The Gastric Sleeve or Vertical Sleeve Gastrectomy (VSG) is also referred to as Sleeve Gastrectomy, Vertical Sleeve, or simply Sleeve. It is a procedure that restricts the amount of food that can be eaten by removing about 75-85% of the stomach. The Gastric Sleeve is a newer weight loss procedure, and unlike gastric banding procedures, it is irreversible. Sleeve Gastrectomy evolved from the more complex Duodenal Switch procedure, and after that it was often performed as a first step in weight loss surgery, to be followed later by another planned procedure, such as a gastric bypass. The Sleeve is now recognized as a standalone or primary procedure by the American Society for Metabolic and Bariatric Surgery.
How it Works
A Gastric Sleeve is a restrictive procedure where the majority of the stomach is removed, by stapling and cutting the stomach to creating a long vertical tube or banana-shaped sleeve. The procedure limits the amount of food you can eat and helps you feel less hungry, and also full sooner after eating. The Sleeve is technically simpler than a gastric bypass surgery, since it does not bypass any of the intestinal tract.
A Sleeve Gastrectomy is performed laparoscopically. Laparoscopic surgery means surgery done with very small incisions, as opposed to an “open” procedure where a large incision is made in the belly. During the Sleeve, the surgeon makes 2 to 5 very small incisions, and uses a narrow telescope with a small camera and other tiny instruments to remove a large portion of the stomach.
Following a gastric sleeve, patients often stay in the hospital for 1-2 days. Similar to a gastric bypass surgery, many patients who have sedentary jobs return to work within 2-4 weeks. Patients with more physically demanding jobs may need 4-6 weeks to recover before returning to work. The patient will attend several follow-up appointments in the year following the surgery to monitor recovery and weight loss and nutritional status and sometimes body composition. As with all bariatric procedures, long-term follow-up is recommended.
Weight Loss Trends
Patients with a sleeve generally lose weight rapidly over 1-2 years, similar to patients who have a gastric bypass. Patients on average experience weight loss of 60% of excess weight after three years.
Patients are usually considered candidates for a Sleeve Gastrectomy if they have BMI of 40 or greater. A patient with BMI between 35 and 40 may be a candidate if they have a co-morbidity such as diabetes, high blood pressure or high cholesterol.
The cost of the Sleeve Gastrectomy can vary quite a bit from practice to practice. In general, but not always, a Sleeve Gastrectomy costs more than a Gastric Band but less than a Gastric Bypass. To best compare costs, find out exactly what the price is covering. Some practices include only the operation in their price, while others offer a package price that includes follow up care and support groups. And as with anything, the ‘cheapest’ surgery does not make it the best choice.
All surgeries have risk of complications. Potential complication of a vertical sleeve gastrectomy include nausea and vomiting, food intolerance, heartburn, infection of the skin incisions, and leakage of stomach contents from the sleeve staple line. A stricture or narrowing can form in the middle of the stomach, which may require that the sleeve be converted to a gastric bypass.