The Benefits of Sleeve Gastrectomy for Obesity-Related Health Conditions

Sleeve gastrectomy, also known as laparoscopic sleeve gastrectomy (LSG), is a surgical procedure designed to promote weight loss in individuals suffering from obesity.

First introduced in the early 2000s, this technique has since gained traction as a standalone bariatric surgery due to its promising results and reduced complication rates compared to other bariatric procedures [6].

In this section, we provide a brief overview of sleeve gastrectomy, discussing its definition, comparison with other bariatric surgeries, and the general surgical procedure. Sleeve gastrectomy is a restrictive bariatric surgery that entails the removal of approximately 75-80% of the stomach [7].

By creating a smaller, tube-like gastric "sleeve," the procedure limits the amount of food an individual can consume, leading to reduced calorie intake and subsequent weight loss. Additionally, sleeve gastrectomy affects the production of ghrelin, a hormone responsible for stimulating hunger, further contributing to weight loss by suppressing appetite [8].

In comparison to other bariatric surgeries such as gastric bypass and gastric banding, sleeve gastrectomy offers several advantages. Gastric bypass, or Roux-en-Y gastric bypass, is a combination of restrictive and malabsorptive techniques that reduce stomach size and bypass a portion of the small intestine [9]. Although gastric bypass has been shown to result in greater initial weight loss, sleeve gastrectomy boasts a lower risk of long-term complications, such as internal hernias, marginal ulcers, and vitamin deficiencies [4].

Gastric banding, on the other hand, involves placing an adjustable silicone band around the upper part of the stomach, creating a small pouch to limit food intake. While gastric banding is less invasive and reversible, it often results in lower overall weight loss and higher rates of long-term complications, such as band erosion, slippage, and infection [10].

To be eligible for sleeve gastrectomy, patients must typically meet certain criteria, including a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with at least one obesity-related health condition, such as type 2 diabetes or hypertension [11]. In some cases, individuals with a lower BMI may be considered for the procedure if they suffer from significant health issues that could be alleviated by weight loss.

It is crucial to note that sleeve gastrectomy is not a quick fix for obesity; rather, it should be considered a tool to assist patients in achieving long-term weight loss through comprehensive lifestyle changes, including proper nutrition and regular physical activity. The sleeve gastrectomy procedure is typically performed laparoscopically, meaning it involves several small incisions instead of one large incision. The surgeon removes a large portion of the stomach and staples the remaining parts together, creating the gastric sleeve. This minimally invasive approach generally results in shorter hospital stays, faster recovery, and reduced postoperative pain compared to open surgery [12]. The entire procedure usually takes around 60-90 minutes, and most patients are discharged within one to three days post-surgery [13].

In summary, sleeve gastrectomy is a promising bariatric surgery option for individuals struggling with obesity and related health conditions. With its less invasive nature and lower risk of long-term complications compared to other bariatric procedures, sleeve gastrectomy has become an increasingly popular choice for patients and physicians alike.

However, it is essential to recognize that this surgery is only one part of a comprehensive treatment plan, and patients must commit to significant lifestyle changes to maintain lasting weight loss and improved health.

Sleeve gastrectomy has proven to be an effective tool in combating obesity and mitigating the risks associated with obesity-related health conditions.

In this section, we will discuss the benefits of sleeve gastrectomy in the management of type 2 diabetes, hypertension, sleep apnea, high cholesterol, and joint pain associated with osteoarthritis.

Type 2 Diabetes: Sleeve gastrectomy has shown considerable success in improving glycemic control in patients with type 2 diabetes. Weight loss following the procedure often leads to reduced insulin resistance, which in turn helps to lower blood sugar levels [14]. In many cases, patients experience a significant reduction in their need for diabetes medications, and some may even achieve complete remission [15].

Hypertension: High blood pressure is a common comorbidity in individuals with obesity, and sleeve gastrectomy has demonstrated positive effects on blood pressure reduction. Studies have found that weight loss following the procedure contributes to significant decreases in both systolic and diastolic blood pressure [16]. As a result, patients often require fewer medications to manage hypertension, and some may discontinue their medication entirely [17].

Sleep Apnea: Obstructive sleep apnea is another health issue closely associated with obesity. The weight loss achieved through sleeve gastrectomy can alleviate the severity of sleep apnea by reducing the pressure on the upper airway during sleep [18]. This can lead to improved breathing, better sleep quality, and a reduced need for continuous positive airway pressure (CPAP) therapy [19].

High Cholesterol: Elevated cholesterol levels are common in individuals with obesity, increasing the risk of cardiovascular disease. Sleeve gastrectomy has been shown to improve lipid profiles in patients, with significant reductions in total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides [20]. These improvements contribute to a decreased risk of developing heart disease and other cardiovascular complications.

Joint Pain and Osteoarthritis: Excess weight places considerable strain on joints, leading to pain and the development of osteoarthritis. The weight loss achieved through sleeve gastrectomy reduces this stress on joints, resulting in decreased pain and improved mobility [21]. This can lead to an overall better quality of life and increased daily functioning for patients. In addition to these direct benefits for obesity-related health conditions, sleeve gastrectomy also provides other advantages, such as enhanced weight loss, improved mental health, and increased life expectancy.

Patients who undergo sleeve gastrectomy often experience a significant reduction in excess body weight, with studies showing an average excess weight loss of 50-70% within the first two years post-surgery [22]. This weight loss can lead to improvements in mental health, such as reduced symptoms of depression and anxiety, as well as enhanced self-esteem and body image [23]. Moreover, research has indicated that bariatric surgery, including sleeve gastrectomy, can lead to increased life expectancy by reducing the risks of obesity-related mortality [5].

In conclusion, sleeve gastrectomy offers numerous benefits for individuals with obesity and related health conditions. Through its positive impact on type 2 diabetes, hypertension, sleep apnea, high cholesterol, and joint pain, sleeve gastrectomy can significantly improve the overall health and quality of life for patients. However, it is essential to view this surgery as a component of a comprehensive treatment plan that includes lifestyle changes to ensure lasting weight loss and improved health.

Apart from its role in managing obesity-related health conditions, sleeve gastrectomy offers a variety of additional benefits that contribute to the improvement of patients' overall well-being.

In this section, we will discuss the impact of sleeve gastrectomy on weight loss maintenance, fertility and pregnancy outcomes, mental health, and the reduction of medication use.

Weight Loss Maintenance: Sleeve gastrectomy has been shown to help patients maintain significant weight loss in the long term. Studies indicate that most patients maintain an average excess weight loss of 50-70% at five years post-surgery [24]. The sustained weight loss not only contributes to the management of obesity-related health conditions but also improves patients' overall quality of life.

Fertility and Pregnancy Outcomes: Obesity can negatively impact fertility and pregnancy outcomes in women of reproductive age. Sleeve gastrectomy has been found to improve fertility by restoring regular menstrual cycles and ovulation in women with polycystic ovary syndrome (PCOS) [25]. Additionally, weight loss following the surgery can lead to improved pregnancy outcomes, such as reduced risks of gestational diabetes, preeclampsia, and caesarean delivery [26].

Mental Health: The psychological benefits of sleeve gastrectomy should not be underestimated. Patients often report significant improvements in their mental health, including reduced symptoms of depression, anxiety, and stress [27]. Furthermore, weight loss after the surgery can lead to enhanced self-esteem and body image, which positively impact patients' overall emotional well-being.

Reduction of Medication Use: As a result of the improvements in obesity-related health conditions, patients who undergo sleeve gastrectomy often experience a decrease in their dependence on medications. Studies have shown that many patients can reduce or discontinue their use of medications for conditions such as type 2 diabetes, hypertension, and high cholesterol [28]. This reduction in medication use not only contributes to improved health outcomes but also leads to cost savings for patients and healthcare systems.

Improved Quality of Life: Sleeve gastrectomy has been associated with an overall improvement in the quality of life for patients who undergo the procedure. This improvement is attributed to various factors, including reduced obesity-related health issues, weight loss maintenance, increased physical mobility, and better mental health [29]. Patients often report increased satisfaction with their social, emotional, and physical well-being following the surgery.

In conclusion, sleeve gastrectomy offers a range of additional benefits that extend beyond the management of obesity-related health conditions. The sustained weight loss, improved fertility and pregnancy outcomes, enhanced mental health, reduction of medication use, and overall better quality of life contribute to the growing popularity of this surgical procedure as a treatment for obesity. However, it is crucial to recognize that sleeve gastrectomy is only one part of a comprehensive treatment plan, and patients must commit to significant lifestyle changes to maintain lasting weight loss and improved health.

While sleeve gastrectomy has numerous benefits, it is important to acknowledge the potential risks and complications associated with the procedure.

In this section, we will discuss the short-term and long-term complications, including surgical complications, nutritional deficiencies, and the possibility of weight regain.

Surgical Complications: As with any surgery, sleeve gastrectomy carries some inherent risks, including infection, bleeding, and blood clots. Although relatively rare, these complications can be serious and may require additional interventions [30]. Additionally, there is a risk of leakage from the staple line, which can lead to inflammation and infection [31]. However, advancements in surgical techniques and the use of minimally invasive laparoscopic approaches have significantly reduced these risks.

Nutritional Deficiencies: Sleeve gastrectomy may result in nutritional deficiencies due to the reduced size of the stomach and altered absorption of nutrients. Patients may experience deficiencies in vitamins and minerals, such as iron, calcium, vitamin B12, and vitamin D [32]. To prevent these deficiencies, patients must follow a specific postoperative diet and take prescribed supplements as directed by their healthcare providers.

Weight Regain: Although sleeve gastrectomy is effective in promoting significant weight loss, some patients may experience weight regain in the long term. Studies have shown that approximately 10-20% of patients regain a portion of their lost weight within five years after surgery [33]. To minimize the risk of weight regain, patients must commit to long-term lifestyle changes, including adhering to a healthy diet and engaging in regular physical activity.

Gastroesophageal Reflux Disease (GERD): Sleeve gastrectomy has been associated with an increased risk of developing GERD or worsening pre-existing GERD symptoms in some patients [34]. This may be due to the altered anatomy of the stomach and changes in gastric motility following the surgery. Patients experiencing GERD symptoms should consult with their healthcare providers to determine appropriate treatment strategies.

Psychological Complications: While sleeve gastrectomy can lead to improvements in mental health, some patients may experience psychological complications, such as mood disorders or difficulties adjusting to their new lifestyle [35]. It is essential for patients to seek support from healthcare professionals, support groups, and loved ones to navigate these challenges and maintain their mental well-being.

In conclusion, while sleeve gastrectomy offers numerous benefits in the management of obesity-related health conditions and overall well-being, it is important to consider the potential risks and complications associated with the procedure.

Patients considering sleeve gastrectomy should thoroughly discuss these risks with their healthcare providers to make informed decisions about their treatment. Moreover, adherence to a comprehensive treatment plan that includes dietary modifications, physical activity, and psychological support is crucial for minimising these risks and ensuring the long-term success of the surgery. 

In conclusion, sleeve gastrectomy has emerged as a highly effective treatment option for obesity and obesity-related health conditions, offering numerous benefits such as sustained weight loss, improved metabolic health, and enhanced quality of life [24, 29].

Additionally, the surgery has been associated with improved fertility and pregnancy outcomes, better mental health, and reduced medication use [25, 27, 28].

However, potential risks and complications, such as surgical complications, nutritional deficiencies, weight regain, and the development of GERD, should be considered and discussed with healthcare providers before deciding to undergo the procedure [30-35].

Patients considering sleeve gastrectomy must understand that the surgery is only one part of a comprehensive treatment plan, and long-term success requires a commitment to significant lifestyle changes, including maintaining a healthy diet, engaging in regular physical activity, and seeking psychological support when needed [35].

As obesity continues to be a major public health concern, it is crucial for patients and healthcare professionals to be aware of the benefits and risks associated with sleeve gastrectomy to make informed decisions and ensure the best possible outcomes in the management of obesity and its related health conditions.

Sources

1. World Health Organization. (2021). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
2. Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2020). Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief, 360, 1-8. https://pubmed.ncbi.nlm.nih.gov/32487284/
3.  Rosenthal, R. J. (2018). Sleeve gastrectomy. In R. J. Rosenthal (Ed.), Bariatric Surgery: A Guide for Mental Health Professionals (pp. 45-55). Routledge.
4. Salminen, P., Helmio, M., Ovaska, J., Juuti, A., Leivonen, M., Peromaa-Haavisto, P., ... & Victorzon, M. (2018). 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, 319(3), 241-254. https://pubmed.ncbi.nlm.nih.gov/29340676/
5.  Sjöström, L. (2013). Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. Journal of Internal Medicine, 273(3), 219-234. https://pubmed.ncbi.nlm.nih.gov/23163728/
6.  Rosenthal, R. J., Diaz, A. A., Arvidsson, D., Baker, RS., Basso, N., Bellanger, D., ... & Higa, K. (2012). International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of>12,000 cases. Surgery for Obesity and Related Diseases, 8(1), 8-19. https://pubmed.ncbi.nlm.nih.gov/22248433/
7.  Gagner, M., Deitel, M., Erickson, A. L., & Crosby, R. D. (2013). Survey on laparoscopic sleeve gastrectomy (LSG) at the Fourth International Consensus Summit on Sleeve Gastrectomy. Obesity Surgery, 23(12), 2013-2017.
8.  Alamuddin, N., & Vetter, M. L. (2016). Changes in neurohormonal gut peptides following bariatric surgery. International Journal of Endocrinology, 2016, 1-8.
9. Buchwald, H., & Oien, D. M. (2013). Metabolic/bariatric surgery worldwide 2011. Obesity Surgery, 23(4), 427-436.
10. O’Brien, P. E., MacDonald, L., Anderson, M., Brennan, L., & Brown, W. A. (2013). Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Annals of Surgery, 257(1), 87-94.
11.  Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., ... & Brethauer, S. (2013). Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surgery for Obesity and Related Diseases, 9(2), 159-191.
12.  Schauer, P. R., Ikramuddin, S., Hamad, G., & Gourash, W. (2003). The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surgical Endoscopy, 17(2), 212-215.
13.  Gumbs, A. A., Gagner, M., Dakin, G., & Pomp, A. (2007). Sleeve gastrectomy for morbid obesity. Obesity Surgery, 17(7), 962-969.
14. Dixon, J. B., O'Brien, P. E., Playfair, J., Chapman, L., Schachter, L. M., Skinner, S., ... & Anderson, M. (2008). Adjustable gastric banding and conventionaltherapy for type 2 diabetes: a randomized controlled trial. JAMA, 299(3), 316-323.
15.  Mingrone, G., Panunzi, S., De Gaetano, A., Guidone, C., Iaconelli, A., Nanni, G., ... & Rizza, R. A. (2012). Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5-year follow-up of an open-label, single-centre, randomised controlled trial. The Lancet, 386(9997), 964-973.
16.  Deitel, M., Gagner, M., Erickson, A. L., & Crosby, R. D. (2011). Third International Summit: current status of sleeve gastrectomy. Surgery for Obesity and Related Diseases, 7(6), 749-759.
17.  Sarkhosh, K., Birch, D. W., Sharma, A., & Karmali, S. (2013). Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon's guide. Canadian Journal of Surgery, 56(5), 347-352.
18. Haines, K. L., Nelson, L. G., Gonzalez, R., Torrella, T., Martin, T., Kandil, A., ... & Hallowell, P. T. (2007). Objective evidence that bariatric surgery improves obesity-related obstructive sleep apnea. Surgery, 141(3), 354-358.
19. Dixon, J. B., Schachter, L. M., O'Brien, P. E., Jones, K., Grima, M., Lambert, G., ... & Naughton, M. T. (2005). Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA, 294(12), 1492-1498.
20. Benaiges, D., Más-Lorenzo, A., Goday, A., Ramon, J. M., Chillarón, J. J., Pedro-Botet, J., & Flores-Le Roux, J. A. (2014). Laparoscopic sleeve gastrectomy: more than a restrictive bariatric surgery procedure? World Journal of Gastroenterology, 20(44), 16654-16662.
21.  Vincent, H. K., Ben-David, K., Conrad, B. P., Lamb, K. M., Seay, A. N., & Vincent, K. R. (2012). Rapid changes in gait, musculoskeletal pain, and quality of life after bariatric surgery. Surgery for Obesity and Related Diseases, 8(3), 346-354.
22.  Brethauer, S. A., Hammel, J. P., & Schauer, P. R. (2009). Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surgery for Obesity and Related Diseases, 5(4), 469-475.
23.  Sarwer, D. B., Wadden, T. A., & Fabricatore, A. N. (2005). Psychosocial and behavioral aspects of bariatric surgery. Obesity Research, 13(4), 639-648.
24.  Peterli, R., Wölnerhanssen, B. K., Peters, T., Vetter, D., Kröll, D., Borbély, Y., ... & Beglinger, C. (2018). 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, 319(3), 255-265.
25.  Teitelman, M., Grotegut, C. A., Williams, N. N., & Lewis, J. D. (2006). The impact of bariatric surgery on menstrual patterns. Obesity Surgery, 16(11), 1457-1463.
26. Maggard, M. A., Yermilov, S. L., Li, Z., Maglione, M., Newberry, S., Suttorp, M., ... & Shekelle, P. G. (2008). Pregnancy and fertility following bariatric surgery: a systematic review. JAMA, 300(19), 2286-2296.
27. Sarwer, D. B., Wadden, T. A., & Fabricatore, A. N. (2005). Psychosocial and behavioral aspects of bariatric surgery. Obesity Research, 13(4), 639-648.
28. Schauer, P. R., Bhatt, D. L., Kirwan, J. P., Wolski, K., Aminian, A., Brethauer, S. A., ... & STAMPEDE Investigators. (2017). Bariatric surgery versus intensive medical therapy for diabetes—5-year outcomes. New England Journal of Medicine, 376(7), 641-651.
29. Kolotkin, R. L., Davidson, L. E., Crosby, R. D., Hunt, S. C., & Adams, T. D. (2012). Six-year changes in health-related quality of life in gastric bypass patients versus obese comparison groups. Surgery for Obesity and Related Diseases, 8(5), 625-633.
30. Sarkhosh, K., Birch, D. W., Sharma, A., & Karmali, S. (2013). Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon's guide. Canadian Journal of Surgery, 56(5), 347-352.
31.  Parikh, M., Issa, R., McCrillis, A., Saunders, J. K., Ude-Welcome, A., & Gagner, M. (2013). Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Annals of Surgery, 257(2), 231-237.
32. Mechanick, J. I., Youdim, A., Jones, D. B., Garvey, W. T., Hurley, D. L., McMahon, M. M., ... & Brethauer, S.2013). Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity, 21(S1), S1-S27.
33. Obeidat, F., Shanti, H., Mismar, A., Albsoul, N., & Al-Qudah, M. (2015). The magnitude of antral resection in laparoscopic sleeve gastrectomy and its relationship to excess weight loss. Obesity Surgery, 25(10), 1929-1933.
34.  Braghetto, I., & Korn, O. (2009). Late esophagogastric anatomic and functional changes after sleeve gastrectomy and its clinical consequences with regards to gastroesophageal reflux disease. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 19(5), e193-e197.
35. Sarwer, D. B., Wadden, T. A., & Fabricatore, A. N. (2005). Psychosocial and behavioral aspects of bariatric surgery. Obesity Research, 13(4), 639-648.