Obesity today ranks as a significant health challenge and studies show obesity to be a major cause of preventable mortality. Researchers in respected journals are showing the significance of Sleeve Gastrectomy surgery as a procedure with low risks. Sleeve gastrectomy (also called gastric sleeve) is usually performed on extremely obese patients, with a body mass index of 40 or more, where the risk of performing a gastric bypass or duodenal switch procedure may be too large. This procedure alone is a suitable operation with minimum risks and some surgeons even prefer it over the gastric banding operation (which is a very friendly operation), because it eliminates the need of having to insert a foreign body.
What is Sleeve Gastrectomy Surgery?
Sleeve gastrectomy surgery is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach, following the major curve. "Sleeve" refers to the appearance of the stomach after the surgeon removes 75 percent to 85 percent of it, leaving an organ with a long, tube-like shape. "Gastrectomy" refers to removal of the stomach. The open edges are then attached together (often with surgical staples) to form a sleeve or tube with a banana shape. The procedure permanently reduces the size of the stomach. The procedure is performed laparoscopically and is not reversible.
What Causes Obesity?
The etiology of obesity is multifactorial. Over eating is the primary cause, but – psychological problems, hormonal imbalance, eating disorders, lack of proper directions in diet could all play a part. Likewise, the treatment options for obesity are varied – including diet and exercise, body contouring surgery, bariatric surgery, psychological counseling, endocrine management, etc. The most common causes for obesity include
Lack of activity
Overeating/ Unhealthy eating habits
Hormonal problems like Cushing’s syndrome and PCOS
Genetic reasons/ Familial obesity
Poor lifestyle.
Who is the Candidate for Sleeve Gastrectomy Surgery?
Patients who are morbidly or severely obese are at increased risk for health problems and tend to have a shortened life span. There is also added potential risk from continued weight increase. The risk of severe obesity is greater than that of its surgical treatments. Persons eligible for sleeve gastrectomy surgery include the following:
Persons at least 100 pounds above ideal body weight
Persons who are at least 80 pounds over weight and have life-threatening obesity related problems such as diabetes, hypertension, sleep apnea, etc.
Above persons who have failed non-surgical attempts at weight loss, specifically a combined regimen of diet and exercise.
How does the Sleeve Gastrectomy Surgery work?
The sleeve gastrectomy works through 2 mechanisms:
It makes the stomach smaller, so you feel full after eating a smaller meal.
The fundus of the stomach is removed. This is the area that secretes ghrelin, a hormone that makes you feel hungry. So, the sleeve gastrectomy may help you to feel less hungry through a hormonal mechanism.
What is the Procedure for Sleeve Gastrectomy Surgery?
"This is a simple enough procedure which takes less than an hour to complete. It is performed laparoscopically (keyhole surgery) and under a general anaesthetic. Your surgeon will make a series of small incisions in the abdomen. He/she will then insert a series of instruments which also includes a small camera. This camera is attached to a thin viewing tube and is able to relay what it focuses on onto a large video screen in the theatre. This screen enables the surgeon to have a close up view of the operation site. This is also useful for the placement of the instruments and the stapling of the stomach. Your surgeon will then remove a large portion of the stomach: the remaining section is stapled together to form a banana shaped tube or sleeve. He/she does not interfere with the small intestine – no cutting or bypassing so food absorption is not affected. It is unlikely that you will have to take any dietary supplements although this will be discussed with you in your aftercare sessions.
There are no changes to the normal digestive functions of the stomach: food will travel down the gullet through to the stomach before carrying on through the small and large intestines. Your much smaller stomach will mean smaller portions of food so weight will start to be lost. And there’s another bonus as well: the large portion of your stomach that has been removed contained the ‘hunger hormone’ ghrelin. This hormone is directly responsible for stimulating your appetite. This has now been removed which means that you will not experience hunger pangs! This will reduce your appetite which means you will eat smaller meals so calorie intake will drop. And this drop means weight will be lost.
It can be the case that this surgery alone will achieve your weight loss goals. Many patients have reported that the surgery has so well that they do not need any more procedures. However, there are those patients who require further surgery, in the form of a gastric bypass or duodenal switch. In these cases they are advised to wait for a year before having further surgery. This is what as known as a ‘two stage’ approach. It is also considered much safer: obesity surgery can be risky and for those patients who are severely or morbidly obese the risks are even greater. So, rather than undergoing what could be a potentially life threatening procedure due to the complexity, time and physical demands on the patient, breaking this down into two individual procedures is a better option.
Sleeve Gastrectomy Surgery with Duodenal Switch or Gastric Bypass
This is the name given to the full, two stage procedure. The first stage, the sleeve gastrectomy is performed first and the second stage, either a bypass or a switch is performed a year later. This is seen as one way of reducing the risks for the obese patient. This is not to say that both aren’t performed at the same time: in some cases the full procedure will be undertaken but surgeons often prefer to do it in two stages.
This is classed as a combination or restrictive/malabsorption procedure.
The duodenal switch is a much more technically demanding procedure and can take around 3 hours to complete. The sleeve gastrectomy is the restrictive element and that is fairly straightforward. The more complex part is the bypass or switch. The reason for this is that involves dividing the small intestine and then rerouting the passage of food through the digestive system. This affects food absorption, with the result being that the patient has to take a daily nutritional supplement for the rest of his/her life. The duodenal switch (DS) element is very similar to the biliopancreatic diversion (BPD/DS) with one difference: the surgeon will leave a larger portion of stomach than for the BPD/DS.
What this means for the patient is that they face a complex procedure with a higher degree of risk. This equally applies to the gastric bypass. The risks are greater for those patients with a high BMI but if we keep it in perspective, they only account for 2% of cases. On the plus side, weight loss can be as much as 80%, or even 90% has been known. It can resolve or even cure Type 2 diabetes and, improve or reduce the risks from other obesity-related conditions. As a greater portion of the stomach is left this does mean that the patient is able to consume bigger portions of food than those who have had the sleeve, bypass or gastric band. They do still need to follow a sensible eating plan, take exercise and attend the follow up sessions on a regular basis.
What are the Preparations before Sleeve Gastrectomy Surgery?
The most important consideration for sleeve gastrectomy is to know about your surgeon. One should always meet with the surgeon prior to the surgery and discuss potential issues. Discuss the quality of aftercare program should be accessed prior to the surgery as a short stay and regular check up is required after the surgery.
The education of the patient is very important. One may also collect printed procedure related information including what to expect and how to deal with it. This research would answer the questions of the patients clearly and explain the exact details of the procedure, the extent of recovery period and the reality of the follow-up care that will be required.
After becoming thorough with information about all aspects of the surgery, comes the physical and psychological evaluation. Each patient is required to have a physical with their primary care physician within six months prior to surgery. This is done to determine that the patient does not have any underlying medical conditions that would prohibit them from having surgery.
A pre operative psychological evaluation is an essential part of preparing for Sleeve Gastrectomy. The comprehensive psychological evaluation consists of a detailed clinical interview and objectively scored psychological tests.
Patients who have high intake of caffeine are suggested to gradually decrease the amount of caffeine they consume. Patients who stop caffeine suddenly at the time of surgery may experience withdrawal symptoms such as intense headaches. Remember that there is a significant about of caffeine in coffee, tea and many soft drinks.
Stop smoking. This is another condition before sleeve Gastrectomy. Cigarettes interfere with the lungs ability to exchange oxygen and nicotine can impair circulation, which can impede healing after surgery and increase the chance of infection.
What are the Post Operative care following a Sleeve Gastrectomy Surgery?
You will receive instructions on when and what you can eat, and how you need to restrict your activity. During the first few days after surgery, you may be restricted from eating. As your stomach stretches during your recovery, you will be able to eat more at a time. It is possible that you may experience frequent heartburn, abdominal pain, and vitamin deficiencies after your gastrectomy. Your doctor may prescribe changes in your diet, medications, and/or vitamin supplements after your procedure.
What are the Benefits of Sleeve Gastrectomy Surgery?
The benefits of Sleeve Gastrectomy surgery are very similar to those for gastric banding, gastric bypass and biliopancreatic diversion (BPD with/without duodenal switch). Dramatic weight loss is the first and most important benefit: if you have had a two stage procedure such as a sleeve gastrectomy with a duodenal switch then you could be looking at least. The following are the benefits:
This is classed as a ‘restrictive’ form of surgery which means that food absorption is not affected.
Weight loss can be as much as 50 to 80%.
Fewer restrictions on the types of foods that can be consumed.
The basic functions of the stomach are still intact so there is no risk of ‘dumping syndrome’.
Removes the area where the ‘hunger hormone’ ghrelin is produced.
Other equally important benefits include a greater sense of self-worth, improved confidence levels and a more positive outlook on life in general. If you have depression and/or anxiety then this will improve as your overall sense of wellbeing improves.
What are the Risks of the Sleeve Gastrectomy Surgery?
Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass. Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss. Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure.
What can you expect after Sleeve Gastrectomy Surgery?
The majority of patients that undergo sleeve gastrectomy surgery achieve a profound weight loss. The average weight loss at one year after surgery is about 50 percent of the person’s measured weight immediately prior to surgery. The range of weight loss from this procedure is between 33 and 83 percent of initial weight. Maximum weight loss is seen within 12 to 18 months after surgery. Also within one to two years of surgery, patients and their physicians routinely report resolution of various obesity-related illnesses including high blood pressure, type 2 diabetes mellitus, and obstructive sleep apnea. Various blood cholesterol (LDL, HDL, triglycerides) levels begin to of fully normalize after sleeve gastrectomy. While the procedure is rather new, it appears to be at least as effective and safe as other, more traditional bariatric surgeries.
Sleeve Gastrectomy Surgery in India
India has become the centre for weight loss surgeries including the Sleeve Gastrectomy surgery for international patients coming all across the world. The world has realized the fact that the healthcare technologies in India are at par with the developed world as used in USA or Europe thereby delivering similar or even better results. While adherence to the highest quality standards of healthcare by competent weight loss surgery specialists seems to the priority treatment.
Sleeve gastrectomy surgery in India comes with highly skilled super specialist surgeons of the nation for better outcome. Medical facility provided in India is attracting the patient’s crowd from the western countries as they seek treatment at low cost. Most of the obesity surgeons and doctors in India performing these weight loss procedures have vast overseas healthcare surgery experience and training from best hospitals.
The foreign patients can therefore avail the finest board certified medical professionals- board certified surgeons, board certified doctors, physician and JCI – JCAHO accredited, government registered and approved private medical Healthcare facilities in India for their respective surgery. Thus one can find world-class low cost hospitals with best clinical facilities in the following Indian cities:
Mumbai
Hyderabad
Kerala
Delhi
Pune
Goa
Bangalore
Nagpur
Jaipur
Chennai
Gurgaon
Chandigarh
Cost of Sleeve Gastrectomy Surgery in India
Recently in India there is a rampant rise of global patients coming for Sleeve Gastrectomy surgery. The reason behind this is quiet obvious, the patients can have high quality medical treatment at quiet low cost, thus making a world class treatments affordable for everyone. In India low cost of Sleeve Gastrectomy surgery is combined with success rates on par with anywhere in the world and hence is one of the fastest areas of growth in medical tourism in India. One can have a fair idea of this benefit after going through the following table:
Procedure
USA ($)
Singapore($)
UK($)
India ($)
Sleeve Gastrectomy
23,000
12,000
17,000
6,580
Laparoscopic Gastric Bypass Roux-en-Y RGB
28,000
15,000
22,000
7,970
Laparoscopic Adjustable Gastric Banding AGB
18,500
10,000
15,000
5,490
Some of the common countries from which patients travel to India for surgery are:
USA
UK
Canada
Australia
Zealand
Nigeria
Kenya
Ethiopia
Uganda
Tanzania
Zambia
Congo
Lanka
Bangladesh
Pakistan
Afghanistan
Nepal
Uzbekhistan
ABOUT INDIA
Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.
Mumbai - A city quite unlike any other in the whole of India, Mumbai (previously named Bombay) is an island city, being located on Salsette Island, alongside the Arabian Sea. With an appealing coastline, many of Mumbai's top resorts and tourist attractions lie around its main beaches, which include both Juhu Beach and also Girgaum Chowpatty Beach, where evening funfairs provide plenty of atmosphere.
Hyderabad - Hyderabad city is the capital city of the Indian state of Andhra Pradesh, in the region of Telangana. Hyderabad city is known for its rich history, food and its multi-lingual culture, both geographically and culturally. Founded in the year 1591 by fifth Qutb Shahi Ruler Muhammad Quli Qutb Shah. Now known as the historicold city, home to the Charminar, Falaknuma Palace, Chowmallah Palace and Makkah Masjid, it lies on the southern bank of the river.
Goa – Goa, a small enclave on the West Coast of India is one of the best holiday destinations in the World. Famous for its long stretch of beaches dotted with shacks, it is a favorite destination for the European tourists who flock to Goa during the winter months. Swaying palms, white sands and sparkling waters: the three essential elements that attract 2 million visitors annually to Goa’s balmy shores are plentiful in this tiny, glorious slice of India
Bangalore - Bangalore, the capital of the Karnataka, is fifth largest city in India. Few Cities in the World has the power to attract and motivate a casual visitor to move there permanently. Bangalore is one of those rare cities, which makes people who are new to the City to call themselves proud Bangaloreans. Bangalore, with a wonderful climate is already a Pensioner's Paradise.
Nagpur - Capital of the "land of oranges" and geographically at the virtual centre of India, Nagpur is endowed with rich forest resources and in itself is the second greenest city in India. The forests around Nagpur are full of best quality teak plantations. Shopping in Nagpur may turn out to be a pleasant experience for the discerning shopper. Nagpur is designed specifically for its many tourists and families to avoid any small annoyances.
Kerala - The Land Kerala is a dramatic, narrow, leaf-shaped strip of land, flanked by the formidable Western Ghats on the east, and the Arabian Sea on the west. A land of unabashed wealth, its people are amongst the most progressive and literate of the Indian populace. This tropical spice garden has lured the Arabs, Chinese and Europeans for many centuries. Christianity and Judaism entered the subcontinent through the legendary white sand beaches of Kerala.
Delhi - Delhi the capital of India main point of arrival for overseas visitors, and the major transport hub. Delhi is just not a city but it is a book that narrates the history of India. The city was built and destroyed seven times and has been witness to the various events, which has brought India through the history books.
Pune - The city of Pune is situated in Maharashtra and is said to be the cultural capital of the state. Located at a distance of approximately 120 km from Mumbai, the city is one of major tourist destinations in India. The rich history, architecture and culture of the city makes it a must visit destination for the tourist coming to India.
Jaipur – The city of Jaipur, painted in pink, grasp the appreciation of every visitor. One can see that hoary charm still alive in the avenues of Jaipur. Jaipur offers World Class Medical Facilities, comparable with any of the western countries. It has state of the art Hospitals and the best qualified doctors.
Chennai – The Gateway to South India, Chennai is famous for its sandy beaches, parks and historic landmarks. With a very distinct culture, the people of Chennai have a special interest in music, dance and all other art forms of South India. Capital of the state of Tamil Nadu, Chennai has embraced both the new and the old with ease
Gurgaon – Gurgaon, the commercial capital of Haryana, is one of the most sought after destination for MNCs, Corporate, residents and Investors as it offers world class standard of living and globally comparable business address in the form of IT parks and Business Centers and along with that very prominent medical hub.
Chandigarh - Chandigarh is the best-planned city in India, with architecture which is world-renowned, and a quality of life, which is unparalleled. Chandigarh is a rare epitome of modernization co-existing with nature's preservation. It is here that the trees and plants are as much a part of the construction plans as the buildings and the roads.
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