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Vertical sleeve gastrectomy

Definition

Vertical sleeve gastrectomy is surgery to help with weight loss. The surgeon removes a large portion of your stomach.

The new, smaller stomach is about the size of a banana. It limits the amount of food you can eat by making you feel full after eating small amounts of food.

Alternative Names

Gastrectomy - sleeve; Gastrectomy - greater curvature; Gastrectomy - parietal; Gastric reduction; Vertical gastroplasty

Description

You will receive general anesthesia before this surgery. This will make you sleep and keep you pain-free.

The surgery is usually done using a tiny camera that is placed in your belly. This type of surgery is called laparoscopy. The camera is called a laparoscope. It allows your surgeon to see inside your belly.

In this surgery:

  • Your surgeon will make 2 to 5 small cuts in your abdomen.
  • The surgeon will pass the laparoscope and the instruments needed to perform the surgery through these openings.
  • The camera is connected to a video monitor in the operating room. Your surgeon will look at the monitor to see inside your belly.
  • Your surgeon will insert thin surgical instruments through the other openings.

Your surgeon will remove most of your stomach.

  • The remaining portions of your stomach are joined together using surgical staples. This creates a long vertical tube or banana-shaped stomach.
  • The surgery does not involve cutting or changing the sphincter muscles that allow food to enter or leave the stomach
  • The surgery may take only 60 to 90 minutes if your surgeon has done many of these procedures.

When you eat after having this surgery, the small pouch will fill quickly. You will feel full after eating a very small amount of food.

Weight-loss surgery may increase your risk of gallstones. Your doctor may recommend having a cholecystectomy (surgery to remove the gallbladder) before your surgery or at the same time.

Why the Procedure Is Performed

Weight-loss surgery may be an option if you are very obese and have not been able to lose weight through diet and exercise.

Vertical sleeve gastrectomy is not a quick fix for obesity. It will greatly change your lifestyle. You must eat healthy foods, control portion sizes of what you eat, and exercise after this surgery. If you do not follow these measures, you may have complications from the surgery and poor weight loss.

This procedure may be recommended if you have:

  • A body mass index (BMI) of 40 or more. Someone with a BMI of 40 or more is at least 100 pounds over their recommended weight. A normal BMI is between 18.5 and 25.
  • A BMI of 35 or more and a serious medical condition that might improve with weight loss. Some of these conditions are sleep apnea, type 2 diabetes, and heart disease.

Vertical sleeve gastrectomy has most often been done on patients who are too heavy to safely have other types of weight-loss surgery. Some patients may eventually need a second weight-loss surgery.

This procedure cannot be reversed once it has been done.

Risks

Risks for any anesthesia are:

Risks for any surgery are:

Risks for vertical sleeve gastrectomy are:

  • Gastritis (inflamed stomach lining), heartburn, or stomach ulcers
  • Injury to your stomach, intestines, or other organs during surgery
  • Leaking from the line where parts of the stomach have been stapled together
  • Poor nutrition, although much less than with gastric bypass surgery
  • Scarring inside your belly that could lead to a blockage in your bowel in the future
  • Vomiting from eating more than your stomach pouch can hold

Before the Procedure

Your surgeon will ask you to have tests and visits with your other health care providers before you have this surgery. Some of these are:

  • A complete physical exam
  • Blood tests, ultrasound of your gallbladder, and other tests to make sure you are healthy enough to have surgery
  • Visits with your doctor to make sure other medical problems you may have, such as diabetes, high blood pressure, and heart or lung problems, are under control
  • Nutritional counseling
  • Classes to help you learn what happens during the surgery, what you should expect afterward, and what risks or problems may occur afterward
  • You may want to visit with a counselor to make sure you are emotionally ready for this surgery. You must be able to make major changes in your lifestyle after surgery.

If you are a smoker, you should stop smoking several weeks before surgery and not start smoking again after surgery. Smoking slows recovery and increases the risk of problems. Ask your doctor or nurse for help quitting.

Always tell your doctor or nurse:

  • If you are or might be pregnant
  • What drugs, vitamins, herbs, and other supplements you are taking, even ones you bought without a prescription

During the week before your surgery:

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), vitamin E, warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
  • Ask your doctor which drugs you should still take on the day of your surgery.

On the day of your surgery:

  • Do not eat or drink anything after midnight the night before your surgery.
  • Take the drugs your doctor told you to take with a small sip of water.
  • Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You can probably go home 2 days after your surgery. You should be able to drink clear liquids on the day after surgery, and then a puréed diet by the time you go home.

When you go home, you will probably be given pain pills or liquids and a medication called proton pump inhibitors.

Your doctor, nurse, or dietitian will recommend a diet for you. Meals should be small to avoid stretching the remaining stomach.

Outlook (Prognosis)

The final weight loss may not be as large as with gastric bypass. And this may be enough for many patients. Talk with your doctor about which procedure is best for you.

The weight will usually come off more slowly than with gastric bypass. You should keep losing weight for up to 2 to 3 years.

Losing enough weight after surgery can improve many medical conditions you might also have. Conditions that may improve are asthma, type 2 diabetes, arthritis, high blood pressure, obstructive sleep apnea, high cholesterol, and gastroesophageal disease (GERD).

Weighing less should also make it much easier for you to move around and do your everyday activities.

This surgery alone is not a solution to losing weight. It can train you to eat less, but you still have to do much of the work. To lose weight and avoid complications from the procedure, you will need to follow the exercise and eating guidelines that your doctor and dietitian gave you.

References

Moy J, Pomp A, Dakin G, et al. Laparoscopic sleeve gastrectomy for morbid obesity. Am J Surg. 2008 Nov;196(5):e56-9.

Richards WO. Morbid obesity. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 15.

Woodward G, Morton J. Bariatric surgery. In: Feldman M, Friedman LS, Brandt LJ. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 7.


Review Date: 1/29/2013
Reviewed By: John A. Daller, MD, PhD, Department of Surgery, Crozer-Chester Medical Center, Chester, PA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Stephanie Slon, and Nissi Wang.
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