Sleeve gastrectomy

Sleeve gastrectomy
Diagram of a gastric sleeve
ICD-9-CM 43.89

Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve or tube like structure. The procedure permanently reduces the size of the stomach, although there could be some dilatation of the stomach later on in life. The procedure is generally performed laparoscopically and is irreversible.

Procedure

Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for whom the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.

Today sleeve gastrectomy is the fastest-growing weight loss surgery option in North America and Asia. In many cases, but not all, sleeve gastrectomy is as effective as gastric bypass surgery, including weight-independent benefits on glucose homeostasis. The precise mechanism that produces these benefits is not known.

Sleeve gastrectomy surgery.

The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia.[1] The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 36-40 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.[2]

Use in children and adolescents

Endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders[3] and the American Society for Metabolic and Bariatric Surgery,[4] sleeve gastrectomy is gaining popularity in children and adolescents. Studies by Alqahtani and colleagues have found that sleeve gastrectomy causes large weight loss in children and adolescents aged 5 to 21 years.[5] Moreover, they compared weight loss with adults and found comparable weight loss.[6] Recent reports from the group show that growth progresses unaffected after sleeve gastrectomy in children younger than 14 years of age.[7]

Complications

Sleeve gastrectomy may cause complications; some of them are listed below:

  • Sleeve leaking (occurs 1 in 200 patients)
  • Blood clots (happens 1% of the time)
  • Wound infections (occurs in about 10-15% of post-op patients)
  • Strictures (occurs 3.5% of post-op patients)[8]
  • Aversion to food and nausea[9]
  • Damage to the vagus nerve which will cause constant nausea
  • Gastroparesis, with a delay in moving food from the stomach to the small intestine
  • Vomiting
  • Esophageal spasm/pain
  • Gastroesophageal Reflux Disease (GERD)

Costs

There are three cost categories for sleeve gastrectomy surgery: pre-op (all fees associated with preparing the patient for surgery including professional fees, lab work and testing), the surgery itself (including surgeon, surgical assistant, anesthesia and hospital fees) and post-op costs (follow-up physician office visits, vitamins and supplements).

Out of pocket costs for the sleeve gastrectomy surgery itself may be offered to the patient as a packaged price or charged separately by the surgeon's office and hospital. Packaged prices may or may not include pre-op and post-op care, depending on the surgical practice.

Average costs for sleeve gastrectomy surgery are $19,000 in the United States, although this varies widely between states; South Dakota and Texas offer the lowest average cost at about $12,000 while the most expensive surgeries are performed in Alaska (average about $58,000).[10] In Turkey this operation costs $6,000 USD. In Jordan the total cost is around $4,000 USD, which includes all pre-surgery tests, x-ray and hospital fees. In New Zealand the cost is approximately $20,000 USD. Superannuation in Australia may be accessed by patients to fund the cost of surgery.[11]

In Denmark the typical Price is 9600 $ as of feb 2018 at a private hospital.

The procedure is covered by several insurance plans if deemed medically necessary. Coverage is required in several states in the USA due to requirements of the Affordable Care Act.[12]

References

  1. ↑ Paluszkiewicz R, Kalinowski P, Wróblewski T, et al. (December 2012). "Prospective randomized clinical trial of laparoscopic sleeve gastrectomy versus open Roux-en-Y gastric bypass for the management of patients with morbid obesity". Wideochirurgia I Inne Techniki Mało Inwazyjne. 7 (4): 225–32. doi:10.5114/wiitm.2012.32384. PMC 3557743. PMID 23362420.
  2. ↑ Karmali S, Schauer P, Birch D, Sharma AM, Sherman V (April 2010). "Laparoscopic sleeve gastrectomy: an innovative new tool in the battle against the obesity epidemic in Canada". Canadian Journal of Surgery. 53 (2): 126–32. PMC 2845949. PMID 20334745.
  3. ↑ http://www.ifso.com%5Bfull+citation+needed%5D
  4. ↑ http://asmbs.org/obesity-and-surgery-learning-center/bariatric-surgery-procedures/%5Bfull+citation+needed%5D
  5. ↑ Alqahtani AR, Antonisamy B, Alamri H, Elahmedi M, Zimmerman VA (August 2012). "Laparoscopic sleeve gastrectomy in 108 obese children and adolescents aged 5 to 21 years". Annals of Surgery. 256 (2): 266–73. doi:10.1097/SLA.0b013e318251e92b. PMID 22504281.
  6. ↑ Alqahtani A, Alamri H, Elahmedi M, Mohammed R (November 2012). "Laparoscopic sleeve gastrectomy in adult and pediatric obese patients: a comparative study". Surgical Endoscopy. 26 (11): 3094–100. doi:10.1007/s00464-012-2345-x. PMID 22648112.
  7. ↑ Alqahtani AR, Elahmedi M, Al Qahtani A (February 2016). "Laparoscopic Sleeve Gastrectomy in Children Younger Than 14 Years: Refuting the Concerns". Annals of Surgery. 263 (2): 312–9. doi:10.1097/SLA.0000000000001278. PMID 26496081.
  8. ↑ "Gastric Sleeve Surgery: Common Risks and Complications". Gastric Sleeve Diet Guide. Retrieved 16 March 2017.
  9. ↑ "Gastric Sleeve Complications Post Surgery". BSIG. Retrieved 5 August 2013.
  10. ↑ Gastric Sleeve: 14 Ways It Will Affect You, Bariatric Surgery Source, retrieved 30 November 2017
  11. ↑ https://www.smh.com.au/healthcare/superannuation-tapped-to-fund-weightloss-surgery-20140103-309hx.html
  12. ↑ Bariatric Surgery Insurance: Complete Patient Guide, Bariatric Surgery Source, retrieved 19 April 2015
  • Pitombo, Cid (2008). Obesity surgery: principles and practice. McGraw Hill Professional. p. 177. ISBN 0-07-149492-8.
  • Nguyen, etc all; Ninh T. Nguyen; Eric J. DeMaria; Sayeed Ikramuddin; Matthew M. Hutter (2008). The SAGES Manual: A Practical Guide to Bariatric Surgery. Springer. p. 131. ISBN 0-387-69170-7.
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