How Does The Sleeve Gastrectomy Work?


The vertical sleeve gastrectomy is a restrictive form of weight loss surgery in which approximately 85% of the stomach is removed leaving a cylindrical or sleeve shaped stomach with a capacity ranging from about 60 to 150 cc, depending upon the surgeon performing the procedure. Unlike many other forms of bariatric surgery, the outlet valve and the nerves to the stomach remain intact and, while the stomach is drastically reduced in size, its function is preserved. Again, unlike other forms of surgery such as the Roux-en-Y gastric bypass, the vertical sleeve gastrectomy is not reversible.

Because the new stomach continues to function normally there are far fewer restrictions on the foods which patients can consume after surgery, albeit that the quantity of food eaten will be considerably reduced. This is seen by many patients as being one of the great advantages of the vertical gastrectomy, as is the fact that the removal of the majority of the stomach also results in the virtual elimination of hormones produced within the stomach which stimulate hunger.

Perhaps the greatest advantage of the vertical sleeve gastrectomy lies in the fact that it does not involve any bypass of the intestinal tract and patients do not therefore suffer the complications of intestinal bypass such as intestinal obstruction, gastric sleeve, osteoporosis, vitamin deficiency and protein deficiency. It also makes it a suitable form of surgery for patients who are already suffering from anemia, Crohn’s disease and a variety of other conditions that would place them at high risk for surgery involving intestinal bypass.

Finally, it is one of the few forms of weight loss surgery which can be performed laparoscopically in patients who are extremely overweight.

Perhaps the main disadvantage of the vertical sleeve gastrectomy is that it does not always produce the weight loss which people would wish for and, in the longer term, can result in weight regain. This is indeed true of any form of purely restrictive weight loss surgery, but is perhaps especially true in the case of the vertical gastrectomy.

Because the procedure requires stapling of the stomach patients do run the risk of leakage and of other complications directly related to stapling. In addition, as with any surgery, patients run the risk of additional complications such as post-operative bleeding, small bowel obstruction, pneumonia and even death. The risk of encountering any of these complications is however extremely small and varies from about 0.5 and 1%. Having said this, the risk of death from this form of surgery at about 0.25% is extremely small.

As a general rule the vertical sleeve gastrectomy is best suited to individuals who are either extremely overweight or whose medical condition would rule out other forms of weight loss surgery. In the case of the former the vertical sleeve gastrectomy would normally form the first of a two-part plan of weight loss, with further bariatric surgery being performed once the patient’s weight has fallen sufficiently to allow for other forms of weight loss surgery to come in to play.

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