published Sunday, June 3rd, 2012

What is gastric sleeve surgery?

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    Dr. Jack Rutledge is seen in this file photo.
    Photo by Brian McDermott

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WHAT IT COSTS

The cost of gastric sleeve surgery can vary, but generally ranges from about $17,000 to $26,000. Coverage depends on the individual's insurance plan. According to BlueCross BlueShield of Tennessee: "The cost of bariatric surgery for the treatment of morbid obesity may or may not be covered by insurance. Some companies, including BCBS, request patients meet certain standards, such as pre-surgical weight loss and psychological consultation, before determining whether the operation is 'medically appropriate.'"

HOW FAT ARE WE?

According to the Centers for Disease Control and Prevention, more than 15 percent of adults in every state are obese. In 2010, 12 states -- including Tennessee -- had an obesity rate of more than 30 percent. Georgia's rate was between 25 and 29 percent.

Obesity-related conditions include heart disease, certain types of cancers, diabetes and stroke.

About 112,000 deaths each year are attributed to obesity-related causes.

Sleeve gastrectomy, or gastric sleeve surgery, is a relatively new type of bariatric surgery.

The laparoscopic operation removes about 85 percent of the stomach, leaving a small space in the shape of a sleeve.

But, said Dr. Jack Rutledge, this is not a "plumbing" surgery, like a gastric band. It's a metabolic operation.

"The sleeve gastrectomy changes the biology that gives people a chance to lose weight that they couldn't otherwise," he said.

The surgery removes the upper outer portion of the stomach, the portion that produces the hunger hormone ghrelin. The reduction of ghrelin production limits the desire to eat.

Sleeve gastrectomy also causes food to reach the terminal ileum, the last loop of the small intestine, more quickly than before. When this happens, satiation hormones are released, sending signals of biological satisfaction to the brain.

Rutledge said there is not yet enough conclusive evidence to determine whether sleeve gastrectomy actually changes a patient's metabolism, which is the rate at which the body burns calories.

"These operations work by giving people a biological chance to get a new, lower and healthier weight set point," he said.

Set points are essentially the high and low weight limits that the body will allow. A patient who had a prior high-low range of 300 to 200 pounds might have a 300- to 150-pound range following surgery.

But while the surgery allows the patient to achieve a lower weight, it does not prevent reaching the high point again. At least 20 percent of gastric bypass patients put back all the weight they lost within five years, Rutledge said.

He expects the statistics for the sleeve to be slightly worse, maybe 20 to 30 percent within five years.

"That's why the lifestyle portion is so important," Rutledge said.

about Holly Leber ...

Holly Leber is a reporter and columnist for the Life section. She has worked at the Times Free Press since March 2008. Holly covers “everything but the kitchen sink" when it comes to features: the arts, young adults, classical music, art, fitness, home, gardening and food. She writes the popular and sometimes-controversial column Love and Other Indoor Sports. Holly calls both New York City and Saratoga Springs, NY home. She earned a bachelor of arts ...

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