Gastric Sleeve

Gastric Sleeve / Vertical Sleeve Gastrectomy

The gastric sleeve is the newest procedure recommended as a stand-alone operation for surgical weight loss. The gastric sleeve was originally employed as the first part of a two-stage procedure on severely obese individuals. The second stage of the procedure was a duodenal switch after the patient would lose weight thus making the operation safer for the patient. The gastric sleeve is a restrictive procedure. It is a comparable but a more efficient restrictive operation than the adjustable gastric band.

How the Gastric Sleeve Works:

As with the other laparoscopic procedures, the surgeon will create five tiny 12 to 1-inch incisions in the abdomen. The surgeon will place a device into the stomach and cut around, divide, and remove about 75- 80% of the existing stomach. The thin muscular lesser curve remains and is shaped like a banana in size and shape. This much smaller stomach restricts dietary intake to correspond to the inside of the constructed stomach, often about 60 – 90 cc volume. The food goes through the pylorus and the intestine in an unaltered fashion.

Advantages of the Gastric Sleeve Include:

• The procedure is a better restrictive operation than the band
  • Removing the stomach rather than placing a band around the stomach offers a much smaller capacity for food.
• Weight loss potential is excellent, but requires proper diet and exercise
• No medical device is implanted in the abdomen
• The procedure has limited risk and can be performed in an outpatient clinic
• Removal of the upper portion of the stomach may reduce Ghrelin, a hormone produced in the stomach that promotes hunger
• There are no associated vitamin deficiencies
• Currently the most common procedure performed in the United States

Disadvantages of the Gastric Sleeve:

• This procedure is not reversible
• No specified changes in the stomach hormones that lead to the great resolution of diabetes mellitus, hypertension, and cholesterol reported by a gastric bypass
  • Weight loss alone may offer improvement in above conditions but not in the same effect as a gastric bypass
• This procedure should not be offered to a patient with significant reflux or Barrett’s esophagus
  • Up to 40 % of patients will have worsening gastic reflux compared to their preoperative state and may require proton pump inhibitors life long
  • If reflux becomes problematic, the sleeve can be converted to a gastric bypass with slight increase in risk
• Carries a risk of staple line leak (<1%), but if occurs can be difficult to repair
• Patients may have significant emesis due to the configuration of the sleeve, bending of the sleeve, or thickening of the sleeve over time.