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Gastric Sleeve

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Sleeve gastrectomy, also called Gastric Sleeve or Vertical Gastric Sleeve (VGS) is a restrictive bariatric surgery. It generates weight loss by restricting the amount of food (and therefore calories) that can be eaten by removing 80 to 90% of the stomach without bypassing the small intestines. During this procedure the surgeon, rather than creating a pouch with silicone rings or polypropylene mesh, creates a small sleeve-shaped stomach by resecting and removing the majority of the stomach.  What is left is larger than the stomach pouch created during a Roux-en-Y bypass—and is about the size of a banana. 

The removed section of the stomach is actually the portion that “stretches” the most in other bariatric procedures.  The long sleeve shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food.  In addition, the nerves to the stomach and the outlet valve (pylorus) remain intact and therefore preserve the functions of the stomach while drastically reducing the volume. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded. The Roux-en-Y gastric bypass stomach can be reconnected (reversed) if necessary.

While Sleeve gastrectomy is a valid option for all patients considering bariatric procedure, it was typically considered as the first stage in a two-part treatment for patients with a BMI of 60 or higher. The second part of the treatment can be gastric or billio-pancreatic bypass if weight loss is not satisfactory. Several surgeons worldwide have adopted the procedure and have offered it to low BMI and low risk patients as an alternative to laparoscopic banding of the stomach.

Advantages

1. Reduces stomach capacity but tends to allow the stomach to function almost normally so most types of food items can be consumed in small amounts.
2. No silicone rings (lap-band) or mesh is wrapped around the stomach.  Thus avoiding problems such as erosions or slippage.
3. Because there is no intestinal bypass, the risk of malabsorptive/maldigestive complications such as vitamin deficiency and protein deficiency is minimal.
4. Significant lower risk of marginal ulcer which occurs in some Roux-en-Y gastric bypass patients.
5. The pylorus is preserved so Dumping Syndrome does not occur or is minimal.
6. There is no intestinal obstruction (due to internal hernia) since there is no intestinal bypass.
7. There is medical evidence that Gastric Sleeve eliminates the portion of the stomach that produces the hormones that stimulates hunger.
8. The limited weight loss data available to date is superior to current Banding procedures and comparable to Gastric Bypass weight loss data.

Dis-Advantages and Risks

• No significant long term (More than 5 years) data is available
• 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. 
• Patient compliance and long term commitment is required since high caloric liquid diets such as ice cream, milk shakes, etc., can be consumed with ease.
• This is not a "small procedure", it involves stomach stapling and gastric resection and therefore surgical complications such as bleeding, leaks, strictures, pulmonary emboli, and other complications may occur.
• Because the stomach is removed, it is not reversible.
• Considered investigational by some surgeons and insurance companies.

Please view the following video for more information:

Gastric Sleeve Overview