily, it is less likely that you are overpowered by sudden hunger attacks where you probably forget the new eating habits.

6.      Watch for beverages rich in calories: In our experience, many people take in a lot of their calories with soft drinks, hot chocolate and milk shakes. This is also possible after the operation, so consider this before drinking high calorie liquids. The type of liquid should be varied and include tea or coffee, diluted fruit- or vegetable juice, light drink with artificial sugar, low fat variants of butter milk, mineral water without gas. 

 

 

Eating program in the hospital:

 

1.on the operation day, you get only tea in little sips. The remaining need for liquids is given by infusion

2. on the first day after the operation you get tea, as much as you want, and for lunch and dinner soup.

3. on the second day you get your first breakfast with tea or coffee, crisp bread with butter and jam. For lunch we serve mashed potatoes, mashed vegetables and mashed meat – only small portions. Please eat with a tea-spoon to enforce slow eating. Between breakfast and lunch and between lunch and dinner you get a snack – pureed fruits or yogurt. For dinner you can choose between several kinds of porridge with applesauce or a sandwich with cream.

Possible beverages are: coffee, tea, mineral water without gas, diluted orange or apple juice.

  1. after the third day, if you respond well to this diet, you get solid food like: potatoes, vegetables, fish, minced meat, dumplings e.g. – well done cooked but not mashed.

After the time in the hospital, you can start to make up your own menus. It is still important, that you eat little, often and chew the food thoroughly.

If you comply with all advices given on your diet, you should have no problems with the healing process. You should not lift any heavy objects for two weeks after your operation, as this may cause abdominal pain.

You must not take aspirin or any other drug such as non-steroid anti-rheumatic drugs, that may irritate your stomach, without gastric protection. Therefore you must inform your doctor of this advice (gastric mucosal prophylactic).

 

 

 

What are the risks associated with gastric sleeve resection?

 

The risk of postoperative complications average out between 3-5%. This includes infections, pneumonia or bleeding. Severely overweight patients run a higher risk of incurring operative complications. The risk of mortality is, according to literature, below 0.3%.

It is also possible to regain weight after some time, because snacks and high calorie food could make the band ineffective.

The main goal is to make radical changes in your lifestyle after gastric sleeve resection. You must learn to have five meals a day and no snacks in between. Also, high calorie drinks such as coca cola, ice-tea or any other soft drinks must be avoided.

Possible risks specific to gastric sleeve resection and their frequency according to statistical data found in the literature and in our series:

- Stomach mucus irritation and swelling due to vomiting or antiinflammatory drug use

- Wound infection

- Blood loss after surgery

 

The average complication rate in literature is

 

 

DOCTOR APPOINTMENTS

After surgery you must undergo regular outpatient check-ups. Initially, these check-ups will be carried out after 3 month and after 6 months. Once your weight has stabilized, check-ups will be necessary on an annual basis.

 

PHYSICAL ACTIVITY

It will be important to alter not only your eating habits, but also your level of physical activity. Patients are generally recommended to start exercising slowly. As weight loss is achieved, physical activities will gradually become easier.

 

 

 

 

References

 

Gagner M, Rogula T.Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch.
Obes Surg. 2003 Aug;13(4):649-54.

Kriwanek S, Schermann M, Ali Abdullah S, Roka R.Band slippage--a potentially life-threatening complication after laparoscopic adjustable gastric banding.
Obes Surg. 2005 Jan;15(1):133-6.

Johnston D, Dachtler J, Sue-Ling HM, King RF, Martin G.The Magenstrasse and Mill operation for morbid obesity.
Obes Surg. 2003 Feb;13(1):10-6.

Carmichael AR, Sue-Ling HM, Johnston D.Quality of life after the Magenstrasse and Mill procedure for morbid obesity.
Obes Surg. 2001 Dec;11(6):708-15.

 

 

 


© 2005 Karl Miller, MD, PhD