The Vertical Sleeve Gastrectomy is a laparoscopic procedure that generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically. About 85 percent or more of the stomach is removed. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from two to four ounces. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the function of the stomach while drastically reducing the volume. Note that there is no intestinal bypass with this procedure, only stomach reduction. The lack of an intestinal bypass avoids potential long term complications such as marginal ulcers, vitamin deficiencies and intestinal obstructions.
Alternative to a Roux-en-Y Gastric Bypass
The Vertical Gastrectomy is a reasonable alternative to a Roux-en-Y Gastric Bypass for a number of reasons:
- Because there is no intestinal bypass, the risk of malabsorptive complications such as vitamin deficiency and protein deficiency is minimal.
- The pylorus is preserved so dumping syndrome does not occur or is minimal.
- There is no intestinal obstruction since there is no intestinal bypass.
- It is relatively easy to modify to an alternative procedure should weight loss be inadequate or weight regain occur.
- The limited two-year and six-year weight loss data available to date is superior to current Banding and comparable to Gastric Bypass weight loss data (see Lee, Jossart, Cirangle Surgical Endoscopy 2007).
You and your surgeon will determine the right procedure to fit your needs.
Advantages and Disadvantages of Vertical Sleeve Gastrectomy
Vertical Sleeve Gastrectomy Advantages
- Reduces stomach capacity but tends to allow the stomach to function normally so most food items can be consumed, in small amounts.
- Eliminates the portion of the stomach that produces the hormones that stimulate hunger (Ghrelin).
- Dumping syndrome is avoided or minimized because the pylorus is preserved.
- Minimizes the chance of an ulcer occurring.
- By avoiding the intestinal bypass, almost eliminates the chance of intestinal obstruction (blockage), marginal ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency.
- Very effective as a first stage procedure for high BMI patients (BMI > 55).
- Appealing option for people who are concerned about the complications of intestinal bypass procedures or who have existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedures.
- Appealing option for people who are concerned about the foreign body aspect of Banding procedures.
Vertical Sleeve Gastrectomy Disadvantages
- 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 intestinal bypass.
- Higher BMI patients will most likely need to have a second stage procedure later to help lose the rest of the weight. Remember, two stages may ultimately be safer and more effective than one operation for high BMI patients. Be sure to discuss your options with your surgeon.
- 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.
- Because the stomach is removed, it is not reversible. However, if maximum weight loss is not achieved it can be converted to a Gastric Bypass.