Sleeve Gastrectomy

The sleeve gastrectomy removes roughly 75 to 80 percent of the stomach - mainly the outer left portion that curves beneath the left rib cage. What remains is a narrow tube with a capacity of around 60 to 100 millilitres. Patients find it helpful to think of the stomach going from a large pouch to something long and narrow.

This is not a bypass. Food still travels the natural route - oesophagus to stomach to intestine - just in a much smaller volume. The pylorus, the valve that controls how food exits the stomach, is left intact, keeping digestion closer to normal.

One change patients often notice before significant weight loss occurs: hunger reduces. This happens partly because the portion of the stomach that produces ghrelin - the hormone responsible for triggering hunger - is removed during the procedure.

Eligibility is not determined by weight alone, though BMI provides a starting point:

• BMI above 35, even without other medical conditions, is generally considered sufficient
• BMI above 32 with diabetes, hypertension, or obstructive sleep apnoea - earlier intervention is often warranted, given the metabolic benefits that follow surgery
• Eating patterns are assessed carefully - sleeve gastrectomy produces better outcomes in some patterns than others
• Psychological readiness is evaluated - patients who understand that surgery changes the stomach, not the circumstances around them, engage better with what follows
• Pre-existing nutritional deficiencies, which are not uncommon among patients presenting here, are identified and corrected before any procedure goes ahead

Most cases are performed laparoscopically:

• Five or six small incisions, each less than 1.5 centimetres, are made across the abdomen
• A camera and surgical instruments are inserted through these incisions
• The left portion of the stomach is divided and removed using stapling devices
• The remaining tissue forms the narrow gastric tube
• The pylorus is preserved, maintaining physiologically natural digestion

Hospital stay is typically two to three days. Walking is encouraged within the first twelve to eighteen hours. Discharge follows once oral fluid intake is comfortable, and observations are stable. Most patients are surprised by how little the external wounds reflect the scale of the internal change.

Compared to gastric bypass, sleeve gastrectomy offers several practical advantages:

• Technically less complex, with no intestinal rerouting
• Lower risk of serious malabsorption
• Avoids dumping syndrome in most cases - the uncomfortable post-meal symptoms that some bypass patients experience
• Preserves the stomach's natural anatomy and outlet

Bypass may still be the better choice for patients with severe, long-standing acid reflux or diabetes that has not responded to medication for many years. The decision is made after a detailed individual assessment.

Diet progresses in stages over the first four to six weeks:

• Week one to two: liquids only
• Week three: soft, blended foods
• Week four onwards: gradual transition to a regular diet
• Portion sizes remain small throughout - sometimes as little as two to three tablespoons per meal initially

Nutritional priorities after surgery include:

• High protein intake at every meal — guidance on meeting this using locally available foods is part of the post-operative programme
• Long-term supplementation with vitamin B12, calcium, and iron — this is not optional and does not stop once weight loss targets are reached
• Structured follow-up at six weeks, then monthly for six months, then annually

Weight loss of 60 to 70 percent of excess body weight is commonly achieved over twelve to eighteen months. Conditions such as type 2 diabetes, hypertension, and joint pain frequently improve within weeks of surgery - often well before the full weight loss has occurred. Weight regain is possible after two to three years if eating patterns gradually expand the sleeve. The surgery provides a meaningful advantage; sustaining it requires consistent effort.

The Department of Bariatric Surgery at UMC Victoria Hospital offers the most advanced gastric sleeve surgery in Kampala with the best possible outcomes. It includes:

• Surgical evaluation by an experienced bariatric team
• Nutritional assessment and meal planning support
• Psychological review as indicated
• Family involvement in consultations - recovery is rarely a solo process

No patient is moved toward surgery before evaluation is complete and expectations are clearly understood. For patients travelling from outside Kampala - from other districts or across the region - the pre-operative process is coordinated to reduce unnecessary trips where possible.