What's wrong with the diet? Physiological component of the diet.

Chapter 33. Bariatrics: effectiveness of sleeve gastrectomy

What we are researching: What is the effectiveness of sleeve gastrectomy?

What's new: How does gastric dilatation affect weight loss and what does medicine therefore recommend?

What we'll learn: How can the risks associated with gastric dilatation, GERD, and vomiting help us make wise choices?

1. Compared to 2021, the total number of MBS performed in 2022 increased from approximately 262,893 to 280,000. Sleeve gastrectomy (SG) continues to be the most frequently performed procedure (Clapp B. et al. 2024) [1].

2. Types of operations. Let's look at the various bariatric surgeries that are most common in the United States as of 2020. These include a duodenal switch (DS), laparoscopic gastric bypass (LRYGB), sleeve gastrectomy (SG), and laparoscopic adjustable gastric banding (LAGB)*. We will focus this chapter on the bariatric surgery procedure for sleeve gastrectomy**. Let us briefly explain the characteristics of changes in internal organs. We explore the effectiveness and side effects of sleeve gastrectomy. After considering all the above operations, we will know their results 1 – 2 years after the operation, when maximum weight loss is achieved (Chapter 35. "Bariatrics: Summary of Effectiveness") [2, 3, 4, 5, 6]. Let's draw conclusions that will help you make a wise choice. So, what is a sleeve gastrectomy operation?

*All descriptions of types of surgical procedures and estimates of the number of operations are taken from the official ASMBS/Resources/Metabolic and Bariatric Surgery website: https://asmbs.org/resources/metabolic-and-bariatric-surgery

** Bariatric operations on the duodenal switch (DS) and laparoscopic gastric bypass (LRYGB) are dedicated to chapters 31 and 32 of this book, respectively.

3. Sleeve gastrectomy (SG). As of 2021, the estimate for the number of transactions was 57.4%. What irreversible changes are made to internal organs? The stomach is divided and stitched vertically, removing more than 85%, forming a tubular or banana pouch, and limiting the amount of food that can be eaten and absorbed by the body (fr. 31.4). How effective is this surgery in reducing body weight?

4. Efficiency. Sleeve gastrectomy remains the most common procedure as of 2020 [4]. This surgical operation significantly narrows the lumen of the stomach, so it is restrictive. The maximum reduction in body weight due to sleeve gastrectomy was observed after 1–2 years and amounted to 25±9% (%TWL) [6]. Like previous operations, sleeve gastrectomy leads to a reduction in signs of diseases associated with morbid obesity (fr. 31.3) [2, 7, 8].

5. Side effects. The complication rate is 13%, which is associated with fewer anatomical changes than in previous bariatric surgeries. There are few complications in the early postoperative period. What are these complications?

6. Early postoperative period. Even though there are not many complications during this period, they are among the most serious complications that are difficult to cope with. These early complications include leakage due to gastric leak (4.9%) and bleeding from a long gastric suture (2.4%). The success of treating these complications depends on the early stage of repeated surgery [3, 9]. Most complications occur in the late postoperative period.

7. Late postoperative period. Most complications include gastroesophageal reflux disease (hereinafter GERD) * (23%), vomiting (18%), narrowing of the lumen (stricture) of the tubular gastric sac (2.3%), stenosis ** (2.4%), leak (2.4%), incisional hernia (2.4%), gastrocutaneous fistula (leakage of pus from the stomach through the skin) and weight gain. Recent studies have shown that dumping syndrome is characteristic not only of gastric bypass, but also of sleeve gastrectomy, but this has not been previously reported [3, 10]. The small amount of gastric pouch resulting from the initial surgery may expand over time (dilatation). What does dilatation of the gastric pouch lead to?