Weight Loss Surgery
Q & A: The Gastric Sleeve with Dr. Schneider
Dr. Benjamin Schneider answers some questions about the gastric sleeve weight-loss procedure.
Q. How new is this procedure?
It is a newer procedure that we have been doing it here at BIDMC for a few years. It was originally designed to be the first part of a two-part operation, but patients found that they were losing significant weight after having it and not coming back for the second phase of the operation. Now, we do it at BIDMC as a stand-alone procedure.
Q. What does the surgery entail?
During the operation, the surgeon removes approximately 60% of the stomach, creating a small, sleeve-shaped pouch. The new pouch can hold only a small amount of food, basically forcing the patient to eat less. The whole procedure is performed laparoscopically.
Unlike some of the other weight-loss procedures, the gastric sleeve does not involve any bypass of the intestinal tract, and the outlet vale and the nerves to the stomach remain intact. This means that patients are at less risk for anemia, osteoporosis and vitamin deficiency.
Q. How is the gastric sleeve better than the other weight-loss procedures?
Because it's done laparoscopically, the average recovery time in the hospital is shorter. And this procedure doesn't involve a foreign body (like the band), so you don't have to worry about anything getting out of position, needing adjustment, etc.
Q. Is the gastric sleeve covered by insurance?
Right now in Massachusetts, United Health is the only insurance company consistently covering the gastric sleeve; however other insurance companies are reviewing this procedure on a case by case basis. If not covered by insurance, the out-of-pocket cost for this operation is approximately $30,000.
Q. Who is a good candidate for this procedure?
In order to be considered for sleeve surgery, patients need to have a Body Mass Index (BMI) of 40 or higher, or between 35 and 40 if they have additional health problems such as diabetes or sleep apnea. The gastric sleeve is a good option for patients who are considered "high risk", or have other health issues that may prevent them from having gastric bypass surgery. It is also a good option for people who are not a candidate for the band or for those patients who do not want a band.
Also, because a large part of the stomach is removed during surgery, many of the signals to the brain that trigger hunger are eliminated as well. As a result, the hunger response is diminished, which may be helpful for patients who have trouble getting their eating under control.
Q. What are the risks?
Many times, patients think that because a procedure is done laparoscopically, it's a minor operation, but that is just not the case. This is a serious operation that requires careful consideration and a willingness to make some major lifestyle changes.
Among the risks to consider are leakage from the new smaller stomach, although the risk is low (less than 5%), a leak may be serious and require further surgery. Bleeding may also occur (less than 5%). During your visit with the surgeon to discuss surgery all of the potential complications will be discussed.
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Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted January 2010