Sleeve Gastrectomy

Usually performed on patients with a BMI >60, the Vertical Sleeve Gastrectomy, (VSG) is a restrictive bariatric procedure. This is oftentimes performed as part one of a two step process, commonly ending in a gastric bypass. In this procedure, the surgeon will staple and divide the stomach, removing about 85% (including the portion that produces the hormone which stimulates hunger), and leaving you with a “sleeve” like portion. The remaining stomach is larger than the pouch left after a gastric bypass (about the size of a banana). This is why it is a safer procedure for patients with a higher BMI, because it allows the body to get used to the new, smaller stomach without too much shock.

Because this is a restrictive bariatric procedure, weight loss can be attributed to the patient being able to eat less in one sitting, and due to the fact that there is no re-routing of the intestines, the risk of malabsorption is minimal. This procedure, as with all other bariatric surgeries, is still only a tool in weight loss surgery, and patient devotion to exercise and healthy eating is imperative. In comparing this procedure to the other restrictive bariatric procedures, patients who opt to have the sleeve do so usually because they are uncomfortable with the idea of having a foreign body in their person (as is the case with the adjustable gastric banding procedure). Patients should be aware, however, that the leftover stomach is removed and therefore irreversible, unlike in the gastric bypass where the entire stomach is left in the body.

While this procedure is usually recommended for patients with a higher risk, higher BMI, it has been performed on patients with a BMI of 35. This procedure is chosen by those patients for a number of reasons. In addition to the lack of a foreign body, patients don’t have to be concerned about intestinal obstruction, ulcers, anemia or any sort of protein or vitamin deficiency. This also means the avoidance of “dumping” syndrome because the rest of the anatomy remains intact. Patients are also able to take anti-inflammatory medications without the concern of pills getting “stuck”, or resulting in ulcers.

Click here to watch a video of the gastric sleeve procedure

As with all other bariatric procedure, the sleeve has its own set of advantages and disadvantages.

Advantages:

• Though this is a relatively new procedure, studies show that weight loss is comparable to a gastric bypass procedure.
• If the weight loss is inadequate, this procedure allows for the ability to be converted into a gastric bypass or a duodenal switch.
• Co-morbid conditions, such as type 2 diabetes, high blood pressure, high cholesterol and obstructive sleep apnea have reported the same resolution rates as the gastric banding procedure.
• In a study led by Dr Lee Jossart and Dr. Cirangle, after two years patients reported 81-86% excess weight loss.
• In a published study comparing 40 adjustable gastric banding patients to 40 sleeve gastrectomy patients, the sleeve patients reportedly lost 57% of excess weight, compared to 41% for the adjustable gastric banding.
• The function of the stomach remains intact, therefore allowing the patient to consume any food, however the amount will be less.
• While very effective as a first step process for patients with a high BMI, it is proven to be quite successful for patients with lower BMI’s as a single step process.
• Low risk for patients who have a number of existing diseases, such as anemia, Crohn’s disease, which would otherwise make it impossible for them to have gastric bypass surgery.
• Can be done laparoscopically, therefore reducing the appearance of scars and other complications that come from having an open procedure.

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Disadvantages:

• Still being a “tool”, patients must avoid “soft calories”, such as ice cream and soda, as they will still be absorbed by the remaining portion of the anatomy.
• Patients run the risk of having leaks and other complications that arise from the stapling of the stomach.
• This procedure is irreversible since the leftover stomach is removed after stapling.
• Higher BMI patients will oftentimes have to follow this surgery with a second step, due to inadequate weight loss.
• This is still considered an investigation procedure, and therefore most insurance companies will not cover any portion of the surgery.
• Because this is a relatively new procedure, the long term results are still unknown
• As with all bariatric procedures, there is still a risk that the surgeon will have to switch from a laparoscopic procedure to an open procedure, if there are complications.
• This procedure, along with all surgery, could result in death.

Patients are asked to research each procedure in great depth and speak with their surgeon regarding any questions or concerns you may have. With hard work and dedication, patients have had success with all the bariatric procedures offered at Carolina Weight Loss Surgery.