The Sleeve Gastrectomy is a surgery only on the stomach (it is only a restrictive procedure) and does not involve any surgery on intestine (which would make it malabsorptive). Sleeve Gatrectomy has also been called partial gastrectomy and Vertical Sleeve Gastrectomy. It basically consists of making a stomach that looks like a pouch into a long tube; therefore the name “sleeve.” The Sleeve Gastrectomy (SG) removes two-thirds of the stomach, which provides for quicker satiety (sense of fullness) and decreased appetite. The smaller stomach pouch restricts food intake by allowing only a small amount of food to be eaten at one time. After the separation of the stomach into a smaller tube, the remainder of the stomach is removed. The valve at the outlet of the stomach remains, this provides for the normal process of the stomach emptying to continue which allows for the feeling of fullness.
SG is now an established first procedure (or first stage of a two part surgery) to prepare the obese patient for biliopancreatic diversion or gastric bypass. It is also used as a single stage procedure. There is no anastomosis or  new connections made between the stomach and the small intestine in this procedure. There is no rerouting of the intestine. There is no malabsorption. There is no dumping syndrome. The Sleeve Gastrectomy is believed to have an advantage over the Adjustable Gastric Band due to removal of the part of the stomach that produces the hormone (Ghrelin) that controls the desire to eat.
The potential complications of the operation on average are typically less than 0.5% compared to 2%-3% in a combined procedure.
Advantages of the Vertical Gastrectomy Weight Loss Surgery:
- The stomach is reduced in volume but tends to function normally so most food items can be consumed, albeit in small amounts.
- Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin).
- No dumping syndrome because the pylorus is preserved.
- Minimizes the chance of an ulcer occurring.
- By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated.
- Very effective as a first stage procedure for high BMI patients (BMI>55 kg/m2).
- Limited results appear promising as a single stage procedure for low BMI patients (35-45 kg/m2).
- Appealing option for the people with existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedure.
- Can be done laparoscopically in patients weighting over 500 pounds.
Disadvantages of the Vertical Gastrectomy Weight Loss Surgery:
- Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass.
- Higher BMI patients will most likely need to have a second stage procedure later to help lose the rest of the weight. Two stages may ultimately be safer and more effective than one operation for higher BMI patients. This is an active point of discussion for bariatric surgeons.
- Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss.
- This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur.
- Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure.
- Considered investigational by some surgeons and insurance companies.
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