Vertical Sleeve Gastrectomy (VSG), or gastric sleeve, is a bariatric surgery that reduces the stomach’s size and shape, making its capacity smaller. This newer procedure is quickly becoming popular with people wanting permanent weight loss surgery. The new shape of the stomach typically resembles a “sleeve” or a “tube.”
Vertical Sleeve Gastrectomy surgery can also be referred to as sleeve gastrectomy, laparoscopic sleeve surgery, laparoscopic sleeve gastrectomy (LSG), and tube gastrectomy.
How Gastric Sleeve Works?
Vertical Sleeve Gastrectomy Surgery works by reducing the stomach of the patient by almost 85%. By reducing the patient’s stomach, people will feel fuller faster, reducing the amount they eat. The majority of hunger hormones (Ghrelin) are taken out, resulting in less desire for food.
Detailed Review of the Gastric Sleeve Surgery
Patients receive sleeve gastrectomy surgery under general anesthesia in the hospital. A few incisions are made, each a couple of inches long in the stomach area, through which the surgeon will use long instruments to perform the surgery laparoscopically. If necessary, the surgeon may switch to open surgery with a larger incision.
The surgeon will reduce the patient’s stomach size by cutting a big portion of it and stapling the remaining creating a sleeve shape. When the stomach is sealed with staples, sutured over, and no leaks found, the surgeon removes the camera and instruments used for the procedure and closes the incisions with absorbable sutures and sterile tape.
The stomach is split, following a pattern known as a bougie. A bougie is a tube for calibration, which aids the surgeon in removing the stomach’s appropriate amount. When the patient undergoes anesthesia, the bougie is inserted through the mouth, down the esophagus into the stomach.
This bougie is a basic pattern (image a cookie-cutter) to allow the surgeon to remove excess stomach – while keeping a necessary portion for nutritional needs.
Related: Gastric Sleeve Surgery FAQs
The 85% removal of the stomach also affects the hunger hormone production – ghrelin, significantly reduced. This reduction in ghrelin will let patients not be bothered by nagging hunger pangs.
Laparoscopic vs. Single Incision Gastric Sleeve
Gastric Sleeve can be performed open, laparoscopically, via single-incision surgery, and endoscopically. Open surgery is no longer common, and most surgeons prefer laparoscopically because of the precise video, which gives surgeons a really clear and detailed sight of the abdomen.
Single Incision is a misnomer, as it generally uses up to 2 small incisions (about 1.5 inches long) vs. the 3 and 5 incisions of laparoscopic surgery.
What are the Risks and Complications that Could Occur?
With any surgery, there are going to be risks, complications, and possible unwanted side effects.
There are numerous health risks of undergoing major surgery, and this is no different. There are more than fifty different risks and complications by undergoing Vertical Sleeve Gastrectomy. Your bariatric physician will enlighten you about the various health consequences of having bariatric surgery.
Some patients may face additional risks because of their current health standing. Risks associated with bariatric surgery include blood clots, infection, and possible leaking of the sleeve.
Advantages of Gastric Sleeve Surgery
There are several pronounced advantages to having gastric sleeve surgery, including a permanent tool for weight loss. There are no malabsorption changes, meaning that your digestive system is not altered.
There are no adjustments that are involved in Lap-Band surgery. Users can stand to lose excess weight quickly; patients can expect significant weight loss within 6 to 12 months – while most patients lose 60 to 70% of their excess weight within the first 24 months.
Patients who undergo sleeve gastrectomy surgery experience rapid weight loss but without a high risk of having nutritional deficiencies. It’s ideal for patients who are extremely obese and intend to have another type of weight loss surgery after they’ve dropped enough weight to become a candidate for the other form of weight loss procedures.
No artificial devices are being implanted into the body, and your intestines do not have to be moved as they do in other types of weight loss surgery procedures. Once the sleeve gastrectomy surgery has been completed, you do not have to visit the doctor frequently for follow-up.
Disadvantages of Gastric Sleeve Surgery
There is risk in the unknown; unlike Lap-Band surgery, which has been the focus of several long-term studies, gastric sleeve surgery lacks long-term studies about the safety and the efficacy of the procedure.
Some patients fail to lose the weight they desire because of unhealthy food choices, which can happen when patients choose unhealthy food options. Over time, the stomach pouch may enlarge with an unhealthy diet.
Related: Gastric Sleeve Complications Rates
Because this form of weight loss surgery is relatively new, it is unknown how long the weight loss will last for patients undergoing the procedure. While there are no artificial devices implanted in the body for the procedure, sleeve gastrectomy surgery does require staples to make the stomach smaller.
There is a risk of bleeding or stomach leakages at the stapled seam. The new shape of the stomach may cause a kink or fold or otherwise become blocked somehow.
Patients who use the sleeve gastrectomy surgery as their primary weight loss procedure (without later using a gastric bypass or another form of weight loss surgery) usually have a hard time keeping up with the small, half cup meal portions necessary to keep stomachs small and will gain weight as soon as they begin consuming larger amounts of food.
Unfortunately, if you overeat, the stomach will begin to expand, which will increase your ability to consume more food. Individuals who undergo the sleeve gastrectomy procedure need to make radical changes in the amount of food they eat to ensure a long-term successful weight loss. If a sleeve gastrectomy patient begins to eat meals larger than one ounce (approximately half a cup per meal with limited fluids), their stomach will stretch, and soon they will start gaining weight again.
Results of Gastric Sleeve Surgery
43% Excess weight after 6 to 8 Years – In the longest gastric sleeve study, researchers have found gastric sleeve effective.
“This study reports the longest follow-up of LSG patients thus far and supports the effectiveness, safety, and durability of laparoscopic sleeve gastrectomy as a definitive therapeutic option for severe obesity, even in high-risk, high-BMI patients.”
50% Excess Weight Loss (mean) after 6 Years – This 2010 “long-term results” study shows positive effectiveness.
“In this long-term report of laparoscopic sleeve gastrectomy, it appears that after 6+ years, the mean excess weight loss exceeds 50%. However, weight regains, and gastroesophageal reflux symptoms appear between the third and the sixth postoperative year. This unfavorable evolution might have been prevented in some patients by continued follow-up office visits beyond the third year. Patient acceptance remains good after 6+ years.”
Gastric Sleeve is an Effective, Durable Procedure – In this landmark, meta-study researchers have found gastric sleeve to be both an effective primary or the first stage weight loss surgery.
“From the current evidence, including 36 studies and 2570 patients, LSG is an effective weight loss procedure that can be performed safely as a first stage or primary procedure. From this large volume of case series data, a matched cohort analysis, and 2 randomized trials, LSG results in excellent weight loss and co-morbidity reduction that exceed, or is comparable to, that of other accepted bariatric procedures.
The postoperative major complication rates and mortality rates have been acceptably low. Long-term data are limited, but the 3- and 5-year follow-up data have demonstrated the durability of the SG procedure.”
Gastric Sleeve Diet
Before and after surgery, your bariatric surgeon will prescribe a strict diet plan. In preparing for the surgery, as well as post-surgery – it’s extremely important to follow your doctor’s orders. By following the nutritional guidelines, you will reduce your risks of complications and side effects. But most importantly, you’ll enjoy greater weight loss.
What to Expect After Gastric Sleeve Surgery?
Gastric Sleeve Surgery isn’t a one-time, magic pill for weight loss. Most people can expect to lose 60% to 70% of their excess weight in two years.
Early after the surgery, people will be put on a strict dieting plan to ensure limited side effects and complications. There will be guidelines, including exercising regularly, eating the proper foods, etc.
Do I Qualify?
Overstitch – Endoscopic Sleeve Gastroplasty
Endoscopic Sleeve Gastroplasty (ESG) reduces the stomach volume similar to the gastric sleeve via an endoscopic stitch device (Overstitch). Endoscleeve procedure produces similar weight-loss results like laparoscopic sleeve gastrectomy (LSG) without the surgery. ESG is also suitable for gastric sleeve revision and can be easily converted to other bariatric operations.