More commonly known as the gastric sleeve, laparoscopic vertical sleeve gastrectomy (LVSG) is rising in popularity. Similar to the duodenal switch (DS), the hormonally active portion of the stomach is removed, with the remaining tubular segment restricting oral intake. However, in contrast to both the gastric bypass (RYGB) and the DS, there is no intestinal rerouting; hence, no malabsorptive component.
For reasons not yet fully known, the resolution of medical problems appears to be weight loss independent, albeit at a slower rate than with the RYGB or DS. The removed portion contains the hunger hormone Ghrelin, leading to earlier satiety. It is, therefore, considered to be a restrictive anorectic operation. Sleeve gastrectomy offers many of the benefits of the more established stapled procedures, while simultaneously avoiding the need for frequent adjustments or the complications associated with embedded foreign bodies as in the Lap Band operation.
The Importance of a Top-Skilled Surgical Team
In pursuing LVSG or similar bariatric treatments, patients should exercise extreme caution when choosing a surgical program. With its rising popularity, many centers whose exclusive focus had previously been on adjustable bands, have now shifted their attention to the LVSG. Whereas it is presented as a technically less demanding operation than either the RYGB or DS, critical nuances do exist, which would be unfamiliar to surgeons inexperienced with the more advanced stapled procedures. Sleeve complications, furthermore, can be prolonged in duration and very difficult to manage. Hence, it is vital for patients to choose programs with an established track record in more invasive procedures such as the RYGB or DS.
University Bariatrics team members are among the earliest proponents and advocates of the gastric sleeve throughout Southern California. They have contributed significantly to its adoption in Thousand Oaks and Los Angeles area through numerous scientific publications, invited presentations, and media events. Our results reflect our constant and unwavering commitment to the three fundamental pillars of successful bariatric surgery: patient education, preparation, and operative safety.
- Does not require the implantation of a foreign body, such as a silastic ring used in gastric banding
- The procedure both mechanically decreases the size of the stomach and also decreases the secretion of the hormone, ghrelin, which is responsible for the feeling of satiety (fullness) (the procedure removes part of the stomach that produces this hormone).
- There is no malabsorption.
- There are no anastomoses or rerouting of the intestinal tract.
- Less vitamin deficiencies when compared to gastric bypass.
- Less long-term maintenance than gastric banding (no band fills needed).
- No vitamin or mineral deficiencies due to malabsorption.
- More weight loss than Adjustable Gastric Banding. 1
- Can offer the benefit of initially decreasing body weight in the severely obese patient, to prepare him/her for another surgery at a later time.
- Potentially slower weight loss than Roux-en-Y Gastric Bypass or Duodenal Switch.
- Not as much clinical data available (when compared to gastric bypass and adjustable gastric banding).
- Potential for gastric leaks (due to stapled resection of the stomach).
Sleeve Gastrectomy FAQ
1. Will I have visible scars from the sleeve gastrectomy?”
a. Gastric sleeve surgery or a “Sleeve Gastrectomy” is a minimally invasive surgery, which is described as a “keyhole” surgery. This means you will have 3-5 small incisions with minimal pain. You will have scars from these incisions, however scars prominence should be greatly diminished with time after surgery or minimal treatment.
2. “What is the standard amount of recovery time?
a. Luckily for you the turnaround time is very quick! You should be able to return to work about a week or two after surgery as long as you do not need to lift, push or pull anything heavy. For the first few weeks after surgery. You may begin light exercise only one week after surgery, initially walking then gradually increasing exercise as you lose weight.
3. “What is the average time-frame for the day of the procedure?”
a. So the average gastric sleeve including the non-surgery time, will take about two hours. In most cases the patients will be up and walking three to five hours after surgery.
4. “Will there be lots of excess skin post-surgery?”
a. Many of the people who are heavy enough to meet the strict surgical criteria for weight loss surgery, they have stretched their skin beyond the point from which it’s possible for it to “snap back”. These individuals tend to seek out plastic surgical options around 18 months after surgery when they have plateaued. However, many others have good elasticity of the skin, and with the help of exercise, may not have much excess skin. This is more of an individual situation than a one size fits-all deal, and there is no way to predict what your skin will do, so exercise as much as you can and cross that bridge once the weight loss has stopped.
5. “Will this surgery effect my ability to get pregnant?”
a. We strongly recommend that you wait at least the 18 months after surgery that it takes for your body to reach a fairly stable weight and nutritional status before attempting to get pregnant. Additionally, we urge you to be conscious that fertility usually increases with weight loss so be sure to take extra precautions. With that said, if pregnancy does occur after surgery, it is of no danger to you or your child. In fact, for women of pregnancy age, the sleeve gastrectomy is the recommended over the other surgeries as it causes much less problems during pregnancy.
6. “What is “Mineral Malabsorption” and how do I avoid it?
a. The good news is…it’s not that bad! In the sleeve, the hormonally active part of the stomach is removed but in contrast to the gastric bypass, there is no re-routing of the intestinal tract and therefore, no malabsorption of any nutrients or vitamins or minerals. With that said however, patients still can get mild mineral deficiencies. Luckily a multivitamin a day for a life of health seems to be a great trade-off.
7. “Does gastric sleeve surgery interfere with daily medications?”
a. In contrast to the gastric bypass, the vertical sleeve gastrectomy does not interfere with the absorption or function of medications. Directly after surgery you may need to crush or convert your medicine into liquid. Additionally, you will want to consult with your physician prior to surgery about the volatility of your medication, as it may not coincide well with your pain medication or digestive tract. At six weeks after the surgery, you may begin to take small pills or capsules as before. Medications that come in larger pill form may still need to be broken or crushed. This is generally a case-by-case situation. As a general rule post-surgery you should avoid aspirin products and anti-inflammatories as they can cause irritation and ulcers. Remember that your vitamins and minerals should always be in a chewable or liquid form for better absorption.
8. “Will I be able to eat normally after surgery?”
a. Yes! After the transitional post-surgery period is over you may again begin to eat normal foods again! The biggest difference is going to be the portion size and the type of food that you should eat. As you’d imagine, you will fill up much quicker than you used to, so eat with caution. Specific post-diet dietary guidelines are to avoid foods high in sugars and limit fats in your diet. Besides those stipulations you may otherwise eat a wide variety of foods but some foods such as dry meats, pasta, rice, breads, asparagus or other stringy fruits and vegetables may be difficult. In terms of food variety tolerance, the sleeve gastrectomy is considered to be superior to the other operations.
9. “I’ve read that the sleeve gastrectomy has a higher complication rate than other surgeries and is riskier… is that true?”
a. This is a common misconception; it is not true. When considering having the vertical sleeve gastrectomy procedure there are numerous factors which you need take into accord. The importance of seeking surgeons and programs with a long history of experience like ourselves cannot be overstated. The rate of complications goes down significantly with more experience. This is a more complicated surgery than a simple band implementation, so doing the research on the surgeon performing your procedure is a must. At University Bariatrics our trained, experienced staff is highly skilled at this procedure. University Bariatrics team members were among the earliest proponents and advocates of the gastric sleeve throughout Southern California. They have contributed significantly to its adoption in Thousand Oaks and Los Angeles area through numerous scientific publications, invited presentations, and media events. Our results reflect our constant and unwavering commitment to the three fundamental pillars of successful bariatric surgery: patient education, preparation, and operative safety.