Table of Contents
Introduction
The impact of sleeve gastrectomy, examining the procedure’s effectiveness in achieving and maintaining significant weight loss, and its influence on various health outcomes.
Sleeve gastrectomy has become popular for those seeking surgical intervention to address obesity and improve their overall health.
As one of the most commonly performed bariatric surgeries worldwide [1], it is crucial to understand the long-term effects of sleeve gastrectomy on both weight loss and health outcomes.
Sleeve gastrectomy, also known as laparoscopic or vertical sleeve gastrectomy, is a minimally invasive procedure that involves removing approximately 80% of the stomach, leaving a small, tube-like pouch [2].
This restrictive surgery limits the amount of food consumed and promotes feelings of fullness, ultimately leading to weight loss.
Sleeve gastrectomy compared to gastric bypass
Sleeve gastrectomy has gained favour among patients and physicians due to its less complicated nature than other weight loss surgeries, such as gastric bypass [3].
Long-term weight loss outcomes following sleeve gastrectomy are multifaceted and depend on various factors, including lifestyle changes, adherence to post-operative guidelines, and the availability of support systems [4]. Although the procedure has been shown to result in substantial weight loss, it is crucial to examine its long-term sustainability and potential risks, such as weight regain or nutritional deficiencies.
To weight loss, sleeve gastrectomy has been associated with significant improvements in obesity-related comorbidities, such as type 2 diabetes, hypertension, sleep apnea, and cardiovascular diseases [4]. Furthermore, the surgery can lead to positive changes in mental health, including improvements in self-esteem and quality of life.
However, it is also essential to address potential risks for mood disorders and the strategies needed to prevent malnutrition and other complications.
Examining these factors, we hope to contribute to the growing body of literature on this topic and aid patients and physicians in making informed decisions regarding bariatric surgery [5].
Background on sleeve gastrectomy
Sleeve gastrectomy, a popular bariatric surgery option, has shown promising results for long-term weight loss and health improvement in individuals with obesity [1].
Providing an overview of the sleeve gastrectomy procedure, discussing its candidacy criteria, and comparing it to other typical weight loss surgeries.
Sleeve gastrectomy, also known as laparoscopic sleeve gastrectomy or vertical sleeve gastrectomy, is a surgical weight loss procedure that involves the removal of approximately 80% of the stomach [2].
The remaining stomach is reshaped into a tube-like structure, significantly reducing its capacity to hold food. This results in earlier satiety and decreased caloric intake, ultimately leading to weight loss.
The procedure is performed laparoscopically, meaning it is minimally invasive and involves small incisions, which reduces postoperative pain, scarring, and recovery time [3].
Candidates for sleeve gastrectomy
Candidates for sleeve gastrectomy are typically individuals with a body mass index (BMI) of 40 or higher or a BMI of 35 or higher with obesity-related comorbidities, such as type 2 diabetes, hypertension, or sleep apnea [4].
In some cases, patients with a BMI between 30 and 34.9 with significant obesity-related comorbidities may also be considered for the surgery. A thorough evaluation by a multidisciplinary team, including a bariatric surgeon, nutritionist, and psychologist, is necessary to determine a patient’s suitability for the procedure.
This evaluation process typically includes assessing the patient’s medical history, psychological readiness, and commitment to lifestyle changes necessary for long-term success following the surgery.
Sleeve gastrectomy offers several advantages over other weight loss surgeries, such as gastric bypass and adjustable gastric banding.
Firstly, it is a relatively more straightforward procedure, with no need for intestinal rerouting or implantation of a foreign device, as seen in gastric bypass and adjustable gastric banding [3].
This makes sleeve gastrectomy less likely to cause complications related to intestinal obstruction, malabsorption, or device malfunction.
Sleeve gastrectomy has resulted in significant weight loss and improvements in obesity-related comorbidities comparable to those achieved with gastric bypass [5].
Gastric bypass may be more effective for patients with severe type 2 diabetes, as it has resulted in higher diabetes remission rates than sleeve gastrectomy [5].
Complications
In terms of complications, sleeve gastrectomy generally has a lower risk profile than gastric bypass but a higher risk profile than adjustable gastric banding [3].
Common complications associated with sleeve gastrectomy include leaks, strictures, and gastroesophageal reflux disease (GERD).
Nevertheless, the overall complication rate for sleeve gastrectomy is relatively low and decreases further with an experienced surgical team.
Sleeve gastrectomy is a popular bariatric surgery option for individuals with obesity, offering significant weight loss and health improvements.
The procedure’s minimally invasive nature, simplicity, and relatively lower risk profile than other weight loss surgeries make it an attractive option for patients and physicians.
To determine the most appropriate bariatric surgery option, it is essential to carefully consider a patient’s specific circumstances, including their BMI, comorbidities, and readiness for lifestyle changes.
Long-term weight loss outcomes
The long-term weight loss outcomes following sleeve gastrectomy are critical to understanding the overall effectiveness of the procedure.
The weight loss trends observed in patients who have undergone sleeve gastrectomy and the factors that influence long-term weight loss success.
Weight loss following sleeve gastrectomy tends to occur in two phases. The first phase is characterised by rapid weight loss, typically within the first six months post-surgery [1].
This initial rapid weight loss can be attributed to the significant reduction in stomach capacity, which limits caloric intake and promotes early satiety.
During this phase, patients may lose up to 60% of their excess body weight [2].
The second phase of weight loss
The second phase of weight loss is characterised by a plateau and gradual weight loss, usually occurring between six months to two years post-surgery.
The rate of weight loss tends to slow down during this period as the body adapts to the reduced caloric intake and patients approach their target weight.
On average, patients can expect to lose approximately 50-70% of their excess body weight within the first two years following sleeve gastrectomy [2].
Long-term studies have shown that most patients maintain a significant portion of their initial weight loss, with an average excess weight loss of around 50-60% at five years post-surgery [3].
Various factors influence the long-term weight loss success following sleeve gastrectomy, including lifestyle changes, adherence to post-operative guidelines, and the availability of support systems.
Lifestyle changes, such as adopting a healthy diet, engaging in regular physical activity, and managing stress, are crucial to losing weight after surgery [4].
Patients who commit to these changes are more likely to experience sustained weight loss and better overall health outcomes.
Adhering to post-operative guidelines
Adherence to post-operative guidelines is another critical factor in achieving long-term weight loss success. Sleeve gastrectomy patients are typically advised to follow a structured diet plan, which includes consuming small, nutrient-dense meals, avoiding calorie-dense and nutrient-poor foods, and staying well-hydrated.
Patients are encouraged to take vitamin and mineral supplements to prevent nutritional deficiencies that may arise due to reduced stomach capacity and altered digestion [4].
Support systems, such as regular follow-up appointments with healthcare providers and participation in support groups, can significantly impact long-term weight loss success.
Ongoing support and monitoring help patients address any challenges they may face, such as emotional eating or difficulties adhering to dietary guidelines and provide them with the necessary tools and resources to maintain their weight loss [5].
Sleeve gastrectomy has resulted in significant long-term weight loss for many patients. The long-term success of the procedure relies heavily on patients’ commitment to lifestyle changes, adherence to post-operative guidelines, and the availability of support systems.
Addressing these factors, healthcare providers can help patients achieve and maintain their weight loss goals, ultimately improving their overall health and quality of life.
Health Outcomes
To weight loss, sleeve gastrectomy has been associated with significant improvements in various health outcomes, particularly obesity-related comorbidities.
The impact of sleeve gastrectomy on common comorbidities, mental health outcomes, and potential nutritional deficiencies and complications.
Improvement in obesity-related comorbidities is one of the most significant benefits of sleeve gastrectomy.
Several studies have shown marked improvements in conditions such as type 2 diabetes, hypertension, sleep apnea, and cardiovascular diseases following surgery [1].
Sleeve gastrectomy has been associated with type 2 diabetes remission rates of up to 60% within the first two years post-surgery, with improvements often observed within days to weeks after the procedure [2].
Similarly, sleeve gastrectomy has significantly reduced blood pressure levels in patients with hypertension and improved sleep apnea symptoms [3].
Impact mental health outcomes
Mental health outcomes following sleeve gastrectomy have also been widely studied. Many patients report improvements in self-esteem, body image, and overall quality of life after surgery, which can be attributed to the substantial weight loss and associated health benefits [4].
To recognise that some patients may be at risk for developing mood disorders, such as depression or anxiety, after the surgery. The reasons for this can be multifactorial, including adjusting to a new lifestyle, challenges with body image, or unmet expectations regarding weight loss.
Monitoring and addressing mental health concerns in post-operative care is essential to ensure patients receive adequate support and treatment when needed [5].
Nutritional deficiencies and complications are potential long-term health outcomes that may arise following sleeve gastrectomy. Due to the reduced stomach capacity and altered digestion, patients may be at risk for deficiencies in essential vitamins and minerals, such as vitamin B12, iron, calcium, and vitamin D [4].
These deficiencies can lead to various health issues, including anaemia, osteoporosis, and neurological complications. To prevent malnutrition, patients are encouraged to follow a nutrient-dense diet and take vitamin and mineral supplements as their healthcare providers recommend.
Regular monitoring of nutritional status through blood tests and follow-up appointments is crucial to ensure early detection and management of deficiencies.
GERD
Sometimes, sleeve gastrectomy patients may experience gastrointestinal complications, such as gastroesophageal reflux disease (GERD), leaks, or strictures. Although these complications are relatively rare, it is vital to recognise and manage them promptly to prevent further health issues [1].
Sleeve gastrectomy has been shown to significantly improve health outcomes in patients with obesity, particularly in terms of obesity-related comorbidities and mental health.
Monitor and address potential nutritional deficiencies and complications to optimise long-term patient health outcomes.
A comprehensive, multidisciplinary approach to post-operative care, including regular monitoring, patient education, and support systems, can help ensure patients achieve the best possible health outcomes following sleeve gastrectomy.
Potential long-term risks and complications
While sleeve gastrectomy offers substantial benefits in weight loss and health improvement, it is essential to recognise and address the potential long-term risks and complications associated with the procedure.
This section will discuss weight regain, gastrointestinal complications, nutritional deficiencies, and the importance of ongoing care and monitoring to optimise patient outcomes.
Weight regain is a potential long-term risk following sleeve gastrectomy, with some patients experiencing partial or complete regain of the lost weight over time [1].
Contributing to weight regain include inadequate lifestyle changes, lack of adherence to post-operative guidelines, and the body’s natural adaptive response to weight loss. Weight regain can negatively impact the improvements in obesity-related comorbidities and overall health outcomes.
To prevent or address weight regain, patients should maintain a healthy diet, engage in regular physical activity, and seek support from healthcare providers and support groups.
Gastrointestinal complications
Gastrointestinal complications are another potential long-term risk associated with sleeve gastrectomy.
Gastroesophageal reflux disease (GERD) is a common complication, with some patients developing symptoms after surgery or experiencing an exacerbation of pre-existing GERD [2].
GERD may require medical or surgical intervention to manage symptoms and prevent complications, such as esophagitis or Barrett’s oesophagus.
Other gastrointestinal complications, such as leaks and strictures, are rare but require prompt recognition and management to prevent further health issues.
Nutritional deficiencies are a well-documented long-term complication following sleeve gastrectomy. The reduced stomach capacity and altered digestion can lead to deficiencies in essential vitamins and minerals, such as vitamin B12, iron, calcium, and vitamin D [3].
These deficiencies can result in various health issues, including anaemia, osteoporosis, and neurological complications.
To prevent malnutrition, patients should follow a nutrient-dense diet, take vitamin and mineral supplements as their healthcare providers recommend, and attend regular follow-up appointments to monitor their nutritional status.
The long-term success of sleeve gastrectomy
The impact on the long-term success of sleeve gastrectomy relies heavily on ongoing care and monitoring. Regular follow-up appointments with healthcare providers, including bariatric surgeons, primary care physicians, nutritionists, and mental health professionals, are essential for early detection and management of potential risks and complications.
These appointments also offer an opportunity for patients to discuss any concerns, receive guidance on lifestyle modifications, and address any challenges they may face in maintaining their weight loss and overall health [4].
While sleeve gastrectomy has demonstrated significant benefits in weight loss and health improvement, it is crucial to recognise and address the potential long-term risks and complications associated with the procedure.
A comprehensive, multidisciplinary approach to post-operative care, including regular monitoring, patient education, and support systems, can help optimise long-term outcomes for patients and ensure that they achieve the best possible health and quality of life following sleeve gastrectomy.
Conclusion
In conclusion, sleeve gastrectomy has demonstrated significant long-term effects on weight loss and health outcomes in patients with obesity.
The procedure has been associated with substantial weight loss, improvements in obesity-related comorbidities, and enhanced mental health outcomes [1].
However, it is essential to recognise the potential long-term risks and complications, such as weight regain, gastrointestinal complications, and nutritional deficiencies, and address them proactively [2].
The key factors contributing to long-term success and patient satisfaction include lifestyle modifications, adherence to post-operative guidelines, support systems, and individualised care [3].
A comprehensive, multidisciplinary approach prioritising patient-centred care can help optimise long-term outcomes and patient satisfaction following sleeve gastrectomy.
Healthcare providers are crucial in guiding and supporting patients throughout their weight loss journey, ensuring they receive the necessary resources, education, and ongoing care to achieve and maintain their weight loss goals and improve their overall health and quality of life [4].
Healthcare providers can help patients reap the full benefits of sleeve gastrectomy and enhance their satisfaction with the procedure by addressing the factors that influence long-term success.
References
- Angrisani L, Santonicola A, Iovino P, et al. Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014. Obes Surg. 2017; 27(9): 2279–2289.
- Salminen P, Helmio M, Ovaska J, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss at 5 Years Among Patients With Morbid Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA. 2018; 319(3): 241–254.
- Gagner M, Hutchinson C, Rosenthal R. Fifth International Consensus Conference: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2016; 12(4): 750–756.
- Peterli R, Wolnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic Roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. JAMA. 2018; 319(3): 255–265.
- Mechanick JI, Apovian C, Brethauer S, et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedure
