29 May, 2024

The History Of The Surgical Sleeve

Surgical sleeve surgery is the most popular bariatric procedure performed today to help patients with obesity lose weight and lower their BMI (body mass index). It is also known as gastric sleeve surgery, and each year, over 160,000 of these are performed in the United States.

Today, we are going to explain the history of gastric sleeve surgery, describe what it involves, and provide the typical weight loss results it yields. Additionally, we will tell you about a newer and less invasive procedure that has proven to provide excellent weight loss results without surgery.

What Is The History Of The Surgical Sleeve For Weight Loss?

The procedure we know today as gastric sleeve surgery was born over time and improved on based on earlier procedures that were done to alleviate acid reflux. A doctor named L.T. Tretbar developed a technique to create a tubular shape during early fundoplication surgeries. He recorded the progress of 20 patients, some for one month and others for as long as 16 months, and noted they lost between 15 and 55 pounds.

Then, in 1988, Dr. D. Hess expanded on Dr. Tretbar’s technique and performed the first open gastric sleeve procedure as part of a more complicated surgery that was a form of what we today call the duodenal switch. He made some modifications to the shape and position of the stomach tube using a vertical position vs. a horizontal one, which helped reduce the amount of ghrelin (the hunger hormone) that was produced and released into the patient’s system. It also alleviated issues like dumping syndrome and ulcers that patients were experiencing with the earlier form of duodenal switch surgery.

In 1999, the technique was tested out by a team of doctors on a pig using small incisions to access the stomach rather than open surgery, becoming the first to be laparoscopically performed. It was then used on humans; however, those with higher BMIs had many complications. To make the surgery safer, one of these doctors (Gagner) decided to split the duodenal surgery into two stages, with the first being done to make the stomach smaller and tube-like and the second part rerouting the intestines. To his surprise, while the patients were healing from the first half of the surgery to prepare for the second half, they lost a considerable amount of weight. Over the years, the procedure has been refined to increase weight loss potential and minimize risks, making gastric sleeve surgery what it is today.

What Does Gastric Sleeve Surgery Involve?

Surgical sleeve surgery normally takes between ninety minutes and two hours to complete, depending on the patient’s specific circumstances. The patient is asleep during the entire procedure using general anesthesia, so they do not feel any pain or discomfort. The steps involved in a typical gastric sleeve surgery include:

  1. The surgeon makes a small incision in the abdomen (about ½ inch in length) and inserts a port. Carbon dioxide gas is pumped through this port to open up the space within the abdomen and allow the surgeon to work freely;
  2. Next, a special tool called a laparoscope, which is a tiny camera, is inserted through the port, providing a clear view of your internal organs on a screen for the surgeon;
  3. The surgeon will make between three and four additional incisions in the same manner to allow other thin surgical instruments to access the surgical site;
  4. Then the stomach is separated into two sections using surgical staples, so the side that remains will be approximately 25% of the original stomach. The surgeon cuts off and permanently eliminates the extra 75% of the remaining stomach tissue after placing the staples;
  5. The instruments are removed, and the abdominal incisions are closed.

Are There Certain Qualifications That Must Be Met Before You Can Have Surgical Sleeve Surgery?

Yes, there are specific qualifications patients must meet before they can have bariatric surgery. Some of these qualifications are imposed by the surgeon who will be performing the operation, and others are conditions put forth by medical insurance companies. If the patient desires the insurance company to help with or to cover the cost of the surgery, they must meet specific criteria. Some of these qualifications include:

  • The patient must suffer from severe obesity, which is determined by a body mass index of 40 or more. Patients with a BMI of 35 who also suffer from obesity-related conditions are also eligible;
  • Patients must have documented proof that they have tried other supervised weight loss programs for at least six months that were unsuccessful. (Programs like Weight Watchers, etc.);
  • Patients must demonstrate that they are physically as well as mentally ready for the challenges they will face before, during, and after surgery. Normally, this means they meet with a team of counselors and other specialists who will help determine their suitability for the surgery.

What Are The Risks Of The Surgical Sleeve?

Surgery always carries some risks, including those associated with using general anesthesia. Gastric sleeve surgery carries the fewest risks when compared to other forms of bariatric surgery however, they are much higher than endoscopic weight loss procedures. The risks of sleeve surgery include:

  • Excessive bleeding;
  • Potential infection;
  • Staple line leaks;
  • Strictures caused by scar tissue;
  • Stomach twisting;
  • Acid reflux;
  • Gallstones.

How Much Weight Can You Lose With A Surgical Sleeve?

The patient’s diligence in following a healthy lifestyle plan, including what they eat and how much physical exercise they engage in, will play a big part in how much weight they lose and how well they maintain their new weight.

The average weight loss after a gastric sleeve varies anywhere from 20% to 60% of their excess body weight in a year. Excess body weight is calculated as the difference in pounds between an individual’s ideal weight (falling into the category of a healthy BMI) and their current weight. For instance, if the patient’s current weight is 250 and their ideal weight is 150, then their excess body weight equals 100 pounds. This individual could lose between 20 and 60 pounds after gastric sleeve surgery during the first 12 months.

Why Don’t More Individuals with Obesity Have Surgical Sleeve Surgery?

Research has shown us that out of the 30 million American adults who qualify for bariatric surgery, less than 2% of them follow through with the operation. Experts feel that individuals are hesitant to proceed with the surgery due to insurance challenges, the patient’s unwillingness to take the risks associated with surgery or their lack of faith in its effectiveness in the long term.

Bariatric surgery does have a fairly long recovery time, and many individuals do not have the financial stability to take extended time away from work. Also, they may not have the support system required to allow them to adequately recover, especially if they are a single parent or have similar circumstances.

Regardless of the reason, for years there has been a huge gap in available medical assistance for patients who want help with obesity but do not, or cannot, undergo surgery. The good news is that advancements in endoscopic procedures have bridged that gap.

Is There A Non-Surgical Sleeve That Can Help Obese Patients Lose Weight?

Yes, endoscopic sleeve gastroplasty (ESG) is a procedure that is done without surgery to make the patient’s stomach smaller, similar to gastric sleeve surgery. ESG has been around for over ten years but recently gained approval from the FDA as a viable weight loss procedure. It helps patients lose weight by reducing the stomach size by about 75% by reshaping and stitching the stomach together from the inside, without cutting or removing any portion of it. Unlike gastric sleeve surgery, which makes permanent alterations to the stomach, ESG can be reversed if necessary.

Endoscopic gastric sleeve vs surgical gastric sleeve

What to Expect from the Non-Surgical Gastric Sleeve Procedure?

ESG is done by a board-certified gastroenterologist who is an expert endoscopist and has vast experience in performing the procedure. It is performed with the use of a special medical device called an endoscope, which resembles a flexible hollow hose but is outfitted with a tiny camera and a light source.

The endoscope is carefully lowered down the patient’s throat until it reaches the stomach, allowing other special tools needed for the procedure access to the stomach as well. The tiny camera transmits a live video stream to a monitor during the procedure, so the doctor can visualize and place the sutures with the utmost accuracy.

The entire procedure is normally completed within about an hour, and then the patient is observed for a period of time before being discharged to go home. Recovery is significantly shorter than that of the gastric sleeve, and the risks are substantially lower because it is not a surgical procedure. Most patients can return to their normal activities within a few days.

The amount of weight an individual can lose after ESG can vary depending on how dedicated they are to changing unhealthy eating and behavior patterns and developing new, healthier ones. Patients who have undergone the ESG procedure have lost an average of 20% of their starting weight or more in one year.

Regardless of whether a patient chooses a surgical sleeve, or ESG, their final results and reaching their ideal weight will depend on their consistent lifestyle choices.

Where Can I Learn More About ESG To Help Me Overcome Obesity?

If you are ready to make some changes to your lifestyle and improve your health, Gut Theory Total Digestive Care is here to help you every step of the way.

Dr. Janese S. Laster is a board-certified expert in Gastroenterology, Internal Medicine, Obesity Medicine, and Nutrition. Her extensive knowledge and experience benefit her patients not only through her expertise in performing weight loss procedures to help them lose weight but also through her ability to effectively teach them the importance of nutrition and strategies to live a healthier lifestyle.

Make your appointment today to learn more about becoming healthier through better nutrition and weight loss. We would love the opportunity to tell you more about endoscopic sleeve gastroplasty and determine if it is right for you. We are conveniently located in the Washington, DC, area, just a short distance from the Dupont Metro Station. Take that first big step to improve your health today!

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