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Laparoscopic Vertical Sleeve Gastrectomy

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The “lap sleeve” also known as the “VSG” or laparoscopic vertical sleeve gastrectomy is a relatively new 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 type 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.

The procedure involves resecting or 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 procedure 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 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 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 sleeve with the gastric bypass and the lap band.

	Lap Sleeve	Gastric Bypass	Lap Band
Expected weight-loss at 3 years	60-70%	70-80%	50-60%
Need for foreign body	None	None	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 sleeve gastrectomy 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