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

Posted in Gastric Sleeve

A New Year, Not Another Diet

By admin on January 15, 2009 at 6:25 pm

Hello again everyone and happy new year!

Each and every year millions of Americans resolve to improve their health, lose weight and exercise at the beginning of the year. Unfortunately, we start out motivated, but the motivation to continue a “diet and exercise plan” for many of us fades after a few months. Most will experience some weight loss and improved energy, but as the stresses of our lives return and old eating habits pounce on us, we begin to lose confidence and self-esteem in our ability to make lasting changes.

The sad truth of most “diets” is that they do not necessarily consist of what or where we like to eat. They also ask us to track portions, calories, fat grams, carbs and many other things that are sometimes difficult to do. The benefit of such dietary and exercise programs is that they attempt to hold us accountable to what we eat, how we eat, when and where we eat and so on. Accountability is a big part of lifestyle change isn’t it. It is often difficult to stay accountable to everything you put in your mouth no matter how motivated you are.

We really are all committed to improving our health and wellness. We are committed to losing weight, but our motivation weans over time, our old lifestyles are corrupted by many years of the “American style of eating and living” and accountability is tedious and difficult to maintain. This is why we experience a 90-95% failure rate of diet, behavioral and exercise to maintain weight loss.

On the positive side, people all across the country do lose weight and keep it off, they exercise 60-80 minutes a day, stay accountable, eat healthful foods and other things, but what about the rest of us, the 90% of us, who feel miserable about ourselves when we fail to persist in our efforts. It isn’t because we are not committed, it isn’t because we don’t care or lack will power. Sure doctors and dietitians tell us that eating a well-balanced diet with healthy carbohydrates, fiber and protein will help us feel full longer and keep weight off. But what about the irresistable pull of the almighty french fry. Also known as the multi-billion dollar advertising campaign of the high calorie, high fat, refined, processed, but tastes o so good American junk food industry screaming at us on a daily basis. Seriously, what’s up with those sinnfully delicious Red Lobster commercials and what is authentic Mexican food? Do people in Mexico really sit around to lunch and dinner each day and eat 1,500 calories and 60 grams of fat worth of greesy enchiladas, ground beef and chips?

Bariatric surgery is the solution for thousands of people each year in the ongoing battle to lose weight, treat numerous chronic health conditions and improve a sense of self-confidence and accountability that is not found elsewhere in the diet industry. Bariatric surgery including the Lap Band System, Realize band, laprascopic gastric sleeve resection and laprascopic R and Y gastric bypass, are life changing, medically necessary procedures of great value. Surgery affords many people in need of a perminant accountablity system, an enhancement if you will of your ability to eat mindfully, with purpose and restraint. To enjoy maybe for the first time, weight loss that has a success rate opposite of a regular diet, about 90% of people losing weight and keeping it off. Yes there are costs, but the costs are often associated with success and not failure as with conventional diets.

Mostly, the surgery itself has life changing qualities. Eating slower, restricted portions, feeling full quickly, having less desire to eat in the first place. With this permanent kind of accountability, one is free to explore opportunities to increase leisure acitivity, possibly pain free or at least greatly reduced, free to explore new healthier recipes without having to worry. Is the scale going to go down to show me I am a success? Success comes with a price. The price of having surgery is a new you and permanent accountability partner. Bariatric surgery is a tool that initially changes your anatomy, then your physiology and appearance; ultimately what is changed goes beyond the physical. For many it changes their lives so much it…………… I can’t truly say what it does. It is beyond me and I am humble enough to tell you I may never understand the “spiritual” side to such a life changing experience. As a challenge for this year. Finish the sentence I started and couldn’t complete, tell someone of your own experience or take the opportunity to discuss starting your own adventure with bariatric surgery. Remember, it is a new year, but not another diet.

Yours Truly
David Kellenberger, RD, PA-C

Posted in Ask the dietitian

Support Groups

By admin on January 15, 2009 at 6:24 pm

Welcome to the NEW YEAR 2009 !

Our first support group this year will be:
Bypass/Sleeve Support group
Speaker: Jake Merrick -Personal Trainer

Getting Motivated to start your Exercise Program
Date: January 7th Wednesday night
Time: 6:30 pm
Location: Dr. Kim’s office 35 Veranda Lane Colleyville, Texas 76034
Phone: 817-581-6100

Lap Band Support Group:
Speaker: Jake Merrick -Personal Trainer
Getting Motivated to start your Exercise Program
Date: January 22nd Thursday night
Time: 6:30 pm
Location: Dr. Kim’s office 35 Veranda Lane Colleyville, Texas 76034
Phone: 817-581-6100

Posted in Uncategorized

Lunch with the Doctor

By admin on January 15, 2009 at 6:22 pm

In January Dr. Kim will start weekly informational classes on Fridays. He will discuss your surgical options answer your questions in an informal setting. He will offer a boxed lunch for your convenience because the session will be scheduled for 12:00 to 1:00 pm. You will have an opportunity to consult with Dr. Kim on a personal one on one basis after the session if you choose and as his schedule permits. Reserve a seat today by calling our office 817-581-6100.

We ask that you go to the home page on our website www.drdkim.net to download a medical history packet. Please complete and send to us prior to the session so that we can make your you are a good candidate for surgery and to verify that your insurance company cover the surgery. The “Lunch with the Doctor” is no charge.
The charge for your office visit will be your co-pay for a specialist office visit.

Posted in Uncategorized