GASTRIC SLEEVE SURGERY
The Verticle Sleeve Gastrectomy (VSG) is a weight loss surgery that
induces weight loss by restricting food intake. With this procedure,
the doctor removes approximately 80-85 percent of the stomach
laparoscopically so that the stomach takes the shape of a tube or
"sleeve." This procedure is usually performed on superobese or high
risk patients with the intention of performing another surgery at a
later time. This surgery may also be done on regular patients (BMI
of 30+) who desire a lower risk procedure than the RNY Bypass while
getting similar results. The second procedure a gastric bypass can
then be done if necessary for the superobese to reach goal.
The vertical sleeve gastrectomy or the gastric sleeve, is a
restrictive form of weight loss surgery in which approximately 85%
of the stomach is removed leaving a cylindrical or sleeve shaped
stomach with a capacity ranging from about 60 to 150 cc, depending
upon the surgeon performing the procedure. Unlike many other forms
of stomach stapling surgery, the outlet valve and the nerves to the
stomach remain intact and, while the stomach is drastically reduced
in size, its function is preserved. Again, unlike other forms of
surgery such as the Roux-en-Y gastric bypass, the vertical sleeve
gastrectomy is not reversible.
Because the new stomach
continues to function normally there are far fewer restrictions on
the foods which patients can consume after surgery, albeit that the
quantity of food eaten will be considerably reduced. This is seen by
many patients as being one of the great advantages of the vertical
gastrectomy, as is the fact that the removal of the majority of the
stomach also results in the virtual elimination of hormones produced
within the stomach which stimulate hunger.
greatest advantage of the gastric sleeve lies in the fact that it
does not involve any bypass of the intestinal tract and patients do
not therefore suffer the complications of intestinal bypass such as
intestinal obstruction, anemia, osteoporosis, vitamin deficiency and
protein deficiency. It also makes it a suitable form of surgery for
patients who are already suffering from anemia, Crohn’s disease and
a variety of other conditions that would place them at high risk for
surgery involving intestinal bypass.
Finally, it is one of
the few forms of weight loss surgery in Mexico which can be
performed laparoscopically in patients who are extremely overweight
or who have a BMI of 30+.
Perhaps the main disadvantage of
the vertical sleeve gastrectomy is that it does not always produce
the weight loss which people would wish for and, in the longer term,
can result in weight regain. This is indeed true of any form of
purely restrictive weight loss surgery, but is perhaps especially
true in the case of the vertical sleeve gastrectomy.
the procedure requires stomach stapling patients do run the risk of
leakage and of other complications directly related to stapling of
the stomach. In addition, as with any surgery, patients run the risk
of additional complications such as post-operative bleeding, small
bowel obstruction, pneumonia and even death. The risk of
encountering any of these complications is however extremely small
and varies from about 0.5 and 1%. Having said this, the risk of
death from this form of surgery at about 0.25% is extremely small.
As a general rule the gastric sleeve is best suited to
individuals who are either extremely overweight or who are looking
to have weight loss surgery with a BMI of 30+. In the case of the
former the vertical sleeve gastrectomy would normally form the first
of a two-part plan of weight loss, with further bariatric surgery
being performed once the patient’s weight has fallen sufficiently to
allow for other forms of weight loss surgery to come in to play. In
the case of the latter, it is designed as a standalone surgery.
Expected Weight Loss
This combined approach has
tremendously decreased the risk of weight loss surgery for specific
groups of patients, even when the risk of the two surgeries is
added. Most patients can expect to lose 60 to 80% of their excess
body weight over a 12 - 24 month period with the gastric sleeve
alone. Most non superobese patients may not even need the second
procedure to achieve their goal weight. The timing of the second
procedure will vary according to the degree of weight loss,
typically 6 - 18 months after completion of the first surgery.
The patient is allowed to leave the
hospital as soon as a few days after the surgery. This is usually on
the third post operative day. The
patient is restricted to a clear liquid diet for 1 week, a
semi-liquid diet for 1 week, followed by a pureed diet for another 3
weeks. If there are no problems, the patient is advanced to a
regular diet. Sweets, alcohol and carbonated drinks should be
banned. Exercising is encouraged from the second post operative week
Vertical Gastrectomy: How it Works
generates weight loss solely through gastric restriction (reduced
stomach volume). The stomach is restricted by dividing it vertically
and removing more than 85% of it. This part of the procedure is not
reversible. The stomach that remains is shaped like a banana and
measures from 2-5 ounces (60-150cc) depending on the surgeon
performing the procedure. The nerves to the stomach and the outlet
valve (pylorus) remain intact with the idea of preserving the
functions of the stomach while reducing the volume. By comparison,
in a Roux-en-Y gastric bypass, the stomach is divided, not removed,
and the pylorus is excluded. The Roux-en-Y gastric bypass stomach
can be reconnected (reversed) if necessary. Note that there is no
intestinal bypass with this procedure, only stomach reduction.
Advantages of the Vertical Gastrectomy Weight Loss Surgery
The stomach is reduced in volume but tends to function normally
so most food items can be consumed, albeit in small amounts.
Eliminates the portion of the stomach that produces the hormones
that stimulates hunger (Ghrelin).
No dumping syndrome because
the pylorus is preserved.
Minimizes the chance of an ulcer
By avoiding the intestinal bypass, the chance of
intestinal obstruction (blockage), anemia, osteoporosis, protein
deficiency and vitamin deficiency are almost eliminated.
effective as a first stage procedure for high BMI patients (BMI>55
Limited results appear promising as a single stage
procedure for low BMI patients (BMI 30-45 kg/m2).
option for people with existing anemia, Crohn's disease and numerous
other conditions that make them too high risk for intestinal bypass
Can be done laparoscopically in patients weighing
over 500 pounds.
Disadvantages of the Vertical Gastrectomy
Weight Loss Surgery
Potential for inadequate weight loss or
weight regain. While this is true for all procedures, it is
theoretically more possible with procedures that do not have an
Higher BMI patients will most likely need to
have a second stage procedure later to help lose the rest of the
weight. Two stages may ultimately be safer and more effective than
one operation for high BMI patients. This is an active point of
discussion for bariatric surgeons.
Soft calories such as ice
cream, milk shakes, etc can be absorbed and may slow weight loss.
This procedure does involve stomach stapling and therefore leaks
and other complications related to stapling may occur.
the stomach is removed, it is not reversible. It can be converted to
almost any other weight loss procedure.
Gastrectomy: Risks and Complications
As with any surgery, there
can be complications. This list can include:
Non-fatal pulmonary embolus 0.5%
Acute respiratory distress syndrome 0.25%
Gastric leak and fistula 1.0%
Small bowel obstruction 0.0%
Post-Op Dietary Plan for Vertical Gastrectomy Weight-Loss Surgery
As with all surgical weight-loss programs, it is
imperative that gastric sleeve patients adhere to a strict
postoperative diet. Once goal weight is achieved, usually 1-2 years
after surgery, most patients can consume about 1000-1200 calories
Long-Term Weight-Loss Results
patients who undergo Vertical Gastrectomy surgery experience a
60-80% loss of excess weight.
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