Gastric Sleeve Surgery and Type 2 Diabetes

Gastric Sleeve Surgery and Type 2 Diabetes

Bariatric surgery, including gastric sleeve surgery, is the most effective treatment for type 2 diabetes. The combination of post-sleeve gastrectomy weight loss, decreased food intake and neuro-hormonal changes result in durable blood glucose improvement and in many cases Diabetes remission. Few studies, however, have addressed the preventative effect of gastric sleeve and bypass surgery on new onset type two diabetes development. “Preventative effect of bariatric surgery on type 2 diabetes in morbidly obese patients: a national French survey between 2008 and 2016 on 328,509 morbidly obese individuals” is a newly published study in the Surgery for Obesity and Related Diseases journal. This French nationwide retrospective study shows 82% reduction in new onset type 2 diabetes development following bariatric surgery in obese patients. Gastric sleeve surgery and gastric bypass were equally effective in reducing the development of type 2 diabetes.

Obesity is a major risk factor for type 2 diabetes. If you live in Houston and suffer from excess weight or type 2 diabetes, bariatric surgery may be a great solution for you. Don’t wait until you develop advanced type 2 diabetes to consider a safe, effective and minimally invasive procedure like gastric sleeve surgery. Gastric sleeve surgery unlike insulin supplementation reverses the underlying pathophysiology of type 2 diabetes. Gastric sleeve surgery increases gastric emptying. Gastric sleeve surgery promotes the secretion of neuroendocrine signals that favor lower insulin resistance, lower blood glucose levels and weight loss. Take control of your health today and invest in it, for your health is your best wealth. Early intervention in the form of sleeve gastrectomy is associated with a higher success rate of type 2 diabetes remission and lower rate of type 2 diabetes related complications.

Houston Sleeve Gastrectomy Technique: Does it Matter?

Sleeve Gastrectomy Technique: Does It matter?

I read with interest the new study “Assessment of Sleeve Gastrectomy Surgical Technique: First Look at 30-Day Outcomes Based on the MBSAQIP Database” published by my colleague Dr. Chaar in JACS current issue. The author compares different techniques in staple line reinforcement in sleeve gastrectomy cases collected in the MBSAQIP database. Continue reading “Sleeve Gastrectomy Technique: Does It matter?”

Gastric Sleeve Revision Surgery in Houston

Gastric Sleeve Revision Surgery Overview

Gastric sleeve surgery is currently the most commonly performed weight loss procedure in Houston, TX. When properly performed, Sleeve surgery results in significant and durable weight loss with minimal short-term and long-term complications. Proper sleeve surgery results in a banana shaped stomach with no twisting, narrowing or retained gastric fundus. The gastric fundus is the upper part of the stomach that stores ingested food, control gastric emptying, and secretes many hormones that affect appetite, hunger and energy metabolism. A retained gastric fundus following a poorly performed sleeve surgery results in poor weight loss and the development of GERD (gastroesophageal reflux disease). GERD also known as acid reflux results in heartburn, cough and food regurgitation. New onset GERD following sleeve surgery is a strong indication of a poorly performed gastric sleeve surgery.

When is Gastric Sleeve revision surgery performed?

If you had a gastric sleeve procedure and you are currently experiencing poor weight loss, or any GERD related symptom like chronic cough, heartburn, and food regurgitation please give us a call. Do not treat yourself with over the counter antacid medications. You need to be thoroughly evaluated by a heartburn and weight loss specialist. If you are found to have an incompletely resected gastric sleeve, or a narrowed sleeve lumen, revision surgery may be offered to amend the problem.

How does Gastric Sleeve revision surgery work?

A revision surgery is indicated following gastric sleeve to correct certain anatomic problems that are causing acid reflux related symptoms and poor weight loss. The most common gastric sleeve revision procedure performed at Houston Weight Loss Surgery Center and Houston Heartburn and reflux center is hiatal hernia repair and resection of retained gastric fundus. A hiatal hernia occurs when the upper part of the stomach migrates into the chest through an enlarged opening in the breathing muscle.  This results in significant weakness in the lower esophageal sphincter leading to bothersome acid reflux and bile gastritis following gastric sleeve surgery.

Is Gastric Sleeve revision a good option for me?

Revision surgery is a complicated procedure and many factors are taken into consideration when evaluating a bariatric patient for potential revision surgery. After thorough assessment, Dr. Darido will discuss with you and at length the best treatment options for you. When indicated, a revision sleeve procedure allows you to alleviate your acid reflux and put you back on the right path for weight loss and healthy life.

Who should perform your Sleeve revision surgery?

It is extremely important to choose a knowledgeable weight loss and heartburn doctor to perform your sleeve revision surgery. Why? Poor weight loss and acid reflux go hand in hand most often following incomplete gastric sleeve resection and poor hiatal hernia repair. A specialist in both fields of acid reflux disease and weight loss, like Dr. Darido, is the most qualified doctor to take good care of you.

How much does sleeve surgery cost?

Surgery cost varies depending on your insurance plan. Our insurance and finance specialists are available to answer all your financial questions.

What is my recovery time?

You will usually spend a night or two in the hospital after surgery. It takes around one week before you can go back to work.

Lets get started

If you would like to learn more about sleeve revision surgery, we encourage you to contact our office for a private consultation. During this relaxed and informative session, you will get to meet Dr. Darido and learn if you are a good candidate for revision surgery.

Does Gastric Sleeve Surgery Cause Barrett’s Esophagus?

Felsenreich et al. recently published in the journal of Obesity Surgery a very interesting study on gastric sleeve surgery long-term outcomes. The study is titled: “Update: 10 years of sleeve gastrectomy-the first 103 patients” and includes all patients who had gastric sleeve surgery prior to 2006 at participating bariatric centers in Austria. Continue reading “Does Gastric Sleeve Surgery Cause Barrett’s Esophagus?”

Gastric Bypass and Sleeve Gastrectomy Revision Surgery

I read with great interest the study published in Surgery for Obesity and Related Diseases by DeMaria et al. It is a retrospective review of 96 gastric bypass patients who underwent conversion of to distal gastric bypass between 2010 and 2016. The Roux or alimentary limb is cut at the jejuno-jejunostomy and transposed distally leaving a common channel between 150 to 200 cm in length. Continue reading “Gastric Bypass and Sleeve Gastrectomy Revision Surgery”

Nissen-Sleeve operation, is it an option?

Nissen-Sleeve operation, is it an option?

David Nocca, MD, head of Bariatric Surgery department at the University of Montpellier in France is currently conducting an international bariatric workshop about a new weight loss procedure: Nissen-Sleeve operation. The French team have already published a pilot study in SOARD in 2016 demonstrating Nissen-sleeve surgery feasibility and safety in 25 patients. The authors advocate that this approach eliminates acid reflux following gastric sleeve surgery with comparable weight loss outcomes to the traditional sleeve gastrectomy. A secondary advantage of Nissen-sleeve surgery is a decrease in the risk of staple line leak at the angle of His. The authors further advocate that the risk of remnant gastric fundus ischemia in Nissen-sleeve surgery is low given the rich blood supply of the stomach. Continue reading “Nissen-Sleeve operation, is it an option?”

Gastric Sleeve Surgery in Houston is Here to Stay

JAMA Obesity Theme Issue: Gastric Sleeve Surgery Is Here to Stay

The Journal of the American Medical Association, JAMA, current issue is entirely devoted to the medical problem of obesity. I was particularly interested by two published randomized studies comparing gastric sleeve to gastric bypass surgery with a 5-year follow-up. The Swiss Multicenter Bypass or Sleeve Study, SM-BOSS, and the Finnish Sleeve vs Bypass, SLEEEPASS, study showed similar weight loss and type 2 diabetes remission rate at 5 years. Reoperation rate was similar to both gastric sleeve and bypass patients in both studies. Repeat surgery was mainly for GERD in gastric sleeve patients and internal hernia for gastric bypass patients. Continue reading “JAMA Obesity Theme Issue: Gastric Sleeve Surgery Is Here to Stay”

Gastric Sleeve Surgery and GERD

I read with great interest the commentary on evaluating the feasibility of phrenoesophagopexy during hiatal hernia repair in sleeve gastrectomy patients. The commentary was recently published in SOARD by Dr. Jose Ferrer from the Bariatric and Metabolic Surgery Center in Valencia, Spain. The author reports his concern about the development of GERD, severe reflux esophagitis, and Barrett’s esophagus following gastric sleeve surgery. Ferrer recommends hiatal hernia repair during gastric sleeve surgery. However, herniorrhaphy alone is not enough sometimes. Additional techniques have been developed such as phrenoesophagopexy, Hill gastropexy, Teres ligament pexy, and different forms of fundoplications to augment the anti-reflux barrier. Continue reading “Gastric Sleeve Surgery and GERD”

Question of the Week from Tina

Question of the Week from Tina:

I’m planning on having VSG in the next three months. I had the Nissen funoplication 3 yrs ago for severe Gerd. My consult will be sometime next month. It seems that there is no contraindication for gastric sleeve after the nissen procedure, according to this article which is a relief to me. It seems nissen reversal prior to VGS would be a much riskier procedure. Will there be enough of the “hunger hormone” side of the stomach to surgically remove and can this side of stomach grow back? Or does it just stretch itself back out if one tends to over eat?

Excellent question Tina. Ghrelin or hunger hormone is mostly secreted by gastric fundus. Ghrelin blood level decreases following gastric sleeve surgery as the gastric fundus is resected. Decreased ghrelin levels contribute to hunger control, increased satiety and weight loss. We don’t have any study evaluating Ghrelin blood level following Nissen Sleeve surgery. I think that a plicated gastric fundus is metabolically equivalent to a resected fundus. Therefore, I expect Ghrelin level to decrease following Nissen Sleeve surgery. Nissen fundoplication is associated with weight loss and a recent study published in 2015 demonstrated decreased Ghrelin levels following fundoplication surgery. Gastric fundus invagination, a weight loss procedure I developed few years ago, prevents Ghrelin level increase with weight loss. I demonstrated this finding in an obese rat model. In humans, gastric fundus invagination has not been studied but I predict that Ghrelin levels will also decrease.

Ghrelin, however, is not the only hormone change responsible for weight loss. Many other signals are equally important like GLP-1 (Glucagon like peptide). GLP-1 decreases following Nissen fundoplication and is likely to decrease following Nissen Sleeve surgery. Increased gastric emptying is thought to contribute to GLP-1 increase and Nissen fundoplication is associated with increased gastric emptying. I have noticed on post-operative contrast studies that Nissen Sleeve procedure increases gastric contrast emptying.

Overall, I think that the plicated fundus is functionally equivalent to a resected fundus. When properly performed, fundus presrving gastric sleeve surgery, in obese patients with history of Nissen fundoplication, results in excellent weight loss results.