Sleeve Gastroplasty

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Severe obesity remains a significant health concern, particularly for individuals who have attempted multiple weight-loss methods without long-term success. In such cases, bariatric (gastric) surgery offers an effective treatment option for sustainable weight reduction.

Several surgical techniques are currently available; however, the most commonly performed procedures include:

1. Sleeve Gastrectomy

2. Roux-en-Y Gastric Bypass

These procedures are preferred because they result in effective and sustained weight loss, have relatively low complication rates, and can be performed using minimally invasive laparoscopic techniques. As a result, patients experience smaller incisions, less postoperative pain, faster recovery, and minimal scarring.

When Should Gastric Surgery Be Considered?

Patients with obesity who meet the criteria established by the Thailand Society for Metabolic & Bariatric Surgery (TSMBS) may be suitable candidates for bariatric surgery, including:

• Individuals with a body mass index (BMI) ≥ 37.5 kg/m²

• Individuals with a BMI ≥ 32.5 kg/m² and obesity-related comorbidities

• Individuals with a BMI ≥ 30 kg/m² with metabolic comorbidities or certain types of type 2 diabetes

Is Gastric Surgery Safe for Weight Loss?

In general, bariatric surgery is considered safe and is typically performed using minimally invasive laparoscopic techniques. This approach results in small incisions, minimal pain, and rapid recovery.

The mortality rate is less than 1%, while surgical complications—such as leakage or bleeding at the surgical site—occur in fewer than 3% of cases and can usually be effectively managed.

Surgical Procedures for Weight Loss

1. Laparoscopic Sleeve Gastrectomy

Laparoscopic sleeve gastrectomy involves removing a large portion of the stomach and reshaping the remaining stomach into a narrow, tube-like structure resembling a sleeve. Approximately 80% of the stomach is removed, leaving a residual gastric volume of about 150 cc.

After surgery, patients consume smaller portions and feel full more quickly. As a result, the body utilizes stored fat as an energy source, leading to significant weight loss. On average, patients lose 70–80% of excess body weight within 18–24 months, depending on the surgical technique used. Long-term weight loss can be maintained when patients follow medical and dietary recommendations.

2. Laparoscopic Roux-en-Y Gastric Bypass

This procedure is more complex and involves creating a small stomach pouch with a capacity of approximately 1–2 ounces, which is then connected directly to the small intestine, bypassing a portion of the digestive tract. This reduces both food intake and nutrient absorption.

As a result, patients eat less, absorb fewer calories, and burn stored fat more efficiently. Average excess weight loss is approximately 80%. However, due to reduced nutrient absorption, long-term vitamin and mineral supplementation may be required.

Pre- and Post-Operative Care for Gastric Surgery

Before Surgery

Patients undergoing bariatric surgery must complete a comprehensive health evaluation. This includes receiving detailed information about the surgical procedure and pre- and post-operative care.

An upper gastrointestinal endoscopy is performed to assess the stomach and assist in surgical planning. Additionally, a liver ultrasound is required to evaluate fatty liver disease, liver stiffness, and the presence of gallstones.

After Surgery

Following surgery, patients will consume significantly smaller amounts of food and must strictly follow nutritional guidelines provided by the medical team to ensure adequate and balanced nutrient intake.

Because the surgery is performed laparoscopically, postoperative pain is minimal, and patients are encouraged to walk soon after surgery. Early ambulation helps prevent blood clots in the legs. Most patients can be discharged within 3–4 days after surgery.

After discharge, patients should carefully follow medical instructions and attend scheduled follow-up visits to monitor recovery and long-term outcomes.

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