What are the recommendations and considerations for a gastric sleeve procedure?

From the Guidelines

Gastric sleeve surgery is recommended for individuals with a BMI over 40, or over 35 with obesity-related health conditions who have been unable to achieve sustained weight loss through diet and exercise, as it can lead to significant weight loss and improvement in obesity-related comorbidities, with a mortality rate of less than 0.1%. Before undergoing the procedure, patients should complete a comprehensive medical evaluation, including psychological assessment, and demonstrate commitment to lifestyle changes 1. The procedure involves removing approximately 80% of the stomach, creating a smaller, sleeve-shaped stomach that restricts food intake and reduces hunger hormones.

Key Considerations

• Patients should be counseled regarding short- and long-term risks, benefits, and outcomes of surgery and the lifelong commitment required to prevent weight regain 1.
• Individuals undergoing bariatric surgery should be managed by an experienced multidisciplinary team comprising the surgeon, a bariatric physician, a dietitian, a physiotherapist/exercise physiologist, and a psychologist or psychiatrist, as well as other local experts, as deemed appropriate 1.
• Daily vitamin and mineral supplements are essential lifelong, including a multivitamin, calcium citrate (1200-1500mg daily), vitamin D (3000 IU daily), vitamin B12 (500mcg daily), and iron for menstruating women 1.

Post-Surgery Care

• Post-surgery, patients typically follow a phased diet starting with clear liquids for 1-2 weeks, progressing to pureed foods for 2 weeks, soft foods for 2 weeks, and finally regular foods with portion control.
• Regular follow-up appointments are crucial for monitoring nutritional status and weight loss progress.
• Potential complications include bleeding, infection, leaks at the staple line, blood clots, and nutritional deficiencies.

Long-Term Success

• Long-term success requires permanent lifestyle changes including regular physical activity (150 minutes weekly), high-protein diet (60-80g daily), avoiding sugary and high-fat foods, and addressing emotional eating patterns.
• The procedure works through both restriction of food intake and hormonal changes that reduce hunger, leading to typical weight loss of 60-70% of excess body weight within 12-18 months 1.

From the Research

Recommendations for Gastric Sleeve Procedure

• Patients undergoing sleeve gastrectomy require long-term and periodic monitoring of biochemical data, weight changes, and caloric and protein intake by a professional nutritionist to prevent malnutrition and nutritional deficiencies 2.
• Dietary education should be conducted according to digestive symptoms, and oral nutritional supplements, including vitamins and minerals, should be provided as needed 2.
• Multivitamins and calcium tablets should be regarded as a minimum, and supplements especially for iron, vitamin B12, vitamin D, and calcium should be added to this regimen based on regular blood testing 3.

Considerations for Gastric Sleeve Procedure

• Sleeve gastrectomy can result in substantial improvements in the severity of type 2 diabetes, metabolic syndrome, nonalcoholic fatty liver disease, and quality of life, but it also reduces appetite and nutrient absorption, impairing digestion and the absorption of nutrients like iron, vitamin B12, and protein-bound nutrients 2.
• Patients who underwent sleeve gastrectomy are at serious risk for developing micronutrient deficiencies, and some vitamins may increase to chronic elevated levels with possible complications in the long-term 3.
• The maintenance of multivitamin supplements more than 3 months postoperatively seems to be of no benefit, and it is preferable to monitor laboratory values and add specific supplements when necessary 4.

Indications and Limitations for Gastric Sleeve Procedure

• Sleeve gastrectomy can be an effective and safe procedure for super-super-obese or high-risk patients, either as a single operation or as a bridge to more definitive surgery 5.
• The main limitation of this novel bariatric procedure is the lack of long-term data on sustained weight loss and resolution of obesity-related comorbidities, and the fact that sleeve gastrectomy is an irreversible operation adds to its weakness as a bariatric procedure 5.
• Sleeve gastrectomy has been shown to produce substantial weight loss and significant improvement in the metabolism of patients with metabolic syndrome, through mechanisms such as restriction of food intake, alterations in the absorption and metabolism of nutrients, and changes in gut hormone secretion and gastrointestinal motility 6.