Vertical / Sleeve Gastrectomy

Vertical Gastrectomy - also known as Sleeve Gastrectomy - is a purely restrictive procedure. The procedure consists of surgical removal of the majority of the stomach, leaving behind a narrow tubular stomach of 2-3 oz. in volume.

Vertical/Sleeve Gastrectomy has its origins in the Duodenal Switch procedure. The restrictive component of Duodenal Switch is achieved by Vertical/Sleeve Gastrectomy, and in certain high-risk patients Vertical/Sleeve Gastrectomy has been used as the first stage in a staged Duodenal Switch procedure. In other words, Vertical/Sleeve Gastrectomy is performed first, and, in 9-12 months, after the patient has lost a significant amount of weight and is at much lower risk for major surgery, the rest of the Duodenal Switch procedure - the second stage - is completed. What was observed in using this approach, though, is that not all patients returned for their second stage procedure; the Vertical/Sleeve Gastrectomy was sufficient in achieving an acceptable weight loss and improvement in health. It was this observation that led to the use of Vertical/Sleeve Gastrectomy as a sole, stand-alone, procedure for weight loss.

When used as a sole procedure, the resultant stomach volume after Vertical/Sleeve Gastrectomy is smaller than that employed with a Duodenal Switch procedure. Because this is a procedure which works solely by limiting food intake, it stands to reason that a smaller stomach volume should be advantageous in maintaining weight loss in the long-term.

To view an animation of this procedure click here.
(This will require the use of Macromedia Flash Player. You can download it here.)

VERTICAL/SLEEVE GASTRECTOMY: How it Works

Weight loss with Vertical/Sleeve Gastrectomy is more than just the result of having a smaller stomach. Limiting food intake with Vertical/Sleeve Gastrectomy has as much to do with how the volume is decreased, how the stomach responds to stretching, how the hunger-signaling capacity of the stomach is altered, and how patients respond to the unique nature of this restriction.

With Vertical/Sleeve Gastrectomy, restriction is achieved by reducing the volume of the stomach along its entire length. It is not a matter of having food pass through a point of obstruction (like a LapBand or gastroplasty) only to reach a large stomach reservoir downstream. Rather, food passes through a relatively normal stomach inlet and then has no room downstream for much to accumulate. The pylorus - a muscular valve found at the downstream end of the stomach - regulates the emptying of the stomach, and until it releases the stomach to empty, the ingested food has no place to go.

Part of what gives us that "full feeling" after we eat is the effect that stretching has on the stomach. Stretch receptors in the stomach signal the brain as the stomach fills up and stretches out. These receptors are especially numerous in the downstream portion of the stomach known as the antrum. With the Vertical/Sleeve Gastrectomy configuration food is essentially funneled to the downstream stomach, making the antrum stretch sooner than it normally would otherwise. This sends a strong signal to the brain resulting in a feeling of fullness.

Another factor regulating appetite is a chemical signal known as ghrelin. This is a "hunger hormone", and the stomach produces a major share of the ghrelin found in the body. Much of this is produced in the portion of the stomach that is removed during the procedure, and this removal of ghrelin producing tissue has an effect on suppressing appetite as well.

These factors all come together in how the patient experiences eating after a Vertical/Sleeve Gastrectomy procedure. The patient eats through an essentially normal stomach inlet, and swallows into a stomach reduced in volume along its entire length. This results in fairly free eating with a modest amount of restriction. The food is held in the stomach by the pyloric stomach valve, and the stomach empties relatively normally when it does. In following patients who have undergone Vertical/Sleeve Gastrectomy, the common experience seems to be having the ability to eat a broad variety of types of food - including dense proteins - but in significantly reduced volumes. Patients are able to eat a wide variety of foods in reduced volumes, without having to resort to the temptation of the soft-calorie syndrome. This combination of the ability to eat food of high quality but of low quantity creates a mix of ingredients for healthy dietary restriction.

Vertical/Sleeve Gastrectomy: Risk

The possible complications of Vertical/Sleeve Gastrectomy are the same of other major bariatric procedures. Leak, infection, blood clots in the leg or lungs, bleeding, pneumonia and death can all occur. As with any surgery, risk is a combination of the severity of the procedure and the underlying health of the patient. All other things being equal, the risk of undergoing a Vertical/Sleeve Gastrectomy lie between Duodenal Switch and Gastric Banding.

Vertical/Sleeve Gastrectomy: Revision Considerations

Patients who have undergone Gastric Banding or Gastric Bypass can be revised to Vertical/Sleeve Gastrectomy if need be. For patients who have undergone Vertical/Sleeve Gastrectomy already, and in whom weight loss has been inadequate, revision to Duodenal Switch or VERGITO procedure may be performed. Unlike other revision procedures, revising from Vertical/Sleeve Gastrectomy is a lesser procedure than performing Duodenal Switch or VERGITO as an initial procedure, as the stomach part of the procedure has already been performed. Given its pedigree as a first stage procedure, Vertical/Sleeve Gastrectomy makes a good platform from which to branch out from.

For a comparison of the procedures our surgeons offer click here. Please note VERGITO and Vertical/Sleeve Gastrectomy will be added to chart soon.