A tube gastrectomy (also known as a “sleeve” gastrectomy) is an operation designed to reduce the size of the stomach. The large expandable portion of the stomach is resected and therefore the amount of food which can be eaten during a meal is reduced. In addition the feeling of satiety or satisfaction after eating is brought on after a smaller volume. It is therefore considered a “restrictive” bariatric procedure.
Originally designed as a first stage operation for patients who are super obese, it has been extremely successful and is now usually performed as a procedure in its own right.
The stomach normally has a large capacity and ability to stretch allowing huge meals to be ingested. This operation removes 90% of this capacity and converts the large gastric pouch into a thing taut tube – hence the name of the procedure.
One effects of this operation is to reduce appetite for patients. First of all the region of the stomach involved in secreting hunger hormones is resected. Secondly the remaining stomach is quite stiff, and doesn't expand easily therefore reducing the amount of food required before the stomach is full. Patients who are committed and eat three sensible meals a day feel “full” and satisfied after a much smaller amount of food than they previously ate. Patients who overeat after this operation complain of tightness in the stomach and are disinclined to continue eating.
Advantages of the tube gastrectomy are that patients have an ability to eat what they like, just in smaller amounts. The requirement for frequent follow up is much less than with gastric banding which appeals to many people. Weight loss has been very good so far with this relatively new procedure and the average amount loss is generally in excess of 50-60% of excess weight at 5 years.
Disadvantages of this procedure are considered to be that it may worsen reflux symptoms in people who are prone to this problem, the absence of any real long term data (greater than 10 years) and the severe consequences of a leak after the resection. A leak occurs in around 1 in 1000 to 1 in 100 patients and can be a terrible complication with a prolonged (months) period in hospital.
Overall this is a very effective restrictive bariatric operation. Patients have a good quality of life and expect very good weight loss. As with any obesity operation a committment to an improvement in dietary habits and regular exercise are important to achieve the best results.
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