Sleeve Gastroplasty

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The problem of excessive body weight in severely obese individuals who have tried various weight loss methods without success still has another option, which is gastric surgery to reduce weight. There are currently many different methods available, but the most popular ones are:

1. Sleeve Gastretomy
2. Roux-en Y Gastric bypass

These surgeries are preferred because they not only lead to effective weight loss but also have low complication rates. Additionally, they can be performed using minimally invasive techniques, resulting in small incisions, minimal pain, quick recovery, and no large scars to worry about.

When should gastric surgery be performed?

Patients with obesity who meet the criteria set by the Thailand Society for Metabolic & Bariatric Surgery (TSMBS) are suitable candidates for gastric surgery, including:

• Individuals with a body mass index (BMI) of ≥ 37.5 kg/m²
• Individuals with a BMI of ≥ 32.5 kg/m² and comorbidities
• Individuals with a BMI of ≥ 30 kg/m² and metabolic comorbidities or certain types of type 2 diabetes

Is gastric surgery dangerous for weight loss?

Generally, gastric surgery for weight loss is performed using minimally invasive techniques, resulting in small incisions, minimal pain, and quick recovery. The mortality rate is less than 1%. Complications associated with the surgery, such as leakage or bleeding at the surgical site, occur in less than 3% of cases and can be addressed.

Surgical Procedures for Weight Loss

1. Laparoscopic Sleeve Gastrectomy:

It is a procedure that involves removing a large portion of the stomach and stitching it to form a tube-like structure resembling a sleeve. Approximately 80% of the stomach is removed, leaving a remaining volume of about 150 cc. After the surgery, patients are able to eat less and feel full quickly. The body then utilizes the excess fat as a source of energy, resulting in a weight loss of approximately 70% of excess weight. The treatment outcome shows that patients can achieve an average weight loss of 70-80% of excess weight within 18-24 months, depending on the surgical technique used. The weight loss tends to be sustained if patients adhere to the doctor’s recommendations.

2. Laparoscopic Roux-en Y Gastric bypass

This procedure is more complex. It involves reducing the size of the stomach to approximately 1-2 ounces and connecting the small intestine to the stomach using a bypass. This reduces the absorption of food. After the surgery, patients eat less, and their bodies absorb fewer nutrients from the food they consume. Additionally, the body burns more fat and accumulated nutrients. Weight loss achieved through this procedure is approximately 80%. However, in the long term, patients may require vitamin supplements due to inadequate absorption of vitamins by the body.

Pre- and Post-operative Care for Gastric Surgery

Before Surgery:

Patients undergoing gastric surgery need to undergo a general health check-up to prepare themselves. In addition, they should receive information and understand the surgical procedure as well as pre- and post-operative care instructions. The surgeon will conduct an endoscopic examination of the stomach to evaluate and plan for the surgery. An ultrasound of the liver is also necessary to assess the presence of fatty liver, liver hardness, and gallstones.

After Surgery:

Patients will be able to consume smaller amounts of food, and therefore, they must follow the recommendations provided by the medical team and nurses to ensure they receive sufficient and balanced nutrition. The surgery is performed using a minimally invasive laparoscopic technique, resulting in minimal pain and enabling patients to resume walking quickly. This is beneficial in preventing blood clots in the legs, and patients can typically return home within 3-4 days after surgery. Once discharged, patients should strictly adhere to the medical team’s instructions and follow-up appointments to monitor treatment outcomes.

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