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New Procedure: The Sleeve

New Procedure Provides Another Option for Patients

By Heather Maloney
Beth Israel Deaconess Medical Center staff

Dr. Dan Jones, Chief of Minimally Invasive Surgery and Director of the Bariatric Program at BIDMC

People struggling with extreme weight loss have a new surgical option available to them: the gastric sleeve procedure, which promises a shorter recovery period and less risk of serious post-surgery complications. Surgeons at Beth Israel Deaconess Medical Center's Bariatric Surgery program have been performing this laparoscopic operation for about a year.

"The gastric sleeve was originally designed to be the first part of a two-part operation," says Dr. Dan Jones, Chief of Minimally Invasive Surgery and Director of the Bariatric Program at BIDMC. "But patients found that they were losing 100 pounds after having it and not coming back for the second phase of the operation. Now, at BIDMC, we do it as a stand-alone procedure."

47-year-old Mehrdad Niknezhad weighed 307 pounds when he had the gastric sleeve operation on December 14th. Now, just over a month later, he has already lost 30 pounds and feels great.

"I am very pleased with the results, and I really haven't had any problems at all," he says. "My wife had gastric bypass surgery a year ago, and she had problems with vomiting, etc., for about three months after surgery. I haven't had any of that."

During the operation, the surgeon removes anywhere from 60% to 80% 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. Therefore, patients are at less risk for anemia, osteoporosis and vitamin deficiency.

Dr. Jones also points out that, because a large part of the stomach is removed, 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.

The gastric sleeve procedure is not yet covered by most insurance companies (currently, United Health is the only company in Massachusetts that covers it). The cost of the operation is approximately $30,000.

Dr. Jones says that the gastric sleeve may be a good option for patients who are considered "high risk", or have other health issues that may prevent them from having gastric bypass surgery.

"I did this procedure on a patient who had several health issues. He couldn't roll over in bed, he needed his knees and hips replaced, he had a hernia eroding through his skin, and he was hospitalized several times for congestive heart failure," Dr. Jones says. "After having the sleeve procedure, he lost 185 pounds and is now able to get around pretty freely in a wheelchair. And now he's healthy enough for doctors to operate on his hips and knees."

The average recovery time is about four days in the hospital, sometimes less. But Dr. Jones points out that it's still a serious operation that requires careful consideration and a willingness to make some major lifestyle changes.

"Many times, patients think that because a procedure is done laparoscopically, it's a minor operation," he says. "But that is just not the case."

The biggest risk with the gastric sleeve is developing a leak in the new smaller stomach, though it's a very small risk (less than 5%). But if there is a leak, the patient will need to return to the hospital so it can be adequately drained.

Mr. Niknezhad is thrilled with the results of his surgery, and says he would recommend the procedure to anyone thinking about weight-loss surgery.

"I considered other procedures, but gastric bypass was too radical and I saw the problems my wife had. And I just didn't think the band would get the job done. I just felt like the sleeve was the right way to go."

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted January 2010

Contact Information

Weight Loss Surgery Center
Beth Israel Deaconess Medical Center
Shapiro Clinical Center, 3rd Floor
330 Brookline Avenue
Boston, MA 02215