Sleeve gastrectomy

Nirmala¹, Subadhra Devi², Maha Lakshmi³

¹Senior Nursing Supervisor, Kauvery Hospital Cantonment, Trichy, Tamil Nadu

²Nurse Educator, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

³Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

Abstract

Morbid obesity and super obesity are major health problems that lead to serious medical issues such as diabetes, high blood pressure, sleep apnea, and reduced quality of life. Sleeve gastrectomy is a widely used bariatric surgery that reduces the size of the stomach to help control hunger and promote weight loss. This procedure is recommended for patients who are unable to achieve weight reduction through diet, exercise, or medication. Sleeve gastrectomy has been shown to produce significant and long-term weight loss, improve obesity-related health conditions, and enhance overall physical and emotional well-being.

Key words: Sleeve gastrectomy; Morbid obesity; Super obesity

Introduction

Morbid obesity (BMI ≥ 40) and super obesity (BMI ≥ 50) are increasing worldwide due to lifestyle changes, genetic factors, and unhealthy eating patterns. People with severe obesity often suffer from breathlessness, fatigue, joint pain, sleep disturbances, and difficulty performing daily activities. These health challenges make weight-loss surgery an important option when conservative methods fail. Sleeve gastrectomy involves removing a large portion of the stomach, creating a small tube-shaped stomach to limit food intake and reduce hunger hormone levels. Because of its safety, simplicity, and effectiveness, sleeve gastrectomy has become one of the most preferred surgical treatments for patients struggling with severe obesity.

Fig (1): Sleeve gastrectomy

*Source: Dr. Anirudhvij. Sleeve Gastrectomy Surgery

Case Presentation

A 28-year-old female patient presented with a long-standing history of morbid obesity. Despite multiple attempts at weight reduction through diet, exercise, and medical advice, she was unable to achieve any significant or sustained weight loss.

Social History: She does not have any social history
Allergies: Not known medicine and food allergies.
Past Medical History:
Past Surgical history:

Physical Examinations

Vital signs

Temperature: 98.6, HR: 72/min, RR: 20/min, BP: 130/80mmhg
SpO2: 100 %
Weight was 145 kg, and her height was 151 cm, resulting in a BMI of 64.4GCS: 15/15

Relevant investigations

S. No	Investigation	Results
1	Haemoglobin	10.8 g/dL
2	HbA1C	10.3
3	Lipid Profile	33.0
4	Sodium	136 mmol/L
5	Calcium	1.05 mmol/L
6	Potassium	3.7 mmol/L
7	pH Blood	7.41

Management

Due to her progressively worsening obesity and its impact on her daily life, she was admitted for an elective laparoscopic sleeve gastrectomy. The surgical procedure was performed successfully without any intraoperative complications, and a drain tube was placed to monitor postoperative output. Her immediate postoperative recovery was uneventful. She tolerated the prescribed diet progression, had stable vital signs, and her pain was well controlled. She was discharged on the 6th postoperative day in good condition with appropriate postoperative instructions. On the 13th day after discharge, the patient returned with complaints of severe abdominal pain. A CT scan of the abdomen and an abdominal ultrasound were performed to rule out postoperative complications such as gastric leak or intra-abdominal collection. Both imaging studies showed no evidence leak or abnormal findings.

USG: Moderate hepatomegaly. No free fluid in the abdomen

Fig (2): USG Abdomen

K/C/O sleeve gastrectomy with post-operative status shows: No obvious evidence of contrast leak at present. No obvious evidence of free fluid / intra-abdominal fluid collection / abscess. Focal areas of altered density in the subcutaneous plane of the anterior abdominal wall on the left side.

Fig (3): Pelvis with Contrast

She was managed conservatively with supportive care and was gradually restarted on oral liquids. Her symptoms improved steadily over the next few days. After achieving stable clinical status, adequate oral intake, and symptomatic relief, the patient was discharged once again in stable condition with advice for regular follow-up and dietary compliance

Skilled Nursing Care

Monitoring Vital Signs

Checked temperature, pulse, respiration, blood pressure, and oxygen saturation at regular intervals.
Watching for early warning signs such as fever, fast heart rate, low blood pressure, or breathing difficulty, which may indicate infection or postoperative complications.

Wound and Drain Care

Inspect the surgical incision for redness, swelling, warmth, or discharge.
Observe the drain site carefully and maintain strict aseptic technique while cleaning or dressing it.
Monitor the drain output for amount, color, and any sudden changes, and report abnormal findings to the surgeon.

Pain Management

Medication given as per doctors’ advice
Encourage comfortable positioning and teach simple relaxation techniques to help reduce discomfort.

Respiratory Support

Encouraged deep breathing exercises and use of an incentive spirometer to prevent lung complications.
Made the patient sit up and walk early to improve lung expansion and circulation.
Monitored for shortness of breath or reduced oxygen levels.

Fluid and Nutritional Care

Clear liquids started as advised and monitored for nausea, vomiting, or abdominal discomfort.
Encourage small, slow sips to avoid bloating or vomiting.
Monitor hydration status by checking urine output, and signs of dehydration.

Infection Prevention

Maintained proper hand hygiene before and after all procedures.
Keep the wound clean and dry.

Mobility and Activity

Assist the patient in early ambulation to prevent blood clots and improve bowel movement.
Teaching simple leg exercises like ankle pumping to the patient
Encouraged the patient’s gradual increase in activity as tolerated.

Patient Education

Instruct on wound care at home, drain care if still in place, and maintaining hygiene.
Explained well warning signs such as fever, severe abdominal pain, repeated vomiting, or fast heart rate that require immediate medical attention.

Discharge Medications

S No	Drug Name	Dose	Duration
1	Tab. Augmentin	625 mg	5 Days
2	Tab. Nexpro	40 mg	5 Days
3	Tab. Paracetamol	500 mg	7 Days
4	Tab. Domstal	10 mg	5 Days
5	Cap. Econorm	250 mg	5 Days

Conclusion

This case highlights the importance of early recognition and prompt evaluation of postoperative symptoms following bariatric surgery. It also emphasizes the vital role of skilled nursing care in monitoring, patient education, dietary guidance, and emotional support throughout recovery. With appropriate medical and nursing management, the patient achieved a safe and stable postoperative outcome and was able to continue her recovery with improved clinical status.

Sleeve gastrectomy

Sleeve gastrectomy

Nirmala1, Subadhra Devi2, Maha Lakshmi3

Nightingale Journals

Nirmala¹, Subadhra Devi², Maha Lakshmi³