What is laparoscopic sleeve gastrectomy (tube stomach)?

Dr.Adem Dervişoğlu, MD, Professor

What is laparoscopic sleeve gastrectomy (tube stomach)?

Tube stomach surgery is the process of removing the large part of the stomach that serves as a container. This method allows for reducing the normal volume of the stomach, which is 1.5-2 liters, to roughly 100-150 ml and reshaping the stomach into a slim hollow tube (turning the stomach roughly to the size and shape of a big banana). In contrast to the gastric banding surgery, no foreign bodies are inserted into the stomach. The goal is to reduce the food quantities that can be eaten at a time but the natural flow of the digestive tract contents is not intervened.

Practically, two factors contribute to weight loss: The first is the restrictive effect due to the reduction of stomach volume. The second is the endocrine effect resulting in the feeling of satiety due to reduced levels of GHRELIN, which is called the fasting hormone and secreted from the removed stomach parts.

Tube stomach surgery allows patients to lose 65-75% of their excess weight in 1-2 years. This weight loss may be higher than this rate in compliant patients.

One of the major advantages of tube stomach surgery includes not interfering with the natural flow of the digestive system contents, minimizing the risk of developing vitamin and mineral deficiencies. Other major advantages include the unlikelihood of developing dumping syndrome, reflux complaints emerging less compared to the gastric banding surgery, and no foreign body placement into the body. The most important disadvantages of tube stomach surgery are the irreversibility of the method in contrast to gastric banding and the long stapler or incision line potentially associated with bleeding and anastomotic leaks.

After a properly performed tube stomach surgery procedure; complaints like nausea, vomiting, and pain occur very rarely in patients complying with changes in the dietary habits and principles. Clearly, the only obvious effect of sleeve gastrectomy that may affect the quality of life adversely after surgery is the development of reflux.

Moreover, the process of adjustment of the patient’s body to the tube stomach occurs more favorably compared to gastric banding and bypass surgery. The efficacy of sleeve gastrectomy for the remission of type 2 diabetes is close or equivalent to that of gastric bypass surgery. However, some studies in the literature have shown that diabetes may recur in the long term. Sleeve gastrectomy is much more advantageous for the length of operation time compared to the gastric bypass surgery. Both operations have similar effects on the quality of life.

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