The Gastric Tube operation or vertical gastrectomy (“Sleeve” in English), is the obesity surgery that has grown the most worldwide in the last 5 years. It is an intervention in which a reduction of the stomach is performed so that the patient feels satiated after eating small or moderate amounts of food, which allows losing weight.
The weight loss is mainly due to two mechanisms, on the one hand due to a “restrictive mechanism” by reducing the stomach volume and on the other hand, patients eat less because they have less appetite due to a “hormonal mechanism”.
The Gastric Tube operation is performed by “Laparoscopy”. Depending on the characteristics of each patient we can perform the surgery through conventional Laparoscopy with 5 mini-incisions or Single Incision Assisted Laparoscopy, with a single umbilical incision leaving an almost inappreciable scar. A small stomach of 100-150 c.c. (normal stomach > 1.000c.c.) is made, respecting all the important parts of the stomach. The procedure lasts about 60 minutes and no junction or bypass between the intestines is performed, which reduces the complications related to the surgical technique.
In which cases of obesity is this technique indicated?
There are no absolute indications and each obese patient must be studied by a qualified professional who will establish the best surgical treatment to combat their obesity. At OBESAN, the patients who are candidates for gastric tube surgery are:
– Patients over 50 years of age and those with a BMI (Body Mass Index) greater than 50 Kg/m2.
– Patients between 20 and 50 years old, with a BMI between 35 and 50 Kg/m2 , with previous abdominal surgeries, women of childbearing age who want to become pregnant, heavy smokers and patients with high surgical risk due to diseases associated with obesity (diabetes, hypertension, increased cholesterol, heart or respiratory diseases…).
What are the advantages of this technique?
It is possible to eat everything in small quantities and several times a day (5-6), preserving the digestive function and respecting the natural filling-emptying system.
Patients do not suffer vitamin losses, as occurs in other more aggressive surgical procedures, nor do they have diarrheic stools, since the small intestine is not modified during surgery, everything that is eaten is absorbed.
Weight loss depends on each patient but is usually between 60-70% of excess weight, much of which is lost during the first 6-9 months.
How should I prepare for surgery?
If we arrive at the day of surgery in the best physical condition, this will minimize the possibility of medical and surgical complications. The ideal would be to lose at least 5 kilos in the months prior to surgery, with the help of diet and exercise. We already know in OBESAN that patients want to undergo surgery because almost all diets have failed and they have serious health problems. But this last effort prior to the surgery is the one that will guarantee the success and also those lost kilos will not be recovered.
Postoperative
How are the first days after a vertical gastrectomy, how long do I need to recover, how many days will I be unable to go to work?
After the intervention, it is usual that a patient operated on for obesity with the vertical gastrectomy technique may have discomfort, but it is usually little discomfort and recovery is usually quick. The same day of the surgery when arriving to the room, the patient can get out of bed, sit on the couch and even take short walks. Usually, two days after the operation, the patient can return home.
Regarding “normal life” as such we can not say that it is so, that is, obviously the first few days the patient should be fed differently, for example the first 24 hours after surgery can only drink liquids and so will be at least during the first week, in which the food will be based on a liquid diet and complementary shakes, then until the first month the diet will be crushed. Afterwards, soft foods will be gradually incorporated progressively towards solids.
Obviously, it is also necessary to take into account some additional care after the operation such as monitoring and caring for the surgical wound according to medical indications or avoiding physical exertion. Regarding professional leave, it depends on how each case evolves, but usually 2 or 3 weeks after the operation most patients return to work.
Follow-up
The follow-up of the operated patient is as important as the preparation prior to surgery. The follow-up must be strictly carried out by the endocrinologist, the psychologist and the surgeon.
During the first months, the patient must have a strict control of the medical visits, to advise him/her on how to eat correctly and to detect any medical or surgical problems.
In OBESAN the follow-up by the surgeon, in the laparoscopic gastric tube, once the intervention has been performed, is weekly, at 1-3-6-12-24 months. However, the follow-up by the endocrinologist should be annual for several years.