Sleeve gastrectomy is a surgical procedure that reduces stomach size. This procedure is usually performed laparoscopically, which involves inserting small instruments through multiple small incisions in the upper abdomen. During Sleeve gastrectomy, about 80% of the stomach is removed.
Reducing the size of the stomach limits the amount of food you can consume. In addition, the procedure stimulates hormonal changes that help in weight loss. These same hormonal changes also help alleviate conditions associated with being overweight, such as high blood pressure or heart disease.
Dr. Dejan Veličković: “The first thing I ask all my patients, when they come for an examination, is what they expect. If patients expect some dramatic weight loss, which is 40-50 kilograms, then we come to some form of surgical treatment. In any case, when a patient comes and asks for help from us, it usually means that he has tried a large number of different conservative methods. These are different diets and different medications that unfortunately resulted in failure. So, we are not the “first line” that treats obese patients and we are not cosmetic surgeons. We are surgeons who mainly deal with pathological obesity. These are people who are not only overweight, but also have a number of diseases that are related to obesity. After all, some people end up asking for our help”.
Pathological obesity
Dr. Dejan Veličković: “Obesity, as a disease, was classified only in the 21st century. More precisely, seven years ago in the United States, and five years ago in Europe. According to the criteria of the World Health Organization, pathologically obese people are those who have a body mass index over 40. These are people who generally have an enormous excess of body weight – 40, 50, 60, 70, even 100 and more kilograms. Thus, not all obese individuals are pathologically obese. According to the criterion of body mass index, people who have a body mass index of 25 to 30 are considered people with overweight, over 30 are obese, over 40 are pathologically obese or morbidly obese. “
Stomach reduction surgery is not for everyone
Dr. Dejan Veličković: “Not everyone can and can’t do it right away. Indications for the surgical treatment of obese patients are set by a multidisciplinary team. The team must consist of an endocrinologist, surgeon, anesthesiologist, cardiologist, pulmonologist and psychologist or psychiatrist. So, some first stage in the treatment of patients is to see the history of obesity: since when they are obese, what are their life habits, what work they do, how much energy they have during the day. This is followed by anthropometric measurements – body height, weight, waist circumference and amount of adipose tissue.
The next phase is a psychologist or psychiatrist examination where some conditions and diseases that are a contraindication for, say, bariatric surgery, such as bulimia or Binge Eating, or excessive overeating, must be ruled out. Patients must understand that surgery is not the end of their treatment and the end of the fight against weight gain. The operation is just the beginning of a fight that will last a lifetime. So, there are several steps that must be taken. These are complete endocrinological evolution, starting with blood count, biochemical analysis, liver function, kidney function, insulin, glycemic profile – read through the analysis before we get to it or make a decision whether the patient is suitable for surgical treatment or not. ”
Reducing the stomach at the expense of the state
Dr. Dejan Veličković: “Fortunately, the state recognized obesity as a disease and recognized the importance of surgical treatment of obesity. Since 2010, at the Clinical Center, there is one multidisciplinary obesity team, which has had some small interruptions in its work, but in recent years we have been working constantly. The team consists of endocrinologists from the Institute of Endocrinology, surgeons and anesthesiologists. Patients already know that this center exists and they know the procedure for coming to us. So, all patients have to go through an endocrinological procedure and then the endocrinologists, after a complete evaluation, take the patients to a consultation, where we all together make a decision on surgical treatment. ”
Criteria for surgical treatment of obesity
Dr. Dejan Veličković: “The decision on the type of surgical treatment is individual and is made for each patient. Some of the most basic criteria are age, gender, and some comorbidities that result from obesity or that worsen in obesity. These are cardiovascular diseases and diabetes. When all this is considered, a decision is made on the type of surgical treatment. ”
Methods of surgical treatment of obesity
Dr. Dejan Veličković: “Nowadays, there are several methods that involve only shortening the stomach (restrictive methods – reducing the capacity of the stomach), there are low-absorptive – methods that affect food absorption and combined methods restrictive and low-absorptive where the stomach shrinks and expels one part of the thin intestines from the process of digestion and food intake. Nowadays, it has been reduced to 2 methods, one is the so-called Sleeve gastrectomy which involves shortening the stomach and significantly reducing the capacity to some 100 to 150 ml, and the other is Roux-En-Y or Gastric bypass where the stomach shortens and one part of the small intestine is expelled from resorption. ”
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