Sleeve Gastrectomy is a laparoscopic weight loss surgery primarily designed for patients with severe obesity. This procedure involves removing approximately 80% of the stomach volume, shaping the stomach into a narrow, tube-like structure, significantly reducing appetite and delaying gastric emptying. Its main goal is to help patients achieve sustained weight control and improve obesity-related metabolic diseases.
The surgery not only reduces stomach capacity but also removes the fundus, which secretes ghrelin, thereby decreasing hunger. This therapy has been recognized by authoritative medical organizations in multiple countries as a first-line surgical option for severe obesity, suitable for patients with a BMI ≥ 35 with comorbidities.
This is a restrictive weight loss surgery that mainly reduces food intake by physically decreasing stomach volume. The procedure preserves the natural anatomy of the stomach but resects the original pouch into a tube approximately 15-20 centimeters long. This structural change causes patients to feel full after consuming a small amount of food.
The mechanism involves three effects: volume restriction, hormonal regulation, and metabolic improvement. After removal of the fundus, ghrelin secretion decreases by about 50-70%, while intestinal hormones such as GLP-1 increase, promoting blood glucose regulation. These physiological changes enable patients to naturally reduce appetite and maintain a feeling of fullness for a longer period postoperatively.
The primary candidates are those with a BMI ≥ 35, or BMI ≥ 30 with obesity-related conditions such as high blood sugar, hypertension, or sleep apnea. Patients who have not responded to traditional diet control, exercise, or medication treatments, and who have no severe cardiopulmonary dysfunction, are considered suitable candidates.
The surgery is also applicable for individuals with joint overload, fatty liver, or cardiovascular risk due to obesity. However, thorough evaluation by a multidisciplinary team is necessary to confirm that the patient is willing to undergo long-term follow-up and behavioral changes.
This is a one-time surgical treatment, usually performed via laparoscopic approach under general anesthesia, with a hospital stay of 3-5 days. The operation takes approximately 1.5-3 hours, using 4-5 small incisions of 0.5-1 centimeter. Postoperative care includes dietary adjustments, exercise plans, and regular nutritional monitoring.
There is no concept of "dosage" per se, but the surgeon will adjust the size of the gastric tube based on the patient’s body size. The standard procedure involves gastric suturing techniques (such as stapling) and bleeding control steps, performed by a specialized surgeon. In the first week after surgery, patients start with a liquid diet, gradually transitioning to a high-protein semi-solid diet.
On average, patients can lose 60-70% of excess weight within two years, with a maintenance rate exceeding 70%. For patients with type 2 diabetes, 60-80% can achieve normalization of blood glucose within one year post-surgery, with some reducing or discontinuing insulin therapy.
Compared to traditional gastric bypass, this surgery preserves the continuity of the digestive tract, reducing the risk of malabsorption. It has a shorter operative time, faster recovery, and laparoscopic techniques reduce wound complications. Long-term follow-up shows significant improvements in quality of life and mental health.
Immediate risks include bleeding, anastomotic leaks, or anesthesia-related complications, with an incidence of about 1-3%. Long-term issues may include deficiencies in vitamin B12, iron, and calcium, requiring regular blood monitoring. About 5-10% of patients may experience worsening gastroesophageal reflux disease (GERD) postoperatively.
Rare cases may develop gastric dilation or anastomotic leaks, potentially requiring reoperation. Psychological effects due to rapid weight changes may cause emotional fluctuations, requiring psychological education. The risk of weight regain within five years post-surgery is approximately 15-20%, emphasizing the importance of strict adherence to dietary guidance.
Absolute contraindications include severe cardiopulmonary insufficiency, uncontrolled psychiatric disorders, substance or food addiction, and refusal to participate in long-term nutritional follow-up. Relative contraindications include coagulation disorders or uncontrolled liver or kidney failure.
Postoperative lifelong supplementation with multivitamins, calcium, and vitamin B12 is necessary, with blood nutrient levels checked every six months. Patients must undergo preoperative psychological assessment and multidisciplinary consultation to ensure behavioral change motivation and social support systems.
Postoperative medication adjustments are necessary, such as significant reduction in diabetes medications to prevent hypoglycemia. Use of non-steroidal anti-inflammatory drugs (NSAIDs) may increase gastric mucosal irritation, so alternative pain management should be considered.
Changes in nutrient absorption after metabolic surgery require avoiding high-sugar diets and following dietary plans prepared by a nutritionist. High-intensity exercise should be avoided within six months post-surgery, with gradual rehabilitation designed by a physical therapist.
Multicenter studies show an average weight loss of 40-60% within one year after surgery, with a long-term maintenance rate of over 70%. Improvements in fatty liver, hypertension, and dyslipidemia are observed in 70%, 65%, and 55% of cases, respectively. The American Society for Gastrointestinal Endoscopy certifies that its long-term effects surpass non-surgical treatments.
The 2016 international metabolic surgery registry study reports a complete remission rate of 50-70% for diabetes post-surgery and a 35% reduction in cardiovascular disease risk. However, outcomes are highly dependent on postoperative behavior adherence, requiring strict compliance with dietary and exercise recommendations.
Other weight loss surgeries include adjustable gastric banding and Roux-en-Y gastric bypass. Gastric banding involves an adjustable band to restrict food intake but has a high long-term slippage rate of 20-30%, with less weight loss compared to sleeve gastrectomy.
Roux-en-Y bypass not only restricts food intake but also bypasses part of the intestine, which may lead to more nutritional deficiencies. Pharmacological treatments like GLP-1 receptor agonists achieve only 10-15% weight loss, requiring long-term injections and are costly. Behavioral therapy has limited effectiveness for severe obesity, making surgery the necessary option.
Patients need to undergo anesthesia assessment, gastrointestinal examinations (such as gastroscopy or upper GI X-ray), and cardiopulmonary function evaluation to confirm no surgical contraindications. Additionally, the doctor will tailor a surgical plan based on body weight, metabolic status, and medical history, providing preoperative dietary and medication adjustment advice.
What are the key principles for dietary adjustments after surgery?Postoperative care involves following a "three-phase diet plan": starting with liquids, gradually progressing to soft foods and then regular diet, with strict control of eating speed and portion sizes. Small, frequent meals are recommended, avoiding high-sugar and high-fat foods, and coordinating with a nutritionist to plan meals to reduce complication risks.
When can patients resume normal activities and exercise?Generally, patients can gradually resume light activities such as walking or household chores within 2-4 weeks, but should avoid lifting heavy objects for at least 6 weeks. Moderate to high-intensity exercise should be delayed for 3-6 months, depending on individual recovery progress, with adjustments made by the physician based on recovery status.
Is long-term vitamin or supplement intake necessary?Due to reduced stomach capacity affecting nutrient absorption, regular monitoring of iron, vitamin B12, and calcium levels is recommended, with adherence to prescribed multivitamin supplementation. If symptoms like fatigue or dizziness occur, additional mineral supplements may be needed to maintain metabolic balance.
If weight loss is not as expected post-surgery, what should be done?If weight loss does not meet expectations, the doctor may suggest adjusting dietary patterns, increasing exercise, or evaluating for behaviors such as binge eating. In rare cases, endoscopic or surgical adjustments to the stomach may be necessary, but only after careful assessment.
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