Is the oldest bariatric procedure being carried out for last 50-60 years.
Surgery involves creating a small stomach pouch & rerouting the small intestines Rest of the stomach remains functional & is connected to intestine.
The person feels full with a small portion of food and due to associated mal-absorption, part of the food is not absorbed by the body.
This surgery results in hormonal changes which lead to better control of blood sugars in diabetic patients.
Complications - Besides usual complications associated with a surgery in an obese like infection, wound dehiscence, pulmonary embolism, incisional hernia etc, specific complications include post op bleeding, leak, dumping etc. The possibility of most of these can be reduced substantially with pre-op preparation, careful technique & post-op compliance.
Special Dietary Requirements – Post op protein requirement is 60-100 gms protein/day. Besides person is expected to consume vitamins, calcium & B12 supplements daily to avoid deficiencies.
Advantages:
Sleeve gastrectomy is a procedure that induces weight loss by restricting food intake. The sleeve gastrectomy is an operation in which the left side of the stomach is surgically removed.
This results in a stomach, which is roughly the size and shape of a banana. Since this operation does not involve any “rerouting” or reconnecting of the intestines, it is a simpler operation than the gastric bypass or the duodenal switch.
Advantages of the Sleeve Gastrectomy: -
Special Dietary Requirement -
Higher protein intake, multi vitamin & mineral supplementation prevents any nutritional deficiencies.
Complications -
The reported incidence of complications is at par with other major surgeries performed on obese. These include – Operative Mortality – ~0.2% (None in our series since 2005).
Intra-operative Complications
~1.4% including bleeding, injury & stapler malfunctioning etc.
Early Complications
This includes wound infections, pulmonary embolism, leaks, bleeding & cardio-pulmonary complications etc.
Late Complications
These includes gall stone formation, incisional hernia, rarely intractable vomiting, ulcer, weight regain, metabolic sequelae including iron deficiency, B12, Folate deficiencies etc.
Weight Loss
The average excess weight loss is > ~70% after sleeve gastrectomy surgery.
Co-morbidity improvement
Robotic surgery reduces possibility of human error coupled with precision offered by highly evolved technology from Intuitive Surgical. Though the surgical cost increases, the quality assurance should be an important consideration.
Ileal Transposition (surgery for thin/ normal weight diabetics)
Ileal Transposition surgery developed by Dr. Aureo de Paula from Brazil, is performed under clinical trial protocol. It is expected to help glycemic control in selected type 2 diabetes mellitus patients.
Ileal Transposition A segment of the last part of the intestine (ileum) is interposed between 2 parts of the small intestine (jejunum) just beyond stomach. No part of the small intestine is removed or bypassed.
Weight Loss
The average excess weight loss is > ~70% after sleeve gastrectomy surgery.
Proposed Mechanisms of Blood Sugar Control:
Blood glucose control even in patients with severe beta cell impairment. The suggested mechanisms of blood sugar control are
Post Op recovery:
Long term results :
Ileal Transposition is based on hindgut hypothesis derived from Roux-n-y gastric bypass surgery. Long term follow up data of gastric bypass has shown 80-100% blood sugar and insulin maintenance even after 14 years
MS, DNB, MNAMS, MRCS, FMAS, FIAGES
Consultant Gastrointestinal, Laparoscopic & Obesity Surgeon.Founder of Centre for Advanced Laparoscopy & Obesity Surgery (CALOS)
He is one of the best Laparoscopic Surgeons in India when it comes to a Hernia, Gall Bladder, Appendix, Colorectal, Varicose Vein and Obesity Surgery.
Practising surgeon in western suburbs of Mumbai since last 15 years.A teaching faculty in laparoscopic surgery at the prestigious Johnson and Johnson, at Ethicon institute.Associate professor and head of unit at K.B. Bhabha hospital Bandra.He is consultant at many prestigious hospital in Mumbai namely Hinduja hospital khar, Raheja fortis Hosp mahim, criticare hosp andheri, kohinoor hospital kurla, beams hosp khar.