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Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 25% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. The result is a sleeve or tube like structure. The procedure permanently reduces the size of the stomach, although there could be some dilatation of the stomach later on in life. The procedure is generally performed laparoscopically and is irreversible.
Sleeve gastrectomy was originally performed as a modification to another bariatric procedure, the duodenal switch, and then later as the first part of a two-stage gastric bypass operation on extremely obese patients for which the risk of performing gastric bypass surgery was deemed too large. The initial weight loss in these patients was so successful it began to be investigated as a stand-alone procedure.
Today sleeve gastrectomy is the fastest-growing weight loss surgery option in North America and Asia. In many cases, but not all, sleeve gastrectomy is as effective as gastric bypass surgery, including weight-independent benefits on glucose homeostasis. The precise mechanism that produces these benefits is not known.
The procedure involves a longitudinal resection of the stomach starting from the antrum at the point 5–6 cm from the pylorus and finishing at the fundus close to the cardia. The remaining gastric sleeve is calibrated with a bougie. Most surgeons prefer to use a bougie between 32 - 60 Fr with the procedure and the ideal approximate remaining size of the stomach after the procedure is about 150 mL.
Endorsed by the International Federation for the Surgery of Obesity and Metabolic Disorders and The American Society for Metabolic and Bariatric Surgery, sleeve gastrectomy is gaining popularity in children and adolescents. Recent studies have found that it is safe and effective, resulting in weight loss similar to weight loss seen in adult patients undergoing the bariatric procedure.
Sleeve gastrectomy may cause complications; some of them are listed below:
There are three cost categories for sleeve gastrectomy surgery: pre-op (all fees associated with preparing the patient for surgery including professional fees, lab work and testing), the surgery itself (including surgeon, surgical assistant, anesthesia and hospital fees) and post-op costs (follow-up physician office visits, vitamins and supplements).
Out of pocket costs for the sleeve gastrectomy surgery itself may be offered to the patient as a packaged price or charged separately by the surgeon's office and hospital. Packaged prices may or may not include pre-op and post-op care, depending on the surgical practice.
Average costs for sleeve gastrectomy surgery are $19,000 in the United States, although this varies widely between states; South Dakota and Texas offer the lowest average cost at about $12,500 while the most expensive surgeries are performed in Alaska (average about $58,000). 
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