Some professionals believe the Gastric Sleeve Procedure (also called Sleeve Gastrectomy, Vertical Gastrectomy, Vertical Sleeve Gastrectomy, VSG and other terms) is the best new surgical option for weight loss. For those patients that are not comfortable considering the gastric bypass or who do not want the Lap-Band (or Realize Band), the Gastric Sleeve is an excellent alternative.
The Gastric Sleeve has been used for approximately ten years. It was originally the first stage of a two-part procedure, with the second stage involving a bypass of the intestines, but it was found that patients who had undergone just the “sleeve” portion of the procedure lost a substantial amount of weight without the need for the second part of the operation. Several centers have begun performing this operation as a permanent weight loss procedure and patients have experienced excellent results.
Early forms of this procedure were done in Australia in 1993 by Dr. Jamieson and in England by Dr. Johnston in 1996. After being modified to improve results, the Gastric Sleeve is now considered one of the three main weight loss surgery procedures and is being performed worldwide.
The Gastric Sleeve causes weight loss through much the same main mechanism as the Gastric Bypass and the Gastric Band, by causing a person to become satisfied, or “feel full,” with smaller amounts of food. By dramatically reducing the amount of food that a person needs to eat before becoming “full,” this surgery provides patients with significant leverage to decrease the amount of calories they eat and to lose weight. This procedure can be used in any patient that qualifies for weight loss surgery and can also be appropriate for selected patients with a smaller amount of weight to lose, who are not candidates for a gastric bypass.
How does Gastric Sleeve work?
This procedure generates weight loss solely through gastric restriction (reduced stomach volume) and earlier satiety (feeling full with smaller amounts of food). The stomach is made smaller by removing approximately 80% (see diagram). The remaining stomach is shaped like a narrow banana and is filled with approximately 3 – 4 ounces (100cc) of food. The goal of this operation is to preserve some of the function of the stomach while drastically reducing the volume. In comparing the Gastric Sleeve to the Gastric Bypass, the gastric bypass will cause a similar feeling of early “fullness” but will also include a bypass of the stomach and a bypass of a small portion of the intestine, resulting in dumping when a person eats concentrated sugars or sweets; the sleeve involves no bypass and does not cause dumping. In comparing the Gastric Sleeve to the Band, the gastric band involves the use of a device made of a plastic polymer to create a small upper stomach pouch resulting in a feeling of early fullness (also called restriction), and the Band requires adjustments; there is no artificial device and no need for adjustments with the gastric sleeve procedure. It’s also important to remember that the Gastric Bypass and Band can generally be reversed if necessary, whereas the Gastric Sleeve cannot.
An additional fact to remember is that the Gastric Sleeve may result in a decrease in food cravings due to the removal of the portion of the stomach that likely produces certain hormones which cause hunger. This is unique to the gastric sleeve, as no portion of stomach is removed with the gastric bypass or band. Although patients report that some hunger and cravings can slowly return, research has shown that even after three years the sensation of cravings if far less after gastric sleeve than with the gastric band procedure, and many patients experienced more significant weight loss. (published in 2006 by Dr. Himpens)
Another key piece of information is that the Gastric Sleeve has been shown to be quite safe and effective for individuals with less weight to lose, meaning safe and effective for individuals with a BMI less than 35-40.
Low BMI individuals who qualify for Gastric Sleeve procedure include:
- Those who are concerned about the potential long term side effects of gastric bypass.
- Those who are considering gastric band surgery but are concerned about having an artificial device attached to their stomach, those who do not want band adjustments, or those who live in an area where they may have trouble finding a physician qualified to do the band adjustments.