Vertical Sleeve Gastrectomy (Sleeve Gastrectomy)

The Vertical Sleeve Gastrectomy (VSG) is relatively new on the scene as a standalone weight loss surgical procedure.  It is the first part of the Biliary Pancreatic Diversion with Duodenal Switch (BPDDS, DS) operation for the super obese patient (BMI > 50).  There are a few instances where the VSG may be the best option when:

1. The patient desires a restrictive operation without a foreign body.
2. A stand alone weight loss surgical procedure for a patient with a BMI < 50 who does not want their intestine bypassed is desired.
3. A staged operation for patients with excessively high surgical risk and BMI is desired.  Staging procedures may reduce the risk of complications for the patient.

Procedure

The operation is performed laparoscopically to minimize post operative pain and speed recovery.  A slender tube is placed through the mouth and alongside the lesser curve (right side) of the stomach after the patient is asleep.  The tube serves as a guide against which surgical staplers are placed to divide and close the body of the stomach from the lesser curve.  The body (80% of the stomach) is removed permanently.  The resulting stomach becomes a sleeve shaped organ with a capacity of only 2-3 ounces.  The pyloric valve (outlet of the stomach) is still in place so patients will not usually have the dumping syndrome after VSG.  Over years the stomach sleeve may dilate some but still has a very small capacity.

Recovery

Patient’s recovery is similar to that of the gastric bypass.  Pain and nausea are typically easily controlled with oral medication.  Activity is progressed slowly and patients may return to a sedentary job after about two weeks.  Before discharge most patients are able to have their drain removed and all patients will undergo a lower extremity venous doppler to evaluate for blood clots in their veins.  Patients may expect an excess weight loss of about 50% of their excess weight with this procedure on average.