Vertical Sleeve Gastrectomy is a bariatric procedure that offers an excellent alternative to both gastric bypass and adjustable gastric banding. It is particularly effective for patients with mild to moderate Body Mass Index (BMI of 35 – 45) as a primary procedure and for very high BMI (greater than 70) as a staged procedure.
Vertical sleeve gastrectomy works mainly by reducing stomach volume. During surgery, the stomach is divided vertically and 80 to 85 percent of it is removed. What is left is a long vertical “sleeve” that is shaped like a banana. The nerves to the stomach and the outlet valve (pylorus) remain intact to preserve the functions of the stomach while reducing the volume it is able to hold.
There is no intestinal bypass with this procedure, only stomach capacity reduction. A sleeve gastrectomy also works because it removes the part of the stomach that produces Ghrelin, a hormone that stimulates appetite. This reduces, but does not eliminate, a person’s appetite.
Patients can expect to lose 50 to 70 percent of excess weight over a one- to two-year period after sleeve gastrectomy. Patients who may benefit from a sleeve gastrectomy over other procedures include those who have previously had small bowel surgery, very high BMI patients (>70) as part of a two-stage procedure, or low BMI (35 – 45) patients who prefer not to or cannot have an implanted device (band) or a malabsorptive (bypass or duodenal switch) procedure.
Other candidates include patients who have a family history of gastric cancer or need frequent EGD’s, and patients who have a history of inflammatory bowel disease or who are scheduled to undergo another procedure (knee replacement, kidney transplant) and need a procedure to lose weight that will have minimal effect on absorption of medications.
Advantages of Sleeve Gastrectomy
- A stomach that is reduced in volume but tends to function normally so most food items can be consumed, albeit in small amounts. It also allows normal absorption of most medications, unlike gastric bypass.
- The elimination of the portion of the stomach that produces a hormone that stimulates hunger.
- The elimination of “dumping syndrome.”
- A minimization of the chance of ulcers occurring.
- A reduced chance of intestinal blockage, anemia, osteoporosis, protein deficiency and vitamin deficiency.
- An appealing option for people with existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedures or procedures that require implants (such as gastric banding).
- The option to perform the procedure laparoscopically in patients weighing more than 500 pounds.
Disadvantages of Sleeve Gastrectomy
- The potential for inadequate weight loss or weight regain – which can happen with any procedure – is higher with gastric banding or sleeve gastrectomy.
- Higher BMI patients will most likely need to have a second-stage procedure later to help lose remaining excess weight.
- Soft foods that are high in calories – such as ice cream, milk shakes, etc. – can be absorbed and may slow weight loss.
- The possibility that leaks and other complications will occur since this procedure does involve stomach stapling (this risk is similar to other bariatric procedures).
- It is a procedure that is not reversible.