Sleeve gastrectomy was initially thought to be a restrictive operation in which the stomach capacity was reduced massively. In this procedure, the bladder-shaped stomach is trimmed with the use of endoscopic staplers to remove the bulk of the organ along its left border, leaving only the right border and some change. In tech- speak, the entire fundus and body of the stomach is resected along the greater curvature, leaving only the lesser curvature and the antrum intact.
This resection, which is almost bloodless, is quickly and effectively done using staplers and vessel-sealing magic devices like Ligasure and Harmonic Scalpel. Once this is done, the capacity of the stomach is reduced to around 80-120 cc. No longer shaped liked a bladder (how could it?) the stomach looks like a hockey stick or banana!
While the reduction in stomach capacity and volume explains why patients (who can only eat smaller meals now) lose weight, this is by no means the full explanation.
It is now known that the stomach, particularly the fundus, secretes an orexogenic (hunger-creating) hormone called ghrelin. Once the fundus is resected, there is a major drop in humger. Patients start focussing on real-life issues and become more productive, and escape the constant torment of cravings and the fight with pangs of guilt and pangs of hunger! Boys start playing rather than sitting at home, munching chips while watching TV! Some of our patients have become gym rats!
The stomach is now being considered a more complex organ than once thought. Apart from the churning of food and the preliminary digestion with its HCl and enzymes, it secretes the intrinsic factor that is needed for Vitamin B12 absorption (the deficiency of which causes a disease called megaloblastic anemia).
Now, on top of all this, the stomach is an endocrine organ as well? Well, well, that means we must respect it even more! Do not abuse the stomach by stuffing it with junk. Eat clean!
