Vertical Sleeve Gastrectomy

The Vertical Sleeve Gastrectomy procedure (also known as Sleeve Gastrectomy, Vertical Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction, and even Vertical Gastroplasty) is done by roughly 20 surgeons globally.  The earliest techniques of this practice were performed by Dr. Jamieson in Australia (Long Vertical Gastroplasty, Obesity Surgery 1993)- and  by Dr. Johnston in England in 1996 (Magenstrasse and Mill operation- Obesity Surgery 2003). Dr Gagner from New York, improved the procedure to include the removal of the stomach (gastroectomy) and made it available to patients with high risk in 2001.  A few more surgeons worldwide have taken on the procedure and made it available to low risk patients and low BMI as an option to laparoscopic stomach banding.

Vertical Gastrectomy: How it Works

This procedure produces weight loss only by gastric restriction (decreased stomach volume). The stomach is restricted by splitting it vertically and taking out greater than 85% of it which is an irreversible phase. The stomach that remains appears to resemble a banana and measures from 1-2 ounces (40-60cc) depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact for the purpose of safeguarding the stomach function while decreasing the fullness. By comparison, in a Roux-en-Y gastric bypass, the stomach is split, not removed, and the pylorus is omitted. The Roux-en-Y gastric bypass stomach is reversible, if necessary. Note this procedure has only a stomach reduction, not a intestinal bypass.

Advantages

The volume of the stomach is reduced but typically operates the same so many foods are able to be consumed, although in small amounts.
Takes out the stomach area that makes the hormones that activates hunger(Ghrelin).
No dumping syndrome because the pylorus is preserved.
Decreases the risk of an ulcer happening.
The risk of intestinal blockage (obstruction) is virtually none since the procedure avoids the intestinal bypass, so anemia, osteoporosis, protein deficiency and vitamin deficiency are not a factor.
Extremely effective as a primary phase procedure for high BMI patients (BMI>55 kg/m2).
Of the few low BMI patients (BMI 35-45 kg/m2) results appear to be positive as a single phase procedure.
Attractive choice for patients with existing anemia, Crohn's disease and many other conditions that make them very high risk for intestinal bypass procedures.
Can be performed laparoscopically in patients who weigh greater than 500 pounds.

Disadvantages

Possibilities for insufficient weight loss or regaining the weight. This is true for all procedures, however, the possibility increases more with procedures that do not involve intestinal bypass.
High BMI patients are more probable to have a second stage procedure later to help lose more weight. Two stages may in the final analysis be the safest and most effective way to go for high BMI patients.
Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow down any weight loss.
This procedure has stomach stapling and which makes leaks and other difficulties associated to stapling may happen.
Due to the stomach being taken out, it is irreversible. It can be changed to basically any other weight loss procedure.