Gastric Sleeve

Sleeve and M&M (Magenstrasse-Mill) gastroplasty surgeries are the two newest techniques aiming at eliminating the remote complications of gastric constriction procedures and improving the dietary habits of patients. The biggest disadvantage of the other techniques (vertical-banded gastroplasty surgery and gastric banding) is the difficulty patients have in adhering to the strict nutritional guidelines, and the complications that such behavior may cause. On the contrary, these new methods eliminate bowel obstruction episodes, vomiting and complications relating to stenosis and implantation of foreign bodies. This contributes significantly to the mental health of patients, facilitates their social life and offers them the possibility to maintain their bodyweight at the desired level.

How do these two procedures work? The fundus and body of the stomach constitute the main compartments where food is stored. The fundus has the capacity of storing approximately 1-1.5 kg (2-4 lbs.) of food. Under normal circumstances, satiation is achieved as soon as the stomach fills up with food. In Sleeve gastrectomy, the storage space of the stomach, i.e. the fundus and most of the body, are removed. With the M&M technique, this part of the stomach is isolated, without being removed. In both cases, the stomach assumes the shape of a tube with a storage capacity of 100 grams (3.5 oz.), i.e. 10 to 15 below normal, without disturbing the nerves of the stomach and without causing malabsorption of nutrients.

Satiation is induced with less quantity of food. The passage of food is not delayed, while evacuation is achieved, resulting in inhibiting hunger and combating bulimic tendencies. Moreover, it has been proved that these methods disturb the secretion of ghrelin, the neurohormone responsible for the feeling of hunger. Ghrelin is produced in the fundus of the stomach and acts on the brain, inducing the feeling of hunger. The reduction of ghrelin is the main reason that Sleeve gastrectomy has been described as the most natural gastric constriction procedure.

As the stomach capacity is constricted physically and not artificially, the feeling of satiation comes naturally, without causing stenoses that are responsible for indigestion, vomiting and bowel obstructions. So there is greater weight loss, without requiring adherence to strict dietary guidelines and long-term medical follow-up.

Sleeve and M&M gastroplasty surgeries are advisable for treating morbid obesity (ΒΜΡ>40). Their results are similar to those of other gastric constriction surgeries. The M&M technique is preferable to the Sleeve in the cases where the fundus of the stomach has to be preserved.

Due to the unique benefits and the lack of ulterior complications, Sleeve gastrectomy is considered safe both in patients over 60 and in patients for whom the other procedures are not advisable. It also constitutes an effective alternative for patients who did not benefit from a previous gastric band procedure.

These procedures are laparoscopic, with short hospitalization (3-4 days) and minimal postoperative pain, while the postoperative complications, if any, can be treated conservatively. However, they may require revision surgery. The main complication is leakage from the suture line, in which case hospitalization is extended. Both procedures are extremely safe and have anti-ulcer results due to the reduction of gastric acid. They do not cause dysphagia or malabsorption of nutrients and do not require long-term medical follow-up. They can be performed even on patients with a history of ulcer, a long medical history or health problems. Both procedures are irreversible.

Between 65% and 75% of the excess weight is lost in just the first year. The average weight loss is 45-60 kg (100-130 lbs.), which means that they are more suitable for people with a Body Mass Index (BMI) between 40 and 55. However, they may help people with morbid obesity (BMI>55) in the context of multiple surgical treatment. There is less possibility of failure with a Sleeve gastrectomy than with gastric banding. Weight gain has been mentioned in 15% of the cases. The M&M technique involves greater risk of weight gain, as ghrelin secretion is not reduced. Up to 88% of the patients are satisfied with the results of the procedures.