The gastric sleeve is a form of stomach reduction for the treatment of obesity. During the operation, a large part of the stomach is removed, so that only a hose-like remainder is maintained and the patients therefore feel much more satiated during eating. Our stomach surgery experts explain here all important information about the prerequisites for the operation, its benefits and risks.
The tubular stomach is a form of gastric reduction for the treatment of obesity. During the operation, a large part of the stomach is removed, so that only a hose-like remainder is maintained and the patients therefore feel much more satiated during eating. Read all important information about the prerequisites for the operation, its benefits and risks!
Tubular stomach surgery or sleeve gastrectomy is a reduction surgery of the stomach for the treatment of obesity (adiposity). The method is based on the principle of food restriction: The surgery is the stomach volume reduced to about the size of a small banana. As a result, the stomach is already filled after small amounts of food. The stomach filling leads to an expansion of the stomach wall, which in turn triggers the feeling of satiety.
In addition, the tube stomach surgery also seems to initiate hormonal processes that curb appetite. There is evidence that after a gastrostomy gastrectomy, the stomach produces lower levels of the so-called starvation hormone "ghrelin", thereby further reducing appetite. At the same time appetite-suppressing messengers are released. These include, for example, "GLP-1" and "peptide YY".
The messenger substances also have a favorable effect on various metabolic processes (metabolism). Therefore, the stomach-shrinking operations are increasingly referred to as metabolic surgery. For example, in many patients an existing diabetes mellitus (type 2 diabetes mellitus) improves markedly after the operation. The tube stomach surgery is carried out worldwide with a strong upward trend. In Germany, sleeve gastrectomy is the most commonly performed procedure of obesity surgery.
Before the actual operation, certain preliminary examinations are necessary. This includes a reflection of the esophagus, stomach and duodenum (esophagogastroduodenoscopy) to exclude pathological changes such as inflammation, ulcers or tumors. Upper abdominal sonography can also be used to assess the liver, gallbladder and pancreas. For anesthesia preparation, an ECG is also written and, if necessary, a pulmonary function examination ("Lufu") is carried out.
Especially with very pronounced obesity (BMI above 40 kg / m2) with fatty liver, a so-called protein-rich liquid phase is recommended to the patients before the tube stomach surgery. It starts about 10 to 14 days before surgery depending on the hospital. During this time, patients should only take liquid, protein-rich foods. The aim of the liquid phase is a slight weight loss and reduction of fatty liver. Precise information on the course of this preoperative liquid phase can be obtained directly from the treating hospital.
In a tube stomach, most of the stomach is removed. Remain a two to three centimeters narrow tube (sleeve stomach) with a capacity of about 80 to 120 milliliters.
The tube stomach surgery always takes place under general anesthesia. In general, however, no large abdominal incision is necessary, but the procedure is performed as a so-called minimally invasive surgery, (keyhole technique) on some small cuts in the abdominal wall. The actual surgery takes just over an hour and is usually done in these steps:
After inserting the surgical instruments and the camera, the abdominal cavity is filled with a gas (usually carbon dioxide) to provide better accessibility and a view of the abdominal organs.
Now the surgeon drives with a so-called stapler (stapler) along the curved lower edge of the stomach (large curvature). The forklift has two functions: First, it separates the lower part of the stomach. At the same time, staples are introduced along the cut, which connect the wound edges and close the remaining gastric tube. A time-consuming seam by hand is therefore not necessary.
The separated stomach portion is pulled with a so-called plastic bag from one of the working channels from the abdomen. Subsequently, dye is introduced into the stomach via a stomach tube. This serves to check the tightness of the staple seam along the cut edge. If no dye emerges, the operation can be completed.
A tubular stomach is a great way to effectively lose weight starting from a body mass index (BMI) of 40 kg / m² for severely overweight people. For additional illnesses such as diabetes, which could improve by the weight loss, a tubular stomach is also laid from a BMI of 35 kg / m².
The prerequisite is that the patient already has several unsuccessful weight loss attempts (with a change in diet and lifestyle) under medical supervision behind him. Patients should be at least 18 and 65 years old or less.
In extremely overweight people, the tube stomach surgery is sometimes performed as a first step in a more complex obesity surgery. If the patient then lost weight and thereby reduces its surgical risk, in a second step, an even more effective operation is performed, such as a biliopancreatic division or gastric bypass. Such operations not only restrict food intake (restriction), but also food utilization (malabsorption).
The chances of success with regard to weight loss are very high in the peritoneal surgery: Initial studies show that patients on average manage to reduce their excess body weight (excess weight) by between 33 and 83 percent. Since tubal gland surgery is a relatively recent surgical technique, there are no long-term results on the success of the method.
In some people, after a few years of weight loss, it comes to a new weight gain. A certain orientation with regard to the long-term expectations is provided by a technique very similar to the tube stomach, the so-called "Magenstraße Mill operation". In this operation, which is no longer usual, a gastric tube was also formed, but the remaining gastric portions were left in the body. This technique, which is comparable to the tube stomach, showed in a study a five-year result of 60 percent excess weight loss (EWL).
A sleeve gastrectomy is a restrictive surgical procedure in which a large section of the stomach is removed. After this procedure, the patient can only consume small quantities of food in one sitting. Our department of Bariatric Surgery performs this kind of surgery on the highest technological level. At our clinic in Friedrichshafen, Germany, we specialise in a variety of surgical methods to counteract obesity.
At our clinic in Germany, a sleeve gastrectomy is performed laparoscopically (keyhole gastric surgery), with the added advantage that the incisions on the skin are small and heal quickly. In this operation, a large portion of the stomach is removed, leaving only a narrow, vertically positioned tube-shaped organ to connect the oesophagus to the intestines. This reduces the volume of the stomach considerably, ensuring that the patient cannot eat large quantities of food or drink large volumes in one sitting. The production of the “hunger” hormone, ghrelin, is also affected, so that the patient no longer feels constantly hungry.
A sleeve gastrectomy is suitable for patients who adhere to regular mealtimes, do not snack between meals and prefer savoury foods to sweet foods. In the first year after the operation, the patient’s excess weight can be reduced by 60 – 70%.
A sleeve gastrectomy is particularly rewarding in the case of extreme obesity that is accompanied by several other disorders and the existence of metabolic syndrome. Such method is less invasive than a gastric bypass and the results with the regard to the control of accompanying disorders (better adjustment or healing of diabetes, influence on insulin resistance) are very satisfactory. However, long-term results of sleeve gastrectomy are not yet available.
A sleeve gastrectomy results in rapid weight-loss, but a gastric bypass remains the more effective method. A sleeve gastrectomy is not indicated in the case of eating disorders such as binge eating or sweet eating (preference of sweets and high-calorie drinks such as fruit juice and lemonade). Neither is it indicated for patients who suffer from heartburn, as this unpleasant condition can be aggravated by this type of surgery. Our specialists at Friedrichshafen Clinic in Germany will advise you on the best option in your specific case.
In a sleeve gastrectomy, the stomach is reduced by over 85% via keyhole surgery. This part of the procedure is irreversible. The formation of a gastric sleeve reduces the volume of the stomach, thereby reducing the volume of food that can be consumed in a single sitting. The portion of the stomach that is removed in a sleeve gastrectomy is formed into a tube. It has a volume of no more than 200 - 300ml. The excess stomach tissue is surgically removed. Ghrelin, the hormone responsible for hunger, which is mostly produced in the part of the stomach that is removed, is produced in much smaller quantities. Therefore, a sleeve gastrectomy also reduces craving for food in the patient. However, the normal functioning of the stomach is retained after a sleeve gastrectomy. The small portion of stomach that is retained can still be examined endoscopically and the oesophagus is unaffected. For more information, feel free to contact us at our clinic in Germany.
In the period immediately following a sleeve gastrectomy, there is a danger of the wound bursting and causing inflammation. A high degree of compliance on the part of the patient is essential after a sleeve gastrectomy. The eating habits must be acutely adapted to suit the surgical method used. An incorrect diet can result in the stomach expanding, thereby making the procedure less effective with regard to weight-loss. Pre-existing acid reflux can increase considerably after a sleeve gastrectomy. Due to the reduction of the stomach volume after a sleeve gastrectomy, only very small quantities of liquids can be consumed, especially to begin with. Usually it is recommended that patients take a vitamin and trace element preparation daily to balance the lower nutrient intake by the smaller stomach. In certain cases, a sleeve gastrectomy might have to be modified into a gastric bypass. Our surgeons at Friedrichshafen Clinic in Germany have a great deal of experience in this type of surgery.
In addition to sleeve gastrectomy operations, our surgeons at the Friedrichshafen Clinic in Germany also perform gastric bypass surgery, gastric balloon surgery and gastric band surgery.
The Adiposity Centre of the Friedrichshafen clinic in Germany offers optimal care and therapy for all patients whose lives are affected by morbid obesity. A sleeve gastrectomy is just one of the options.
The basis of the interdisciplinary multi-modal, multi-level approach at the Friedrichshafen clinic in Germany is the close cross-discipline specialist competence of our physicians and surgeons in the treatment of obesity, which provides excellent medical and therapeutic care of the patient, 24 hours a day, both before and after major surgical procedures such as a sleeve gastrectomy.
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