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Dr. David Kim Kim Bariatric Institute

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

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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