Vertical Sleeve Gastrectomy

Basic Description

  • • Restricts food volume and may decrease hormones that affect hunger
  • • Divides stomach vertically with 70%-85% of stomach permanently removed
  • • Cannot be converted to gastric bypass
  • • No intestinal rerouting
  • • 50%-60% weight loss reported
  • • Acid reflux
  • • Not reversible

Vertical sleeve gastrectomy (VSG) is becoming the surgery of choice for many surgeons and patients due to ease of surgery and elimination of bowel rearrangement with potential long-term complications. This procedure was first introduced in 1988 called a biliopan- creatic diversion with duodenal switch (BPD-DS) [9]. Weight loss is achieved by limiting food portions and malabsorption mechanisms. The BPD is reported to exceed any other bariatric surgery for short- and long-term weight loss. Despite these good results, the numbers of BPD procedures have decreased, leaving the RYGB and VSG the most popular patient preference.

In the VSG procedure, 70%-85% of the stomach along the greater curvature is removed. The pylorus is retained and normal food grinding of the bolus enters the duodenal loop on its way to digestion and absorption. The sleeve resembles a long, thin banana whose size depends on the surgeon [10].

Increased problems with gastroesophageal reflux disease (GERD) have been associated with the sleeve, especially smaller sizes. A normal stomach can hold approximately 1,500 mL but the VSG reduces this volume to 90-220 mL.

The reduced stomach size causes early satiety and reduced oral intake, but increasing evidence suggests weight loss lifestyle modifications need to be made or else increased satiety from hormone changes can limit success. Studies have shown that when a sleeve is filled with saline the pressure inside rose to 43 mmHg compared with 34 mmHg when the stomach is intact. The surgery reduces the stomach’s ability to distend causing fullness and reduced food intake.

Another aspect of appetite control in the VSG is the reduction of ghrelin-producing cells that are lost in the resecting and removal of most of the stomach [11]. Ghrelin is an endogenous hormone that stimulates the release of growth hormone and appetite. It plays a role in body weight regulation by initiating food intake. Ghrelin levels in VSG patients have been shown to remain low longer than 6 months postoperatively, which aids the weight loss process [12].

Laparoscopic sleeve gastrectomy is also gaining in popularity according to Young et al. because of lower morbidity with reduced blood loss, shorter operative time, and lower rate of deep wound infections [13].

The usual nutrient deficiencies of folate and vitamin D were identified by van Rutte et al. before and after sleeve gastrectomy [14], and Gehrer et al. reported fewer nutrient deficiencies from VSG than RYGB [15].

 
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