Vertical Sleeve Gastrectomy(VSG) Laparoscopic Gastric Sleeve Dallas-Ft.Worth

By drdkim on January 27, 2009 at 8:53 am

Thank you for re-visiting our blog. I wanted to write about one of the most rapidly growing bariatric surgeries in my practice, and I believe, in the Dallas – Ft.Worth area……The Vertical Sleeve Gastrectomy. I will refer to it as “VSG” for the remainder of this article. I first performed VSG 2 years ago, and at that time, I thought it would have a solid place in the category of effective bariatric surgeries. I am pleased that after 2 years and several hundred VSG patients later, that this prediction has come true. I would like to take this time to discuss the specifics about this operation to aid in the decision making process.

In, this operation, I remove approximately 75% of the outside of the stomach (called the greater curve) while maintaining the openings that allow food to enter and exit from the stomach. Please see the animation in our video section of this website. The result is a tube or “Sleeve” in the shape of a banana that will hold about 60-120 cc’s. There is no manipulation of the intestines, and this has specific advantages that I will discuss later. The nerves to the stomach are also preserved, so stomach emptying is not an issue. This operation is performed laparoscopically (or through a scope) so it is minimally invasive and performed through 5-6 small incisions (about 1-2 inches in length). It generally takes less than 1 hour to perform. Because 75% of the stomach is cut out and removed, this operation should be considered not reversible.

There are several advantages to this operation. Because the function of this stomach is preserved, it allows patients to have a more “normal diet” with less restrictions. When I first performed this operation 2 years ago, I wondered how patients would swallow. I find today, patients seem to swallow and digest their food quite well however, requiring far less food. I find that most of my sleeve patients feel quite full with 3-4 ounces of food without difficulty swallowing. Because the intestines are not altered, it does not run the risk of developing ulcers.

A great advantage of this operation is that because there is no re-arrangement of the intestines, there is no significant potential for vitamin and mineral deficiency. VSG then becomes ideal for patients who already suffer from vitamin deficiencies, osteoporosis, anemia, or have medical conditions that can adversely affect digestion in the future (such as Crohn’s disease). Autoimmune diseases such as Lupus are contraindications to the Lap Band procedure. They could still be candidates for gastric sleeve.

This operation is unique in that in our practice, we are seeing weight loss similar to that of gastric bypass. Patients also seem to behave like gastric bypass patients in that it controls hunger quite well in most cases. Removal of the upper, outer portion of the stomach (called the fundus) as is done on this Gastric Sleeve operation, leads to the dramatic reduction in the levels of the hunger hormone, Ghrelin. This hormone is made in the fundus, and probably accounts for the drop in this hormone after Vertical Gastric Sleeve because it is virtually cut out.

Because a stapler is used to perform this procedure, the risks of the operation are inherently associated with the stapler device itself. One such risk is leakage of stomach contents if the staples open up and create a “leak”. This could be life threatening and difficult to heal. Bleeding internally from the staple line can also occur however, to decrease the chances of both leaks and bleeding, I perform endoscopy (also known as an EGD scope) along the inside of the Sleeve itself to examine the staple line both on the inside and the outside. I perform this at the time of the Sleeve operation. The risks of these complications are quite small at 1%. The risks of dying from this procedure have been quoted nationally at .25% which is much less than gastric bypass and slightly higher than the Lap Band. As with all of the bariatric surgeries, complications can consist of pneumonia, pulmonary embolism, injuries to surrounding structures, all of which occur at very low rates of .5% to 1%.

Surgeons will employ this operation as a primary operation or for conditions that I have listed above. They will also use Sleeve Gastrectomy (or Vertical Sleeve Gastrectomy) as the first part of a two part procedure-this is usually reserved for patients with extremely high body weights. It can also be used as an alternative surgical technique (when discussed pre-operatively with the patient) if the surgeon suspects an extremely large liver, or if numerous adhesions may be suspected from multiple prior surgeries.

In summary, Vertical Sleeve Gastrectomy, or the Vertical Gastric Sleeve is becoming rapidly popular in my Dallas-Ft.Worth based practice for many reasons. It appeals to patients who don’t want an implant or the follow-up of a Lap Band, but are concerned about the risks of gastric bypass surgery. It allows patients the ability to lose a significant amount of weight, that approaching gastric bypass without as many risks. In the rare patient who has not lost enough weight with the band, I have been converting this subset of patients who don’t want a bypass, or don’t qualify for a bypass, into a Gastric Sleeve operation. I believe this operation will gain in popularity for years to come.

Some other names for the Vertical Gastric Sleeve: Laparoscopic Vertical Gastric Sleeve, VSG, Gastric Sleeve, Sleeve Gastrectomy, Gastric Sleeve Resection, Greater Curvature Gastrectomy, Gastric Reduction, Partial Gastrectomy, Vertical Gastroplasty

I hope you have enjoyed this article. Please come visit our blog section regularly as we will be posting several interesting topics and adding new columnists who can bring their perspective to the world of bariatric surgery.

David Kim, MD FACS

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Gastric Bypass Bariatric Surgery Patient Experience Dallas Ft Worth Texas

By admin on January 16, 2009 at 4:03 pm

LAUREN: Hi I’m Lauren and I started considering gastric bypass surgery when I was 24 years old, which is a few years ago, and that was before gastric bypass was publicized on TV, and I did a lot of internet research, but that really wasn’t what I was ready for at that moment. I then had my daughter, and at my highest weight I was 300 pounds, and I started looking at obesityhelp.com, and I started reading testimony from some of Dr. Kim’s patients, and I decided to come in for the seminar.
My daughter, when she was a year old, I had a situation and this is what got me thinking about surgery again. We were at the park and there was this jungle gym, it’s one of those dome jungle gyms. And she crawled in the middle and started shoving rocks down her throat, and I couldn’t get to her, you know? And the park was empty, and I couldn’t fit through this jungle gym to get to her, and of course she’s, like, a year old, you know, she wasn’t listening to me, so I had to go run and get a little 7 year old go come and pull her out of there. And at that point, you know, it was my duty as a mother to have the ability to protect my child, and I didn’t like the idea that my weight, you know, could stand in-between me being there for her.
The most significant change in my life since surgery is definitely that I feel like I’m unburied and I can be seen for who I am, you know? Before I could have all the potential in the world, but part of achieving your potential is other people believing it, and it was very hard for me to get over that. So I definitely–it’s the best thing I ever did in my life because of that reason.
The thing about Dr. Kim is not only is he a talented surgeon, but, you know, you can just tell by the people that have done surgery with him, how they just love–they love him, they love the hospital, you know, they’ve just all had a good experience. So that is definitely something I’d like to tell people.

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Lap Band Surgical Weight Loss Surgery Patient Experience Dallas Texas

By admin on January 16, 2009 at 4:01 pm

MR. BOB OXFORD: Hi, I’m Bob Oxford. I came to see Dr. Kim back in April of 2005 because I had hit an all time high of 424 pounds, 56 inch waist and a 5X shirt, and I just had no energy, and knew if I had another heart attack–I’ve had one before, that I probably would never survive it, and was just tired of sleep apnea, the diabetes, the whole nine yards.
So I heard his commercial on the radio going to work one morning, called Pam, gave her the information, and got everything scheduled to come in, said it’s time for a change.
I met Dr. Kim actually at the symposium. Then when I came in to meet the staff and talk to them I was afraid they would look at me like oh, you’re just another fat person. But they actually looked at me as hey, you’re just a person. It don’t matter what you weigh, let’s help you do what you need to have done. They were all very positive, very caring, very concerned.
I guess the most significant overall change in me has been my energy level and my self-confidence. Before I was not the kind of person that would get up and talk in front of somebody or a group of people, and now it’s like I can’t keep my mouth shut. I come to his once a month symposiums and I’m more than happy to get up in front of the crowd, tell them my story, and answer any questions.
I finally discovered that I like to go shopping, I have more energy, I finally bought a bicycle, the first one I’ve owned in, oh, 20 something years. You don’t have to be ashamed of this type of surgery, that this is actually for most people a life saving surgery.

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Gastric Sleeve Patient Testimonial Dallas Ft Worth Texas

By admin on January 16, 2009 at 3:57 pm

MR. JOSÉ AGUILAR: My name is José Aguilar and I’ve been overweight for the last seven or eight years. One of the reasons my I wanted to go ahead and proceed with the surgery instead of dieting was because I almost had a stroke on January 1st of 2007. I like to travel a lot, and in 2006 I was in China, I almost passed out and because of my overweight, so that was not a life, so I decided to do something about my weight, to go ahead and proceed with gastric sleeve resection, and so far I’m very pleased with the results. I have lost about 111 pounds and I don’t regret it. The only regret that I have is not doing anything about my weight in the last eight years. I could have been somewhere right now if I had done this eight years ago. And I was walking back to work two weeks after surgery, and I was flying exactly on the same day I went back to work. So I didn’t have any complications, the recovery was really fast. Overall the surgery exceeded my expectations.
The most significant change in my life has been my health improvement. Prior to surgery I was pre-diabetic; I had a lot of comorbidities that were making my life very unpleasant. Well, after surgery most of those things were gone, including hypertension, headaches, migraine. I don’t have any pre-diabetic condition.
Another thing that changed my life drastically was my love life. I was obese most of my, well, the last eight, nine years, and I never dated during that time. I never went out with friends. I was deprived from society, and the surgery brought a lot of benefit, not only health, but economic wise. Now I’m saving a lot of money on food because I don’t buy groceries anymore, I just pay for a meal at the restaurant and I eat, like, for two full days out of it.

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Obesity Weight Loss Surgery Patient Testimonial Dallas Ft Worth Texas

By admin on January 16, 2009 at 3:52 pm

MELINA: My name is Melina and I think that the moment when I knew that it was something for me was when my husband started talking about his surgery, and the prospect of him having to have it. We researched a lot about what it meant, how it changed your life, and it just seemed everything was very positive, that our life together would go in a positive direction, health wise.
I had been overweight my whole life, pretty much, and tried a lot of different diets and all kinds of exercises. I had been on appetite suppressants and was able to lose, you know, a decent amount of weight; 50 pounds, but I had gained all of that back, and so just once we researched this and all the information with Dr. Kim, and through the websites, and books and everything, it just felt like this was something that it was going to be a really good tool.
We had tried everything that we could try so I think at that point we said let’s go forward and it was going to be a real life change. And it has, you know, it really helped us change everything. We exercise a lot, we are very active, I feel very healthy. Now there’s just a confidence about me. Just a lot of things that, you know, before you were always very aware of, now it’s just, you know, you’re able to enjoy life.
Dr. Kim’s staff has been wonderful. I’ve told people, you know, this is–their staff is so informative. You will be a very informed patient before, during, and after surgery, and they were all very welcoming. Dr. Kim has a great bedside manner. Everybody that you meet is very helpful and very courteous and very loving towards you in answering any questions.
Then all the nurses that you work with during your stay at the hospital, you know, you can ask them anything, and they’re very open about telling you what to expect, and that was very helpful to me. So I mean, everybody has been wonderful.

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Gastric Bypass Weight Loss Surgery Patient Testimonial Ft Worth Texas

By admin on January 16, 2009 at 3:50 pm

KELLY: My name is Kelly, and my primary care physician–I was having trouble with blood pressure, I was on blood pressure medication for a while, and he suggested I have the surgery, and he himself recommended Dr. Kim’s office, and so that’s why I came here; as a referral.
The first thing I did, I went to one of the seminars, the informational seminar. It was on a Wednesday evening, and met Pam, and I met Dr. Kim, and everybody was very friendly and welcoming. I was impressed with the organization, everything was well laid out to make the steps pretty simple and straightforward, and they gave an informational packet, and I just followed the steps, and got where I am today.
The biggest change since I had my gastric bypass surgery was just the energy level that I have. I have much more energy, I can exercise and not–and just feel I could get a good workout. I get to go to my doctor and I don’t have to take my blood pressure medicine anymore, and he’s impressed with the clean bill of health and how much healthier and how much better I’m doing.
It’s also fun to go shopping for clothes now. I don’t have to just buy what fits, I can buy the clothes that I like, and so it’s just–it’s fun to shop. I recommend all my friends to come if they’re interested in the surgery; to come see Dr. Kim.

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Laparoscopic Gastric Bypass Surgery Patient Testimonial Dallas Texas

By admin on January 16, 2009 at 3:48 pm

MELISSA: My 3 year old was only 2 after I had the surgery and I could not lift her for several weeks afterwards. But she understood and was great, and my relationship with her and my son totally changed. I’m a lot more active, I’m a lot more hands on parent than I was prior to having surgery, and I did not think that I could be more hands on, to be honest with you. And I get out in the front yard and in the backyard, and I play football, and baseball, and I’m just so much more active. And I can go to the gym now and not be embarrassed about what I look like, and I know it sounds weird, but overweight people, you have a fear of going to the gym, and that’s where you really need to be, and so even after–right from the beginning I started my walking in the hospital. I started my laps and my walking in the hospital, and I felt so much better and I was more confident in going to the gym, like I did belong there. It just has changed my life all the way around.

My work relationship; I have gotten a promotion within my job and it is just totally changed. I speak, I do public speaking in my job. I was pretty confident when I would get up in front of people I thought before, but now I’m even more confident in myself.

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Laparoscopic Revision Surgery Dallas Ft Worth Texas Dr. David Kim

By admin on January 16, 2009 at 3:46 pm

DR. DAVID KIM: Laparoscopic revision surgery is a category in which operations that have been performed, typically outside of this practice. Patients were referred to me for me to correct operations so that patients can lose more weight, or to correct a complication that might have occurred after their primary procedure. These operations have a higher risk, but in patients who are suitable for these operations they can benefit significantly from a revision. They can regain their health and possibly lose more weight than they did initially.

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Gastric Sleeve (Vertical Sleeve Gastrectomy) Dallas Ft Worth Texas

By admin on January 16, 2009 at 3:43 pm

DR. DAVID KIM: Laparoscopic gastric sleeve resection is an operation that’s gaining much popularity and more favor with my patients. It is an operation in which we will be removing 75 percent of the volume of the stomach while maintaining the natural openings into and out of the stomach. The advantages of this operation is that it is a simpler operation to perform, therefore decreasing the chances of complications, as compared to gastric bypass.
It also, because we are not realtering the gastrointestinal tract, decreases the chances for complications with vitamin deficiencies. Patients can lose weight approaching gastric bypass surgery in a fairly rapid weight loss over a one year period of time, and this also allows patients to get rid of their medical problems with almost the same success as gastric bypass surgery.
The disadvantages of laparoscopic gastric sleeve resection is that it is a new operation. Because this operation has been around in the United States now for just approximately less than two years, we don’t have much data about this procedure, but we believe that it is going to be a long term popular and successful operation. The other disadvantage is that it is not covered by most insurance companies. Because a long tube with resistance is created, it does significantly reduce the amount of food that a patient can eat.

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Laparoscopic Gastric Bypass Surgery Dallas Ft Worth Texas

By admin on January 16, 2009 at 3:41 pm

DR. DAVID KIM: Laparoscopic gastric bypass, or the laparoscopic gastric bypass and Roux-N-Y procedure, which it is also known as, is an operation that can yield dramatic results.
What is happening in this operation is that I am separating the top of the stomach, which will be about the size of an egg or smaller, and separating this away from the remainder of the stomach. This limits the amount of food that you will eat. I also use a section of the small intestine and sew this up to this pouch in such a manner that the food that you swallow will not come in contact with the upper gastrointestinal tract. This leads to a less absorption of fats and calories, and thus leading to a pretty dramatic weight loss.
The advantages of this operation are it allows the patient to possibly lose the most amount of weight as compared to the other procedures. In most cases a patient will lose up to 80 percent of their excess body weight. This also allows for a dramatic reduction in a patient’s medical problems, so they have the highest possibility of getting rid of diabetes, and high blood pressure, as well as other co-morbidities.
This operation has been around for approximately 40 years, so we know it is a very durable operation, even 10 and 20 years after the operation has been performed. And lastly there are no adjustments to be made, so the office visits are approximately, after the initial visit after the surgery, on an every four month basis for the first year, and then every year after that to make sure that things are going well.
A patient does incur a higher risk, so these risks, and some of these are a higher chance of blood clots, as well as bleeding, these complications are a result of much more surgery taking place at the time of the operation. Patients will have a slower recovery, with regards to their return to work, which is typically around one to two weeks.

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