Gastric Sleeve Resection

One of the newer surgical options in the field of weight loss surgery is the Gastric Sleeve Resection, also known as the Vertical Sleeve Gastrectomy (VSG). This restrictive weight loss procedure permanently reduces the size of the stomach which limits the amount of food that can be eaten at any one time. While the gastric sleeve is sometimes effective as a stand-alone weight loss procedure, most bariatric surgeons consider the gastric sleeve as the first operation in a two-stage process. The second procedure, which is either gastric bypass or duodenal switch, is performed at a later time. The purpose of the two-stage approach is to make weight loss surgery safer for high-risk patients, particularly those individuals with a body mass index (BMI) greater than 60, who have health conditions that make them unacceptable patients for a combined restrictive/malabsorptive surgery.

During gastric sleeve surgery, the bariatric surgeon removes approximately 60 to 80% of the stomach along the greater curvature and leaves only a small tube, or “sleeve” for the new stomach pouch. By reducing the size of the stomach, an individual should eat less and lose weight. The stomach reduction is not reversible and the cutaway part of the stomach is removed from the body, not left in place as with other bariatric procedures. Since the normal stomach outlet and small intestine are left intact with this procedure, it is a less complicated operation than either gastric bypass or duodenal switch surgery. Compared to adjustable gastric banding surgery, the gastric sleeve does not involve implanting a medical device into the body in order to restrict eating.

Expected Weight Loss Results

Patients who undergo the gastric sleeve procedure will typically lose 30 to 50% of their excess body weight during the following six to eighteen months. This weight loss will make it safer to proceed with the second-stage of the process, either gastric bypass or duodenal switch surgery, which involves rerouting the small intestine. The timing of the second procedure will depend on the rate of weight loss following the gastric sleeve surgery.

Patient Considerations for Gastric Sleeve Surgery

• Safer option for individuals with BMI greater than 60 to undergo two-stage process of gastric sleeve followed up with duodenal switch or gastric bypass after partial weight loss
• Option for patients concerned about long-term side effects of weight loss surgery that involves rerouting and bypassing a portion of the small intestine, such as intestinal obstruction, ulcers, anemia, osteoporosis, protein deficiency, and vitamin deficiency
• Restrictive weight loss option for patients who are not comfortable having a medical device implanted into their body as with the LAP-BAND or REALIZE Band
• Surgical weight loss option for patients with health problems or complex medical issues that may prevent them from having other types of weight loss surgery, such as anemia, Crohn’s disease, anti-inflammatory drug use, or extensive prior surgery
• Revision option for gastric band patients experiencing problems with their band but who do not want to convert to a bypass type of operaton

Advantages of Gastric Sleeve Weight Loss Surgery

• Promotes weight loss by restricting amount of food that can be eaten at any one time
• Removes the part of the stomach that produces the hunger stimulating hormone ghrelin
• Digestive system it not changed and digestion occurs normally
• Does not cause malabsorption or nutritional deficiencies as it does not involve rerouting or bypassing the small intestine
• Less chance of developing ulcers than with gastric bypass surgery
• Dumping syndrome not likely to occur as the stomach outlet (pyloric valve) remains intact, unlike gastric bypass surgery
• Less complicated procedure than gastric bypass or duodenal switch surgery
• Can usually be performed laparoscopically on extremely obese patients
• Does not require a gastric band being implanted into the body
• Does not require adjustments or fills as with a LAP-BAND or REALIZE Band
• Safer than a combined restrictive/malabsorptive weight loss surgery for patients who have many health problems
• Expected weight loss is 30 to 50% of excess weight in the first one to two years
• May be converted to gastric bypass or duodenal switch if necessary for additional weight loss

Disadvantages of Gastric Sleeve Weight Loss Surgery

• As it is a purely restrictive weight loss procedure, inadequate weight loss or weight regain is more likely than with a procedure involving intestinal bypass
• With time, new smaller stomach pouch may stretch (also occurs with gastric bypass surgery)
• Although the gastric sleeve helps control hunger and limit amount of food that can be eaten at any one time, weight loss will not occur without a healthy, low-calorie diet and regular exercise (same as with other purely restrictive procedures such as LAP-BAND and REALIZE Band)
• If performed as the first part of a two-stage process, a second malabsorptive weight loss surgery such as the duodenal switch will need to be performed at a later time
• The surgery is not reversible as a portion of the stomach is permanently removed
• Leaks or bleeding may occur along the stomach stapling edge
• Procedure may not be covered by some insurance companies
• All surgery and anesthesia involves some level of risk including bleeding, blood clots, infection, pneumonia, or complications
• Lack of published data for long-term weight loss results

Gastric Sleeve Weight Loss Surgery

While the gastric sleeve procedure will help a person control their eating, weight loss depends on adopting a new diet and exercise lifestyle. Many bariatric surgeons recommend eating five small, healthy meals a day with no snacking in-between meals. The surgery itself does not require many food restrictions as the stomach continues to function normally, but high-calorie and high-fat foods and drinks must be avoided for weight loss to occur.

Performing the Gastric Sleeve Resection as a stand-alone weight loss surgery is a new approach and considered experimental by many bariatric surgeons and insurance companies. Long-term weight loss results are not available, although expected weight loss in the first one to two years is 30 to 50% of excess weight. At that time, a malabsorptive weight loss procedure such as the duodenal switch may be performed in order to promote further weight loss.