Vertical Sleeve Gastrectomy

Vertical Sleeve Gastrectomy – also known as Sleeve Gastrectomy – is a purely restrictive procedure. The procedure consists of surgical removal of the majority of the stomach, leaving behind a narrow tubular stomach of 2-3 oz. in volume.

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Weight loss with Vertical Sleeve Gastrectomy is more than just the result of having a smaller stomach. Limiting food intake with Vertical Sleeve Gastrectomy has as much to do with how the volume is decreased, how the stomach responds to stretching, how the hunger-signaling capacity of the stomach is altered, and how patients respond to the unique nature of this restriction.

With Vertical Sleeve Gastrectomy, restriction is achieved by reducing the volume of the stomach along its entire length. It is not a matter of having food pass through a point of obstruction (like an adjustable gastric band or gastroplasty) only to reach a large stomach reservoir downstream. Rather, food passes through a relatively normal stomach inlet and then has no room downstream for much to accumulate. The pylorus – a muscular valve found at the downstream end of the stomach – regulates the emptying of the stomach, and until it releases the stomach to empty, the ingested food has no place to go.

Part of what gives us that “full feeling” after we eat is the effect that stretching has on the stomach. Stretch receptors in the stomach signal the brain as the stomach fills up and stretches out. These receptors are especially numerous in the downstream portion of the stomach known as the antrum. With the Vertical Sleeve Gastrectomy configuration food is essentially funneled to the downstream stomach, making the antrum stretch sooner than it normally would otherwise. This sends a strong signal to the brain resulting in a feeling of fullness.

Another factor regulating appetite is a chemical signal known as ghrelin. This is a “hunger hormone”, and the stomach produces a major share of the ghrelin found in the body. Much of this is produced in the portion of the stomach that is removed during the procedure, and this removal of ghrelin producing tissue has an effect on suppressing appetite as well.

These factors all come together in how the patient experiences eating after a Vertical Sleeve Gastrectomy procedure. The patient eats through an essentially normal stomach inlet, and swallows into a stomach reduced in volume along its entire length. This results in fairly free eating with a modest amount of restriction. The food is held in the stomach by the pyloric stomach valve, and the stomach empties relatively normally when it does. In following patients who have undergone Vertical Sleeve Gastrectomy, the common experience seems to be having the ability to eat a broad variety of types of food – including dense proteins – but in significantly reduced volumes. Patients are able to eat a wide variety of foods in reduced volumes, without having to resort to the temptation of the soft-calorie syndrome. This combination of the ability to eat food of high quality but of low quantity creates a mix of ingredients for healthy dietary restriction.

Vertical/Sleeve Gastrectomy: Risk

The possible complications of VerticalSleeve Gastrectomy are the same of other major bariatric procedures. Leak, infection, blood clots in the leg or lungs, bleeding, pneumonia and death can all occur. As with any surgery, risk is a combination of the severity of the procedure and the underlying health of the patient.