Gastric Sleeve SurgeryGastric Sleeve Surgey

The Gastric Sleeve Surgery which is also known as Lap Sleeve, VSG, Laparoscopic Vertical Sleeve Gastrectomy and/or Gastric Sleeve Gastrectomy, is a relatively new surgical weight loss procedure. The procedure was originally intended for a two step procedure in patients that were so obese that conventional procedures such as the bypass and duodenal switch were too risky. The initial results for these types of patients were quite promising in the initial phase and led investigators to wonder what the results of this procedure would be in patients who were not as obese.

Gastric Sleeve Surgery involves removing approximately 80% of the stomach. This is accomplished by using a surgical stapler and a sizing tube which leaves the stomach as the shape of a slender banana. The procedure works by primarily providing restriction. The advantage of this type of weight loss surgery is that the restriction is not as dramatic as seen in the lap band or the gastric bypass. In addition, some of the pioneers in this procedure believe that there are some metabolic advantages with the lap sleeve. These thoughts are based on significantly improved control of diabetes and hypertension without a proportionally significant amount of weight loss.

The perceived advantages of Gastric Sleeve Surgery over the Lap Band include:

  • Chemical hunger suppression
  • No foreign body
  • No adjustments
  • Easier follow-up
  • Can eat more “natural” portions
  • No long term risks related to a foreign body such as malfunction, erosion and slippage
  • Reported better weight loss and diabetes improvement

The perceived advantages of Lap Sleeve over the Gastric Bypass include:

  • No stapling of intestine
  • No dumping syndrome
  • Can eat more “natural” portions
  • Less nutritional concerns

The chart below compares the Gastric Sleeve with the Gastric Bypass and the Lap Band:

Gastric Sleeve Gastric Bypass Lap Band
Expected weight-loss at 3 years 60-70% 70-80% 50-60%
Need for foreign body None one Yes, band and port
Need for adjustments No No Yes
Stomach size after surgery 200-300 cc 30-60 cc 30-60 cc
Number of years studied <5 years >25 years <10 years in the USA
Reversibility Never Somewhat Yes
Cost $13,500 to $18,000 $18,500-$25,000 $12,000 to $13,500
Insurance Coverage Rare Routine Routine
Hunger Suppression Chemically Chemically Mechanically
Metabolic Benefit Some Significant None
Risk of leak <5% <2% <1%

The risks of Gastric Sleeve Surgery include:

  • Relatively new procedure with no long-term results
  • Most insurance companies do not cover it yet but this is subject to change in 2010
  • Need for B12 supplementation
  • Chronic nausea and vomiting
  • 100% irreversible

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