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TECHNICAL INFORMATION - Vertical Sleeve Gastrectomy

What is a Sleeve Gastrectomy, and how does it work? PLEASE READ - VERY IMPORTANT!

The sleeve is a more complicated and longer surgery than the adjustable gastric band. We recommend it in the following cases:

For patients who may be considering the gastric bypass, it is a shorter and less drastic form of surgery - less complex with fewer risks of complications during and just after surgery,. There is also not the need for regular post-op blood tests and the frequent checks for malnutrition/vitamin & mineral deficiencies which often result from the malabsorption element of bypass. Statistical studies show the weight loss achieved is comparable to Bypass, and significantly greater and more rapid than with the Band.
For patients considering a gastric band, but who are willing to accept the non-adjustable nature of the sleeve it has the added benefit of greatly reducing Ghrelin production (the hormone which signals hunger to the brain). Patients with a "higher" BMI may be much more suited to a sleeve than a band - weight loss from the sleeve is usually greater and faster than from the band. There are some medical conditions which would prevent a patient having the sleeve, but not prevent a band being fitted or a Gastric Wrap (Laparascopic Greater curvature Plication) performed.
As a general rule, the Sleeve Gastrectomy is ideal for those patients with a higher BMI than 40

Sleeve Gastrectomy Diagram The Vertical Sleeve Gastrectomy procedure is performed regularly by less than 50 specialist surgeons worldwide. The earliest forms of this procedure were conceived of by Dr. Jamieson in Australia (Long Vertical Gastroplasty, 1993) - and by Dr. Johnston in England in 1996 (Magenstrasse and Mill Operation). Dr Mark Gagner in New York refined the operation to include gastrectomy (removal of stomach) and offered it to high risk patients in 2001.

Several surgeons worldwide have adopted the procedure, including Dr.Cierny in the Czech Republic, and have offered it to low BMI and lower risk patients as an alternative to laparoscopic banding of the stomach. Dr Cierny is a pioneer of the Sleeve Gastrectomy in the Czech Republic, and a recognised expert in this procedure.

At first it was offered to very high BMI patients as the first stage in a two stage procedure, the second stage being Gastric Bypass. The Sleeve Gastrectomy was seen as a much less risky procedure, enabling these patients to lose sufficient weight to enable them to have a safe Bypass at a later date.

Because of the successful results obtained from the Sleeve Gastrectomy on these patients, it was decided to offer the procedure as a "stand alone" operation, and to recommend it as a very effective alternative to laparoscopic banding of the stomach and the more complicated and post-operatively difficult Gastric Bypass to patients who qualify for Bariatric Surgery. In recent years the Sleeve has started to become a very popular choice for Bariatric surgeons, growing in popularity. There is a growing body of evidence and research statistics to support the argument that the Sleeve Gastrectomy as a relatively straightforward restrictive procedure produces weight loss results comparable with Bypass. Long term difficulties with the Gastric band, such as failure of the port, or slippage of the band and erosion/migration through the stomach wall are not a feature of Sleeve Gastrectomy, of course. Once the procedure is completed and the necessary health checks take place in the hospital before you are discharged, the Sleeve requires no on-going maintenence, and there are no mechanical devices inside the body that can potentially fail or cause harm.

The Sleeve Gastrectomy is a restrictive operation to limit how much food you can eat by significantly reducing the size of your stomach (by 75% or more). The left side of your stomach is surgically removed, resulting in a new stomach which is roughly the size and shape of a banana. It is carried out laparoscopically, under a general anaesthetic, like the band, with 5 or 6 very small incisions, and is therefore much less traumatic than open surgery, with a shorter healing time and less risk. Since this operation does not involve any "rerouting" or reconnecting of the intestines, and therefore no "malapsorption", it is a simpler operation than the Gastric Bypass, and you should suffer none of the side effects experienced by bypass patients, such as the inability to absorb some nutrients, vitamins and trace elements resulting in malnutrition, nor should you experience " dumping syndrome" common after bypass because your digestion is unaltered.

Although your stomach will be much smaller, its function remains the same and you will still be able to absorb all the vital nutrients you need without having to take supplements by injection, though we strongly recommend oral supplements after surgery, to ensure you have your full daily quota of vitamins and minerals. You will note that there is no intestinal bypass with this procedure, only stomach reduction. This lack of an intestinal bypass avoids potentially costly long term complications such as marginal ulcers, vitamin deficiencies and intestinal obstructions.

Gastric Sleeve Diagram The portion of your stomach which is removed is responsible for secreting Ghrelin, which is a hormone that is responsible for appetite and hunger. By removing this portion of your stomach rather than leaving it in place, the level of Ghrelin is reduced to almost zero, resulting in a significant reduction or loss of appetite. An excellent study by Dr. Himpens in Belgium demonstrated that the food cravings in Vertical Sleeve Gastrectomy patients 3 years after surgery are much less than in Lap Band patients and this probably accounts for the comparatively greater weight loss.

The removed section of the stomach (fundus) is actually the portion that "stretches" the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food. Not only is your appetite reduced, but very small amounts of food will give you early and lasting feelings of fullness!

Most patients lose substantially more than 50% of their excess weight within the first 12 months after a sleeve gastrectomy.

The sleeve gastrectomy has a number of advantages over other bariatric procedures, and it may be a better solution for you than the Adjustable Gastric Band. Unlike the band, a sleeve gastrectomy does not require the implantation of an artificial device inside your abdomen, or frequent adjustment (filling and emptying saline solution by injection through a port under your skin) Dr Himpens and his colleagues in Brussels have published 3 year results comparing 40 Lap-Band patients to 40 Laparoscopic Vertical Sleeve Gastrectomy patients. The Vertical Sleeve Gastrectomy patients had a superior excess weight loss of 57% compared to 41% for the Lap Band group.

A Note on BMI (Body Mass Index) and co-morbidities

Your BMI will help Dr Cierny to assess your suitability for surgery, but there are several other factors which influence his decision.

You may be a yo-yo dieter, going through the "thinner" phase of your yo-yo effect now, but you can show your BMI has been substantially higher in the past.
The way in which your excess weight is distributed around your body may make your obesity of greater risk to your overall health, that is why it is often useful for Dr Cierny to see photographs of you
Your racial origin may make you more likely to develop some of the serious co-morbidities related to obesity at a lower BMI than others. There is research which suggests individuals of Asian origin are more likely to develop weight- related illnesses at a lower BMI.
Co-morbidities. Our list of co-morbidities is not exhaustive, and some co-morbidities, such as Diabetes Mellitus (Type II Diabetes), can have more serious implications than others. There is a strong body of evidence for the link between sustained weight loss, achieved by Bariatric surgery, and improvements in Type II Diabetes
*Co-morbidities are medical conditions that exist in addition to obesity and are often a result of being overweight. Co-morbidities are a factor in determining apatient's eligibility for bariatric surgery.
Co-morbidities include:- Type II diabetes mellitus; Obstructive sleep apnoea; Hypertension; Venous stasis disease; Significant impairment in activities of daily living; Stressurinary incontinence; Gastroesophageal reflux disease; Fertility problems; Obesity-related psychosocial stress; Sexual dysfunction; Degenerative joint disease; Chronic back pain Osteoarthritis; Gallbladder disease; Asthma; Congestive heart failure; Anaemia; Menstrual irregularity; Carcinoma (breast, colon, uterine cancer).

High Risk Patients

The risks involved in surgery for some patients are greater than for others. Statistically "higher risk" patients fall into one or more of the following categories:

Age over 50 - As with most operative procedures, people older than 50 are known to be at higher risk during surgery
BMI over 50 - those patients whose Body Mass Index is over 50 tend to be more at risk of peri-operative and post-operative complications
Male Patients - Men are more likely than women to suffer from certain conditions that can increase surgical risk. These include diabetes, hypertension and metabolic syndrome (also known as syndrome X or insulin resistance syndrome), a condition characterized by a group of risk factors including hypertension, high triglyceride levels, low HDL levels and high blood sugar levels after fasting.
High Blood Pressure (Hypertension) - People with high blood pressure (hypertension) often suffer from heart disease and/or chronic blood vessel inflammation, both of which increase the odds of serious surgery-related complications.
Heart or circulatory problems or a history of ischemic heart disease, or disease of the heart valves
History of Pulmonary embolism (blood clots in the lungs) - People who have previously had a blood clot in their lungs (pulmonary embolism) or legs, or who are genetically at risk for developing blood clots are at elevated surgical risk. All patients, regardless of their risk for clotting, are prescribed blood-thinning medications during the course of their stay in the clinic.
A history of breathing problems, pulmonary and bronchial disease, asthma or chronic bronchopulmonal obstructive syndrome. People who have suffered from these problems are more likely to encounter difficulties during or after surgery and present a higher risk for anaesthesia
A history of hiatal hernia, gastro-oesophagal reflux disease, stomach ulcers or a history of chronic diseases of the digestive tract (e.g.Chron's disease, Barrett's oesophagus)
A previous open major abdominal surgery in the upper abdomen might also signal a higher probability of adhesions which would prolong the proceedure and make the operation technically more difficult.

If you fall into one or more of the higher risk groups Dr Cierny may well ask for additional medical reports/tests to be made available to him prior to making his decision on your approval for surgery.

Patients who are in High Risk categories usually require additional tests, treatments and medication at the hospital, either before or after their surgery to ensure maximum care and safety. This will generate additional costs for the hospital. If you are regarded as a high risk patient because you can be placed into one or more of the categories listed above, your medical questionnaire will be carefully evaluated by the team at the hospital (together with any further medical information you are asked to provide) and we will let you know into which Risk Band Dr Cierny and the team have placed you when providing your quotation. Extra charges for High Risk patients will either be £200.00 (Risk Band I), £390 (Risk Band II) or £760 (Risk Band III - the most vulnerable patients)

Further information on any complications and risks associated with Bariatric surgery can be found in the FAQ's section of the website.