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January 16, 2018

Sleeve Gastrectomy for Weight Loss

JAMA. 2018;319(3):316. doi:10.1001/jama.2017.18519

Obesity affects 1 in 3 people in the United States. Many people with obesity have trouble losing weight.

Some operations are very effective in assisting weight loss for patients with obesity. One of these operations is the sleeve gastrectomy. In this operation, part of the stomach is removed by a surgeon, which results in a patient eating less and losing weight. Sleeve gastrectomy can help people lose more than 20% of their total body weight in about a year. For example, persons with a body mass index (BMI) of 40 or who are approximately 100 lb over their ideal body weight can expect to lose about 60 lb from the surgery. Once a patient loses the weight, he or she tends not to gain it back. In the January 16, 2017, issue of JAMA, several articles report on laparoscopic sleeve gastrectomy for treating obesity. These articles show both lasting long-term weight loss and improvement in weight-related medical conditions such as diabetes and high blood pressure.

When Is Sleeve Gastrectomy Recommended?

Sleeve gastrectomy may be considered when BMI (calculated as weight in kilograms divided by height in meters squared) is greater than 40 or if BMI is greater than 35 and a patient has 1 or more weight-related medical conditions, and if dietary, lifestyle, and other treatments have been ineffective. Before surgery, patients usually undergo several months of evaluations and education to ensure that surgery is appropriate for them.

How Sleeve Gastrectomy Is Performed

Laparoscopic surgery involves the use of fiber-optic imaging devices that are inserted in the abdomen. A surgeon removes part of the stomach through small incisions, creating a narrow “sleeve” out of the stomach. This smaller stomach limits the amount of food that can be eaten at one time. It helps patients feel full with less food. The operation also causes changes in the production of hormones made by the stomach and intestines that decrease hunger.

Risks and Complications of Sleeve Gastrectomy

Nausea and vomiting are the most common side effects and usually resolve soon after surgery. More serious complications are seen in about 2 of every 100 patients. These include blood clots in the lungs (pulmonary embolism) or legs (deep vein thrombosis), which may be indicated by symptoms such as chest pain, shortness of breath, or leg swelling. While less common, blood clots may also form in the blood vessel that brings blood to the liver from the intestines (portal vein thrombosis). Leaking or bleeding around the stomach can cause fever and abdominal pain. These more serious complications can be treated and tend to occur within 2 weeks of the operation. Long-term complications after sleeve gastrectomy may also occur and can include acid reflux, narrowing of the sleeve, too little weight loss, too much weight loss, vitamin deficiencies, and weight regain.

What to Expect After Surgery

Most patients are in the hospital for 1 to 2 days and can resume their usual physical activities within 4 to 6 weeks after surgery. Medications are given for pain and nausea. Opioid pain medications are usually needed only for a short period following surgery, if at all. Most patients also receive medication to prevent blood clots. Walking helps to prevent blood clots, and after having this surgery, you will be encouraged to get out of bed as soon as possible. Physical activity is important after surgery to maximize weight loss and prevent weight regain. The diet immediately after the operation starts with small volumes of liquid that are gradually advanced to well-chewed solid foods over several weeks. The health care team will help plan a balanced intake of protein and other nutrients. To reduce the risk of bone density loss and nutritional deficiencies, the health care team will discuss vitamin supplements and monitoring as part of regular follow-up visits and health maintenance.

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Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Topic: Obesity