• The Procedure
• Benefits
• Risks
• Contraindications

The Procedure

The best way to currently describe this weight loss surgery procedure is to present the following position statement from the AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY (edited for clarity for non surgeons).

The bariatric procedure commonly called "vertical sleeve gastrectomy (VSG) is a form of unbanded gastroplasty involving subtotal gastric resection for creation of a long lesser curve-based gastric conduit. This procedure may be viewed as the gastric component of the more established malabsorptive procedure of biliopancreatic diversion with duodenal switch (BPD/DS). The VSG procedure has been utilized as a first-stage bariatric procedure to reduce surgical risk in high-risk patients by induction of weight loss and this may be its most useful application at the present time. Sleeve gastrectomy appears to be a technically easier and/or faster laparoscopic procedure than Roux-en Y gastric bypass or BPD/DS in complex or high risk patients including the super-super-obese patient (BMI > 60 kg/m2).

The mechanism of weight loss and resultant comorbidity improvement seen following sleeve gastrectomy may be related to gastric restriction or to neurohumoral changes observed following the procedure due to the gastric resection or some other unidentified factor(s).

There are currently 15 published reports in the scientific literature describing short-term outcomes in 775 patients after sleeve gastrectomy. A single study provides data up to 3 years after the procedure and no follow-up beyond 3 years has been reported. The reports describe surgical treatment of patients with preoperative body mass index ranging from 35 to 69 kg/m2 and excess weight loss ranging from 33% to 83%. Comorbidity resolution 12 to 24 months after sleeve gastrectomy has been reported in 345 patients demonstrating resolution rates of diabetes, hypertension, hyperlipidemia, and sleep apnea after sleeve gastrectomy are comparable to results of other restrictive procedures.

Similar to other forms of gastroplasty, perioperative risk for sleeve gastrectomy appears to be relatively low, even in high risk patients. Published complication rates range from zero to 24% with an overall reported mortality rate of 0.39%. Only a single prospective randomized trial is published which compares sleeve gastrectomy to a more widely accepted bariatric procedure. In that trial, sleeve gastrectomy was found to be at least as effective and durable as adjustable gastric banding at one and three years following surgery.

Long-term (> 5 yr) weight loss and comorbidity resolution data for sleeve gastrectomy has not been reported at this time. Weight regain or a desire for further weight loss in a super-super-obese patient may require the procedure to be revised to a gastric bypass or biliopancreatic diversion with duodenal switch. Detailed informed consent including information about the possibility of long-term weight regain and the potential need for subsequent conversion to another procedure is suggested before the sleeve gastrectomy is planned for an individual patient. Decisions to perform this procedure should also be in compliance with ethical guidelines published by the ASMBS.

To see how this compares to the adjustable gastric banding or laparoscopic gastric bypass procedures click here

Benefits

Preliminary studies demonstrate excess weight loss ranged averaging 50-60% after 2-3 years from the surgery. Unlike the gastric bypass or BPD/DS which have excellent weight loss results after 20-25 years of follow-up, there is no data on weight loss with VSG beyond 3 years. Studies are on-going.

In addition to the weight loss, if you have any of these conditions, they will improve or resolve after the surgery:

• Diabetes
• Hypertension
• Sleep apnea
• Dyslipidaemia
• Asthma
• Low back pain and vertebral disk disease
• Weight-bearing osteoarthritis of the hips, knees, ankles, and feet
• Skin fold dermatitis
• Urinary stress incontinence

Finally, the health benefits gained with weight loss surgery can reduce your risk of death by as much as 62% compared to staying morbidly obese. For more details click "It's not just weight loss. It's health gain".

Risks

General risks from the published literature"

• overall death 0.4%

Specific risks based on our own personal experience:

Contraindications

• Pulmonary disease requiring oxygen therapy
• Extremely limited mobility
• Endocrine disorders such as Cushing's Syndrome and Prader Willi Syndrome
• Psychological instability
  • Drug or alcohol abuse
  • Inability to cope with the changes in diet and life modification after surgery
  • Refusal to be assessed by psychologist or psychiatrist

 Complex medical conditions increase the risk of surgery and are considered on a patient-by-patient basis.