The vertical gastrectomy, or sleeve gastrectomy, is a type of restrictive weight loss surgery. Vertical gastrectomy surgery causes weight loss by restricting the amount of food that is able to be consumed before feeling full.
The vertical gastrectomy surgery isolates a small section of the stomach for processing food, limiting the size of meals to approximately one ounce after surgery. The surgery is typically performed on patients who are too heavy to have other types of weight loss surgeries with the expectation that a second surgery will be performed once weight has been lost.
The patient who undergoes this procedure must make radical changes in his food intake and lifestyle in order for the procedure to have a successful long-term outcome. Because the stomach has the ability to stretch to accommodate food, the stomach can expand greatly from the one-ounce capacity the surgery allows for. Meals should be small -- less than half a cup -- and drinking fluids with meals can fill the pouch, preventing the intake of solid food at that time.
The Vertical Sleeve Gastrectomy Procedure
The surgery is typically performed in a hospital or a surgery center, using general anesthesia. Surgeries are performed laparoscopically, which allows the surgeon to work using long instruments placed in the body via incisions a few centimeters long. In some cases, the surgery will performed “open,” with the larger traditional incision, or a surgery that begins laparoscopically may be converted to the open procedure when the surgeon determines it is necessary.
The surgery begins with multiple half-inch long incisions in the area of the stomach. The instruments are inserted through these incisions, and the surgeon begins by removing up to 85% of the stomach. The sides of the stomach are then joined by staples, leaving the stomach smaller and tubular in shape, but retaining the sphincter muscles at the top and the bottom of the stomach.
Once the surgeon determines that the staples are holding the stomach closed and no areas are leaking, the instruments are withdrawn and the incisions are closed, typically absorbable sutures and sterile tape.
Typical Outcomes After Vertical Sleeve Gastrectomy
This procedure is considered a starting point for people who are so obese that they are not candidates for gastric bypass surgeries like Roux-en-Y or biliopancreatic diversion. For patients who are too heavy for gastric bypass and unable to lose enough weight to become a candidate, this surgery provides an opportunity to lose enough weight to have a more radical surgery done once their body size will allow it.
For patients with less weight to lose, this procedure does not produce the same levels of weight loss as other types of surgery. Many patients who intend to have this procedure as their only weight loss procedure have difficulty maintaining the tiny portions required to keep the stomach pouch size small. If the patient begins to consume larger quantities of food, the pouch stretches and weight loss can stop, or in some cases, weight gain begins.
Total weight loss is less than most types of surgery and the procedure is not reversible because the area of the stomach is removed rather than stapled to prevent food from entering. The risk of malnutrition that faces many bariatric (weight loss) surgery patients is not present with this surgery, as the body continues to absorb nutrients as it did prior to surgery. This surgery is currently being studied as a stand-alone surgery for patients with lower BMIs, but still remains investigational.
Many patients will chose another type of surgery, not because of the procedure itself, but because few surgeons perform the surgery and many insurance companies consider it investigative, or experimental. Insurance companies do not pay for surgeries classified as investigational but may pay other types of weight loss surgery.
Sources: Bariatric Surgery For Severe Obesity. Consumer Information Sheet. National Institute of Diabetes and Digestive and Kidney Diseases. March 2008. http:// http://win.niddk.nih.gov/publications/gastric.htm .
Frequently Asked Questions About Obesity and Bariatrics. American Society of Bariatric Surgeons. 2008. http:// http://www.asbp.org/siterun_data/faq/news.php?q=5405d8a903c83e89cb649f1b518ef1be .
Jones,Nicolas V. Christou, MD, PhD, Didier Look, MD, and Lloyd D. MacLean, MD, PhD. " Weight Gain After Short- and Long-Limb Gastric Bypass in Patients Followed for Longer Than 10 Years." Annals of Surgery 2006 November; 244(5): 734–740.
