Vertical Sleeve Gastrectomy (VSG)
The Vertical Sleeve Gastrectomy (VSG) is the newest surgical procedure available to help severely over weight patients lose weight.
The Vertical Sleeve Gastrectomy (VSG) is the restrictive portion of the Duodenal Switch Procedure. The duodenal switch procedure is usually reserved for the super obese, i.e. patients who weigh in the 450 to 600 pound range. In these patients, this risky procedure was typically done in two stages. The first stage involves removing a large portion of the stomach changing the stomach into a narrow tube. The remaining stomach is similar in size and shape to a banana. Patients who underwent this procedure lost much of their excess body weight and many never required the second stage of the procedure. Similar success has been seen in patients undergoing the procedure with lower BMIs as well.
Bariatric Surgeons began performing the Vertical Sleeve Gastrectomy (VSG) as a standalone procedure in the US in 2001. The last 3 years has seen a rapid rise in the number of VSG procedures performed at bariatric centers across the US. Recently a number of bariatric surgery centers have published their experience with the (VSG) Vertical Sleeve Gastrectomy surgery. Several centers have performed over 1000 (VSG) procedures. Weight loss seen in (VSG) Vertical Sleeve Gastrectomy patients both short and long term is very encouraging. Excess weight loss approaching 80% at 2 years follow (VSG) is commonly seen. This is similar weight loss seen in patients having Gastric Bypass over the same time interval. Patients undergoing the Vertical Sleeve Gastrectomy often experience more weight loss and a faster rate of weight loss compared to patients who underwent the Lap Band® procedure. Patients who had the (VSG) also experience improvement or resolution in their co morbidities similar to the Gastric Bypass and Lap Band®.
The Vertical Sleeve Gastrectomy (VSG) is a restrictive procedure. No intestinal transection or re-routing is required. This makes the (VSG) much safer than the gastric bypass. Approximately 70 % of the stomach is removed. The remaining tubular stomach can only hold about 80 cc of fluid or around 5 bites of solid food. Patients can only eat small amounts of food before feeling full similar to the Lap Band® procedure. Patients report almost no hunger between meals and often have to remind themselves to eat!! This is probably due to removing the portion of the stomach that produces hunger stimulating hormones like Grehlin . Unlike the Lap Band® procedure no adjustments are required so fewer follow-up visits are required.
Since a portion of the stomach is removed, the procedure is considered nonreversible. Risks particular to the Vertical Sleeve Gastrectomy include bleeding from the staple line 1.4%, staple line leak 2.4%, stricture formation, pouch dilation 2.8%, and GERD (chronic heart burn) symptoms 4.7%. Long term results (>5 years) are not yet available.