Sleeve Gastrectomy

• What is it? This is a relatively new form of restrictive weight loss surgery. In the operation, which is usually done with a laparoscope, about 75% of the stomach is removed. What remains of the stomach is a narrow tube or sleeve, which connects to the intestines.
  
  Usually, a sleeve gastrectomy is a first step in a sequence of weight loss surgeries. It's typically followed up by gastric bypass or biliopancreatic diversion, which will result in greater weight loss. However, in some cases, it might be the only surgery you need.
  
   
• The Pros. For people who are very obese or sick, standard gastric bypass or biliopancreatic diversion may be too risky. A sleeve gastrectomy is a simpler operation that allows them a lower-risk way to start losing weight. Afterwards, once they've lost weight and their health has improved -- usually after 12-18 months -- they can go on to have a second surgery, such as gastric bypass. In people with high BMIs, sleeve gastrectomies result in an average weight loss of 40% to 50% of excess weight after three years. People with lower BMIs tend to lose even more of their excess weight. The preliminary evidence suggests that sleeve gastrectomy works about as well as adjustable gastric banding. 
  
  Because the intestines aren't affected, a sleeve gastrectomy doesn't affect the absorption of food, so nutritional deficiencies are not a problem.
• The Cons. Since a sleeve gastrectomy is often just the first step in weight loss surgery, you will probably face further operations later on. Unlike gastric banding procedures, a sleeve gastrectomy is irreversible. Most importantly, since it's relatively new, the long-term benefits and risks aren't yet known.
• The Risks. Typical surgical risks include infection, leaking of the sleeve, and blood clots.

Medical Policy

This alternative surgical approach to gastrectomy involves resection of the greater curvature of the stomach resulting in a stomach remnant shaped like a tube or "sleeve."  It can be performed by open or laparoscopic technique and can be done as a stand-alone procedure or as the first in a two-stage procedure subsequently followed by a malabsorptive procedure, such as biliopancreatic diversion with duodenal switch.  It has been proposed by some surgeons for very high risk patients where weight loss following sleeve gastrectomy may improve a patient's overall medical status and reduce risk for subsequent more extensive malabsorptive procedures..... This is from Anthem website

• What is it? Gastric bypass is the most common type of weight loss surgery. It makes up about 80% of all weight loss surgeries in the U.S., and combines both restrictive and malabsorptive approaches. It can be done as either a minimally invasive or open surgery.
  
  In the operation, the surgeon divides the stomach into two parts, sealing off the upper section from the lower. The surgeon then connects the upper stomach directly to the lower section of the small intestine. Essentially, the surgeon is creating a shortcut for the food, bypassing a section of the stomach and the small intestine. Skipping these parts of the digestive tract means that fewer calories get absorbed into the body.
  
   
• The Pros. Weight loss tends to be swift and dramatic. Most of it happens in the first six months. It may continue for up to two years after the operation. Because of the rapid weight loss, health conditions affected by obesity -- like diabetes, high blood pressure, high cholesterol, arthritis, sleep apnea, heartburn, and other conditions -- often improve quickly. You'll probably also feel a dramatic improvement in your quality of life.
  
  Gastric bypass also has good long-term results; studies have found that many people keep most of the weight off for 10 years or longer.
   

What to Expect After Weight Loss Surgery

Obesity affects more than 60 million Americans. Obese people often suffer serious health problems and have higher rates of heart attacks, strokes, diabetes, and cancer. For severely obese people who can't lose weight any other way, weight loss surgery can quite literally be lifesaving.

But weight loss surgery is no quick fix. To be successful, surgery must be followed by lifelong changes in eating and behavior. And weight loss surgery, like any major surgery, carries risk. What can you expect after undergoing weight loss surgery?
 
How Much Weight Will You Lose After Surgery?

The main thing to expect after weight loss surgery is -- as expected -- weight loss! On average, people lose 61% of excess weight after gastric bypass surgery.

Other surgeries such as gastric banding, result in about 47% of excess weight loss.

Obesity-related medical problems generally improve after weight loss surgery. Some of these improvements can be dramatic:

• Underweight 18.5
• Normal weight 18.5-24.9
• Overweight 25-29.9
• Obesity 30 or greater

You have a BMI of 50.8.
This puts you in the Super Morbid Obesity category.
Your BMI is extremely high and is enough to qualify you for bariatric surgery.

Benefits…

·                         Weight loss: Immediately following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure. Although most patients then start to regain some of their lost weight, few regain it all.

·                         Obesity-related conditions improve: For example, in one study, blood sugar levels of most obese patients with diabetes returned to normal after surgery. Nearly all patients whose blood sugar levels did not return to normal were older or had diabetes for a long time.

Obesity affects more than 60 million Americans. Obese people often suffer serious health problems and have higher rates of heart attacks, strokes, diabetes, and cancer. For severely obese people who can't lose weight any other way, weight loss surgery can quite literally be lifesaving.

·                         Lifestyle Changes After Weight Loss Surgery…

Weight loss surgery can produce dramatic results. But the gains from losing weight are not automatic. The process requires permanent lifestyle changes to be successful.
Eating small frequent meals. The small stomach created by weight loss surgery can only hold so much. Eating large meals can cause problems. Many people with obesity are "binge eaters." Adapting to eating smaller meals can be a challenge.

·                         More than 60 million obese people are living in the U.S., according to the American Obesity Association (AOA), and about nine million are severely obese. Being overweight is the second leading cause of preventable death in the U.S., after smoking, according to the AOA.

·                         Obese people are at higher risk for complications, particularly if they have early signs of diabetes or heart disease