The Sleeve Gastrectomy

What is a "Sleeve Gastrectomy?"
The 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 the intestines
  • 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 duodenal switch
  • It may be used as the first stage of a 2-stage operation. (See below)

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 bariatric surgery.

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 substantially safer.

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 Disadvantages?
The sleeve may not result in quite as extensive weight loss as the gastric bypass or the duodenal switch.

FAQ

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.

 

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