Sleeve Gastrectomy

Sleeve Gastrectomy (SG) also called Vertical Sleeve Gastrectomy is another type of weight loss surgery that produces weight loss because of limiting how much can be eaten (that is, a restrictive type of bariatric surgery). During this laparoscopic (minimally invasive) surgery, the surgeon removes the bigger bag-like portion of the stomach (the fundus and part of the body of the stomach) amounting to approximately 60-80% of the stomach. The stomach becomes reduced to the shape of a near-tube from the esophagus to the duodenum, and we call it the "sleeve." There is actually no "sleeve" inserted.  The term is just descriptive. 

Originally, this operation used to performed on superobese or high risk patients as a first-stage lower risk procedure, to allow for some weight loss, in order to make the second stage (duodenal switch or gastric bypass) less risky. There is growing evidence that the "Sleeve Gastrectomy" is a good stand-alone operation. It is becoming a hot topic in national bariatric surgery meetings, particularly the American Society of Metabolic and Bariatric Surgery. Patients lost weight better than after a Lap Band. Gastric bypass and duodenal switch still produce more weight loss. Resolution of co-morbidities after SG has also been impressive.

There is evidence that the sleeve gastrectomy may do more than just restricting how much to eat. By removing the fundus of the stomach, the main source of Ghrelin is removed. Ghrelin is the "Hunger Hormone". So, there may be also a benefit related to a hormonal effect, helping to suppress appetite, independent of the restriction.

Weight loss has been estimated to be 68% of the excess weight. Its advantages compared to gastric bypass is that it is much less likely to lead to bowel obstruction, ulcers, and malnutrition. The disadvantage is that the weight loss on the long-term may be less than gastric bypass and duodenal switch. There is no dumping syndrome. Its advantages over the adjustable gastric banding (eg, Lap Band) is that weight loss is better, and there is no need for adjustment, which would be appealing to patients who live far away from their bariatric surgeon or those who are on the go and too busy to follow appointments for adjustments. Disadvantages include possible leak (though the incidence is very low) and that it is irreversible. However, after a Lap Band, the stomach is never the same. A second surgery after a sleeve gastrectomy is probably easier to do than a surgery after removing a Lap Band. Remember, after all, the operation was designed to allow for a subsequent duodenal switch or gastric bypass. So, you keep options open.

More insurance companies now do cover for this procedure, but others are still "dragging their feet".  Currently, most patients who undergo a "Sleeve Gastrectomy" will choose it as an appealing option if they have to pay cash, since it is less expensive than gastric bypass, and could even be less expensive than the Lap Band.

From the Bariatrics Lounge: 

My Favorite WLS in 2011? Sleeve Gastrectomy!