Sleeve Gastrectomy

Obesity is fairly self diagnostic and can be determined with a simple physical exam by a doctor. However, the doctor may perform certain tests to determine the level of obesity and the presence of other obesity related disorders. The following diagnostic procedures may be followed.

• Physical exam - during the physical exam, the first thing that the doctor would measure would be the person’s body mass index (BMI). Body mass index is determined by diving a person’s weight by the square of the person’s height. People with a BMI higher than 25 upto 29.5 are considered overweight whereas those with a BMI of over 30 are considered obese. A BMI higher than 40 poses a need for surgery.
• Medical history – the doctor may take a full medical history to decide the course of the treatment. The doctor would potentially check for the presence of any other medical conditions and whether the patient’s weight has responded to diets or exercise in the past to confirm the need for surgery.
• Tests – the doctor may require other tests for co-morbid conditions like hypertension, diabetes, heart disease etc. Other illnesses such as Prader-Willi syndrome, Cohen syndrome, Cushing’s syndrome and hypothyroidism can also cause obesity. Obesity can automatically be handled if these conditions are confirmed and treated.

The sleeve gastrectomy procedure is performed laparoscopically in most cases. This is done by making several small incisions in the abdomen. The surgical instruments are inserted through these incisions. The stomach is then reduced in size to almost 15% of its original size to form a small narrow tube almost like the shape of a banana. The open edges are then stapled and the excess stomach tissue is removed and discarded. Reducing the size of the stomach automatically reduces the amount of food one can consume thus aiding in weight loss. It also reduces the production of the hunger producing hormone ghrelin, which would make the patient feel satiated with smaller quantities of food. It does not involve re-arranging the intestines like in gastric bypass, and is therefore less invasive. 

• The possibility of a leak in the stomach along the staple line that can cause its contents to overflow in the bloodstream. This can be life threatening and would require a second surgery
• Infection at the site of incision
• Excessive bleeding
• Requirement for a second surgery
• Formation of blood clots in the veins (deep vein thrombosis) or pulmonary embolism (clots in the lungs)
• Damage to other nearby internal organs  

• You will be staying in the hospital for three to four days after the procedure.
• The first follow-up appointment is scheduled on the seventh to tenth day from the surgery when the clips and dressings are removed.
• After the procedure, you will be required to have a sugar-free, non-carbonated liquid diet for the first seven days.
• You can start with pureed foods after one week. This diet can continue for another three weeks.
• Regular food can be started approximately four weeks after the surgery.
• The patient needs to eat small quantities of food at a time and chew it slowly.
• The doctor will prescribe multivitamins that need to be taken twice a day.
• A calcium supplement will be prescribed to be taken once a day.
• A vitamin B-12 injection will be given once a month, for the rest of life.
• Follow-ups and frequent medical checkups will be required for the first several weeks following the procedure.
• The regular check-ups may include blood tests and other examinations.
• The patient is expected to lose about 70% of his excess body weight, approximately 6 to 8 kgs on an average every month.

There are several changes in the body that may occur due to the rapid loss of weight in the first three to six months following the surgery:

• Body aches
• Exhaustion
• Flu-like symptoms
• Dry skin
• Feeling cold
• Thinning or loss of hair
• Changes in mood