Tubular gastrectomy: what does it consist of?

In a tubular gastrectomy, part of the stomach is removed. This may seem drastic, although it is not a complicated procedure.

Last update: 23 November, 2021

Tubular gastrectomy is a surgical procedure that is practiced for the purpose of reducing the size of the stomach. It is performed under anesthesia, laparoscopically, so it is considered a moderate risk technique.

Thanks to tubular gastrectomy, the production of hormones that induce appetite is also decreased. Therefore, lower your intake because of satiety.

For all this, can help morbidly obese people lose weight. However, it also carries risks and some side effects.

What is a tubular gastrectomy and what is it for?

Tubular gastrectomy is also known as gastric sleeve. The term derives from gastros (stomach), -tomy (cut, incision or excision) and tubular. The latter is due to the fact that the stomach is left with that shape, like a tube.

Currently, it is one of the most used techniques in bariatric surgery, next to bypass gastric, to treat obesity. These types of procedures are aimed at modifying digestive functioning.

In the case of tubular gastrectomy, part of the stomach is removed, reducing its capacity between 150 and 200 cubic centimeters (cc), which means an approximate reduction of 80%. In this way, the person will experience satiety faster.

In addition, it decreases the production of ghrelin, which is a hormone synthesized by the stomach, responsible for regulating appetite. With all that, it is expected to achieve a gradual weight loss, which is sustainable over time.

How is the procedure performed?

Tubular gastrectomy is done under general anesthesia and by laparoscopy, resulting in a less invasive surgery. The steps are the following:

  1. Several incisions are made (5), from the pylorus to the cardia.
  2. The working instruments are introduced into the body through these incisions.
  3. A part of the stomach is cut out, using mechanical suture devices.
  4. The segments are joined, using clips made of a biocompatible material.
  5. Then the remaining part of the stomach is removed.
  6. Finally, the laparoscope and other instruments are removed and the incisions are sutured.

The process can take from an hour to an hour and a half. Upon completion, the patient is transferred to the resuscitation section and then to recovery.

The stomach has a natural capacity that is reduced when these surgeries are performed.

How to prepare for a tubular gastrectomy?

To start, a clinical study of the patient should be performed. This implies assessing the general health status, identifying possible risk factors.

If deemed necessary, you should consult a specialist: endocrinologist or cardiologist, among others. Preoperative examinations include chest x-ray, electrocardiogram, and abdominal ultrasound. A functional respiratory test may also be required.

It should be noted that the intervention will only be approved after evaluations and after verifying that the patient has tried to lose weight by different means without success.

In the weeks leading up to surgery the person may need to start a physical activity program and that it modifies certain habits, such as tobacco consumption. There may also be restrictions regarding food and medication discontinuation.

Care after tubular gastrectomy

After the tubular gastrectomy, while the patient is in recovery, some tests will still be done to assess gastrointestinal function. The next day, the patient can get up to do their personal hygiene. Discharge usually occurs between the third or fourth day.

With regard to food, from the second day the patient can begin to drink liquids. Gradually you will incorporate purees and soft foods, but avoiding sugar.

Approximately Between the first and third month after the operation, you will be able to return to your regular diet. Of course, this progression depends on the adaptation and tolerance of each person.

On the other hand, it is recommended to start an exercise routine. First, smooth, controlled, progressively increasing, although without constituting an intense effort.

Advice regarding food

It is very important that the person get used to the capacity of their stomach. This means that you should eat less and, in addition, chew well and slowly.

In general, it is recommended to incorporate more vegetables and fruits into the diet, as well as lean protein and a lot of fiber. Avoid fats, sweets, fried foods and carbonated drinks.

In the first days, the diet will be strictly liquid and then it can be solid. But in general, it is advisable not to drink liquids during the meal, nor half an hour before or after.

Food can be divided into 4 or 5 servings a day. If breakfast is scarce or very early, a mid-morning snack is also allowed.

And you should always eat a small amount. In fact, the first few days only a maximum of 3 or 4 tablespoons are tolerated.

Benefits and advantages of the procedure

The results of tubular gastrectomy are positive in about 70% of cases. It is estimated that the person may lose more than half their weight, although this does not happen immediately, but within a period of 2 years.

In addition, with the intervention, an improvement in other aspects can be achieved. In particular, it positively affects the risk of diseases associated with obesity, such as high blood pressure, high cholesterol, heart disease, type 2 diabetes and obstructive sleep apnea.

Compared with other procedures, it is more effective than bypass, although its risks are slightly greater than those of the gastric band. Nevertheless, the gastric sleeve has the disadvantage of being irreversible, as a part of the stomach is removed that can no longer be replaced.

Among the bariatric surgeries, the tubular gastrectomy appears as the most effective, although it is irreversible.

For whom is tubular gastrectomy recommended?

In a very special way, the gastric sleeve is indicated in people with overweight problems who have not achieved positive results with diets and various approaches.

Among those potentially eligible to perform the procedure are people who are in some of the following cases:

  • Body mass index (BMI) between 35 and 40, who have diabetes, high blood pressure or heart disease.
  • Morbid obesity: BMI over 40.
  • Extreme obesity: BMI over 50.

Risks and complications

Like any surgical procedure, in tubular gastrectomy there are possible risks, although they are considered low or moderate. The most frequent complications are the following:

  • Bleeding in the stomach or peritoneal cavity.
  • Infection in any of the incision points.
  • Gastric content leak, despite suture.
  • Gastroesophageal reflux.
  • Malnutrition
  • Constipation.
  • Hernias

Surgery needs patient commitment

Sagging skin after a tubular gastrectomy can be corrected by cosmetic surgery (for example, tummy tuck). However, you also have the alternative of exercising.

In general, for most people who undergo this operation it is not difficult to adjust to the new size of their stomach and eat little. All of this translates into quality of life.

But this doesn’t happen overnight or effortlessly. There are a certain number of patients who cannot change their habits. Therefore, they may not lose enough weight.

It might interest you …