Vertical (Sleeve) Gastrectomy

In the video below, Dr. Ross McMahon describes the vertical (sleeve) gastrectomy.

The Vertical (Sleeve) Gastrectomy procedure generates weight loss by restricting the amount of food that can be eaten.The stomach is divided vertically with 85 percent of it being removed. This part of the procedure is not reversible.

The nerves to the stomach and the outlet valve (pylorus) remain intact to preserve the stomach function while reducing its volume. There is no intestinal bypass with this procedure, only stomach reduction. The procedure is appropriate for both low and very high BMI patients.

High-BMI Patients (BMI 50-60)

This procedure can be performed laparoscopically in very high BMI patients to try to reduce the overall risk of weight-loss surgery. Once a patient's BMI goes above 60, it is increasingly difficult to perform a Roux-en-Y gastric bypass laparoscopically. In addition, a Roux-en-Y gastric bypass tends to yield inadequate weight loss for patients with a BMI greater than 60.

The stomach restriction that occurs allows these patients to lose more than 100 pounds and in many patients more than 200 pounds. This weight loss allows significant improvement in health and effectively "downstages" a patient to a lower risk group. Once the patients BMI is lower (35-40), they can undergo the "second stage" of the procedure, such as the Roux-en-Y gastric bypass or even a Lap-Band.

Low-BMI Patients (BMI 35-45)

This procedure has proven to be safe and effective for lower BMI patients, with 90 percent achieving a BMI below 35 after five years. Low BMI individuals who should consider this procedure include:

• Those who are concerned about the potential long-term side effects of an intestinal bypass such as intestinal obstruction, ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency.

• Those who are considering a Lap-Band but are concerned about the use of a foreign body.

• Those who have other medical problems that prevent them from having weight-loss surgery, such as anemia, Crohn's disease, extensive prior surgery, and other complex medical conditions.

• People who need to take anti-inflammatory medications. Usually, these medications need to be avoided after a gastric bypass because the risk of ulcer is higher.

Advantages

• The stomach is reduced in volume but tends to function normally so most food items can be consumed, albeit in small amounts.

• Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin).

• No dumping syndrome because the pylorus is preserved. 

• Minimizes the chance of an ulcer occurring. 

• By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated. 

• Very effective as a first-stage procedure for high BMI patients (BMI>55).

• Limited results appear promising as a single-stage procedure for low BMI patients (BMI 35-45).

• Appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures. 

• Can be done laparoscopically even in patients weighing more than 500 pounds.

Disadvantages

• 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. 

• Higher BMI patients will most likely need to have a second-stage procedure later to help lose the rest of the weight. Two stages may ultimately be safer and more effective than one operation for high BMI patients. 

• Soft calories, such as ice cream, milk shakes, etc, can be absorbed and may slow weight loss. 

• This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur. 

• Because the stomach is removed, it is not reversible. It can be converted to almost any other weight-loss procedure. 

• Considered investigational by some insurance companies. 

Long-Term Weight-Loss Results

On average, patients who undergo Vertical Gastrectomy surgery experience 60 to 80 percent loss of excess weight.