Vertical sleeve gastrectomy

Definition

Vertical sleeve gastrectomy is surgery to help with weight loss. The surgeon removes a large portion of your stomach. The smaller stomach limits the amount of food you can eat by making you feel full after eating small amounts of food.

See also:

• Gastric bypass surgery
• Laparoscopic gastric banding
• Obesity

Alternative Names

Gastrectomy - sleeve; gastrectomy - greater curvature; gastrectomy - parietal; gastric reduction; vertical gastroplasty

Description

You will receive general anesthesia before this surgery. This will make you unconscious and unable to feel pain.

The surgery is usually done using a tiny camera that is placed in your belly. This type of surgery is called laparoscopy. The camera is called a laparoscope. It allows your surgeon to see inside your belly. In this surgery:

• Your surgeon will make 2 to 5 small incisions (cuts) in your abdomen. The surgeon will pass the laparoscope through one of these openings. It will be connected to a video monitor in the operating room. Your surgeon will look at the monitor to see inside your belly. Your surgeon will insert thin surgical instruments through the other openings.
• Your surgeon will remove most (about 80 - 85%) your stomach. The remaining portions of your stomach are joined together using staples. This creates a long vertical tube or banana-shaped stomach.
• The surgery does not involve cutting or changing the sphincter muscles that allow food to enter or leave the stomach
• Your surgery may take only 30 - 60 minutes if your surgeon has done a lot of these procedures.

When you eat after having this surgery, the small pouch will fill up quickly. You will feel full after eating just a very small amount of food.

Weight-loss surgery may increase your risk for gallstones. Your doctor may recommend having a cholecystectomy (surgery to remove your gallbladder) before your surgery.

Why the Procedure Is Performed

Weight-loss surgery may be an option if you are very obese and have not been able to lose weight through diet and exercise.

Vertical sleeve gastrectomy is not a "quick fix" for obesity. It will greatly change your lifestyle. You must diet and exercise after this surgery. You may have complications from the surgery and poor weight loss if you don’t.

People who have this surgery should be mentally stable and not be dependent on alcohol or illegal drugs.

This procedure may be recommended for you if you have:

• A body mass index (BMI) of 40 or more. Someone with a BMI of 40 or more is at least 100 pounds over their recommended weight. A normal BMI is between 18.5 and 25.
• A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are sleep apnea, type 2 diabetes, and heart disease.

Vertical sleeve gastrectomy has most often been done on patients who are too heavy to safely have other types of weight-loss surgery. A second weight-loss surgery may be needed eventually for some patients

This procedure cannot be reversed once it has been done.

Risks

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems

Risks for any surgery are:

• Blood clots in the legs that may travel to your lungs
• Infection, including in the incision, lungs (pneumonia), or bladder or kidney
• Blood loss
• Heart attack or stroke during surgery

Risks for vertical sleeve gastrectomy are:

• Injury to your stomach, intestines, or other organs during surgery.
• Leaking from the line where parts of the stomach have been stapled together
• Scarring inside your belly. This could lead to an obstruction (blockage) in your bowel in the future.
• Gastritis (inflamed stomach lining), heartburn, or stomach ulcers
• Poor nutrition, although much less than what gastric bypass surgery
• Vomiting from eating more than your stomach pouch can hold

Before the Procedure

Your surgeon will ask you to have tests and visits with your other health care providers before you have this surgery. Some of these are:

• A complete physical exam
• Blood tests, ultrasound of your gallbladder, and other tests to make sure you are healthy enough to have surgery
• Visits with your doctor to make sure other medical problems you may have, such as diabetes, high blood pressure, and heart or lung problems, are under control
• Nutritional counseling
• Classes to help you learn what happens during the surgery, what you should expect afterward, and what risks or problems may occur afterward
• Visit with a mental health provider to make sure you are emotionally ready for major surgery. You must be able to make major changes in your lifestyle after surgery.

If you are a smoker, you should stop smoking several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risks of problems. Tell your doctor or nurse if you need help quitting.

Always tell your doctor or nurse:

• If you are or might be pregnant
• What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

• Do not eat or drink anything after midnight the night before your surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You can probably go home 2 days after your surgery. You should be able to drink clear liquids on the day after surgery, and then a puréed diet by the time you go home.

When you go home, you will probably be given pain pills or liquids and a medication called proton pump inhibitors.

Your doctor, nurse, or dietitian will recommend a diet for you. Meals should be small to avoid stretching the remaining stomach.

Outlook (Prognosis)

The final weight loss may not as large as with gastric bypass. However, this may be enough for many patients. Because vertical sleeve gastrectomy is a newer procedure, there is less data about the long-term benefits and risks. Talk with your doctor about which procedure is best for you.

The weight will usually come off more slowly than with gastric bypass. You should keep losing weight for up to 2-3 years.

Losing enough weight after surgery can improve many medical conditions you might also have. Conditions that may improve are asthma, type 2 diabetes, high blood pressure, obstructive sleep apnea, high cholesterol, and gastroesophageal disease (GERD).

Weighing less should also make it much easier for you to move around and do your everyday activities.

This surgery alone is not a solution to losing weight. It can train you to eat less, but you still have to do much of the work. To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your doctor and dietitian gave you.

References

Townsend Jr. CM, Beauchamp RD, Evers BM, Mattox KL. Townsend: Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders; 2007. Chapter 17

Moy J, Pomp A, Dakin G, Parikh M, Gagner M. Laparoscopic sleeve gastrectomy for morbid obesity. Am J Surg. 2008 Nov;196(5):e56-9.

Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008 Mar;247(3):401-7.

Himpens J, Dapri G, Cadière GB. A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg. 2006 Nov;16(11):1450-6.