The Sleeve Gastrectomy
What is a "Sleeve Gastrectomy?"
sleeve gastrectomy, sometimes called the vertical sleeve
gastrectomy (VSG) or laparoscopic sleeve gastrectomy
(LSG), is an operation in which the left side of the
stomach ("greater curvature") is surgically
removed. This results in a new stomach that is roughly
the size and shape of a banana. Since this operation
does not involve any "rerouting" or reconnecting
of the intestines, it is a simpler operation than the
gastric bypass or the duodenal switch. Unlike the LAP-BAND®
procedure, the sleeve gastrectomy does not require the
implantation of an artificial device inside the abdomen.
In some cases, the sleeve
gastrectomy is performed as a definitive therapy for
obesity. For certain patients, in particular those with
a body mass index greater than 60, the sleeve gastrectomy
may be the first part of a 2-stage operation.
How Does the Sleeve Gastrectomy Work?
The sleeve gastrectomy works through 2 mechanisms:
- It makes the stomach smaller, so you feel full after
eating a smaller meal.
- The fundus of the stomach is removed. This is the
area that secretes ghrelin, a hormone that makes you
feel hungry. So, the sleeve gastrectomy may help you
to feel less hungry through a hormonal mechanism.
What Are the Advantages of the "Sleeve?"
The sleeve gastrectomy has a number of advantages
over other bariatric procedures:
- It does not require disconnecting or reconnecting
- It is a technically simpler operation than the gastric
bypass or the duodenal switch. Some data suggest that
the operation may be safer than gastric bypass or
- It may be used as the first stage of a 2-stage operation.
What is a 2-Stage Operation?
Certain patients may have a body shape that
makes their surgery more technically difficult. For
example, patients with a BMI over 60 -- particularly
those who carry their weight in their belly area --
may be at increased risk for bariatric surgery. If you
fall into this category, you may benefit from a 2-Stage
In the staged approach,
a multi-step operation like the gastric bypass or the
duodenal switch is broken down into 2 simpler and safer
operations. In the first stage, a sleeve gastrectomy
is performed. This allows to lose 80 to 100 pounds or
more, which will make the second part of the operation
The second stage operation
is usually performed 8 to 12 months after the first.
The "sleeve" stomach is converted into a formal
gastric bypass or duodenal switch. This will permit
additional weight loss and will provide a much more
permanent result than sleeve gastrectomy alone.
Both stages of the surgery
can be performed laparoscopically, giving the advantage
of shorter recovery, shorter incisions, fewer incision-related
problems and less pain.
Are There Any
The sleeve may not result in quite as extensive
weight loss as the gastric
bypass or the duodenal switch.
Q. Do all insurance
companies approve the sleeve gastrectomy?
A. No, many insurers are either unaware
of the sleeve gastrectomy or consider it to be
investigational, even though it has been used
for over 5 years now. In the New York area, this
operation is acceptable to United Healthcare and
Oxford insurance plans. Medicare and some other
insurers refuse to cover the sleeve gastrectomy
or the 2-stage operation.