The Longitudinal « Sleeve » Gastrectomy

The Longitudinal Gastrectomy or Gastronomic Sleeve:
Also called « gastroplasty vertical calibrated with gastric resection » or « longitudinal gastrectomy », sleeve gastrectomy is a digestive surgical procedure performed on patients suffering from morbid obesity. This operation involves the removal of part of the stomach so that it forms a tube. Practiced for the first time in 2001, the sleeve-gastrectomy allows patients to lose considerable weight by provoking a feeling of rapid satiety generated by the reduction in the level of ghrelin, the appetite hormone.

Sleeve and BMI:
Obesity surgery concerns adults with significant overweight, i.e. with significant obesity with a BMI greater than or equal to 40 kg/m² or severe obesity with a BMI greater than or equal to 35 kg /m² associated with at least one complication that surgery can improve (type 2 diabetes, arterial hypertension, sleep apnea syndrome for example).

The choice of surgical technique is made by the multidisciplinary team and the person concerned. Many criteria are taken into account, including: the experience and technical environment of the surgeon and the anesthesia team, the extent of obesity, BMI, medical and surgical history, age, the associated digestive pathologies, the presence or absence of type 2 diabetes, current treatments and eating disorders.

There are two main types of surgical techniques:
So-called pure restrictive techniques such as sleeve gastrectomy,sleeveand so-called restrictive and “poorly absorptive” mixed techniques such as bypass or biliopancreatic diversion. In 2014, sleeve gastrectomy accounted for nearly 60% of obesity surgery procedures.

The sleeve, the most frequently performed technique, consists of removing approximately 2/3 of the stomach. This restrictive technique involves removing the part containing the cells that secrete the appetite-stimulating hormone, ghrelin. The stomach is reduced to a vertical tube and food passes quickly through the intestine. The weight loss is around 25-35 kg. This technique does not disturb the digestion of food because it is first slowed down during its passage through the tube and then evacuated very quickly through the intestine. The sleeve therefore acts by 2 complementary mechanisms: the restriction associated with a decrease in the rate of ghrelin, the hunger hormone, thus causing a lack of interest in food.

In practice : the operation is generally performed under laparoscopy and under general anesthesia. The duration of hospitalization varies from 2 to 10 days depending on the type of intervention and the general condition of the person. It can be extended if complications arise after the operation. It is necessary to plan at least 2 weeks off work after leaving the hospital. Like any intervention on the abdomen, the postoperative course can be painful.

After the surgery : what you need to know
Long-term follow-up is essential and it is sometimes necessary to perform a second surgery. In addition, it is important to know that this intervention is irreversible. Resuming physical activity is only recommended between the 2nd and 4th week.

Feed :
After the procedure, you eat liquid food and then in puree form. Solid food is gradually restored.

Recommendations from the High Authority for Health:

1. Take small amounts with each meal and chew slowly.
2. Take your meals seated and in peace.
3. Stop eating as soon as you feel the first digestive tugs and as soon as you no longer have the feeling of hunger (satiety).
4. Do not drink while eating (but enough between meals).
5. Eat a balanced and varied diet to avoid nutritional deficiencies and increase the chances of losing weight.
6. Maintain an adequate protein intake (meat, fish, eggs, dairy products).
7. Avoid carbonated drinks, sugary drinks, sauces and fried foods, as well as sweets and fatty foods.

Complications:
Complications of the sleeve are rare but can occur:

1. The risk of postoperative fistula is one of the main risks of this intervention. The practice of a TOGD, esophagogastric transit between the first and the third postoperative day and before the resumption of food is necessary in order to detect a fistula.
2. Other complications may appear in the days following the operation, such as perforation or hemorrhage.
3. Gastroesophageal reflux disease, inflammation of the esophagus, or stomach enlargement may also occur.
4. An infection at the level of a scar in the few weeks following the operation may appear.
5. Nutritional deficiencies that can cause anemia, gastric ulcer or tube stenosis can also occur.

Successes/failures of the sleeve:
Failures can occur. They are mainly linked to a lack of follow-up, non-compliance with post-operative recommendations such as the obligation to modify one's eating behavior and the absence of resumption of regular physical activity.

1. Aged 18 to 60.
2. Having no psychological contraindication.
3. Does not present any specific operative risk.

It is only offered after failure of other weight loss methods (dietary monitoring, physical activity, etc.).