Monday, July 7, 2014

What is Vertical Sleeve Gastrectomy (VSG)

The Vertical Sleeve Gastrectomy, also known as Sleeve Gastrectomy or Vertical Gastrectomy,  generates weight loss by restricting the amount of food (and therefore calories) that can be eaten by removing 85% or more of the stomach without bypassing the intestines or causing any gastrointestinal malabsorption.  It is a purely restrictive operation.

This procedure generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from 1-5 ounces (30-150cc), depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume.

Frequently Asked Questions

How big will my stomach be after surgery?
The size of your stomach will vary depending on the surgeon. All surgeons use a tube to guide them when stapling the stomach. This tube size can vary from 1-2 ounces to as large as 6-8 ounces. This is a very important question to ask when considering this surgery, since those patients with larger pouches may have less weight loss.

Is removing the stomach safe?
This type of stomach removal has been performed with the Duodenal Switch procedure since the mid 1980’s.  It does involve stapling, just like in the gastric bypass and has similar risks. Interestingly, patients do not ever return asking for their stomach back but many do wonder if it is possible to reduce the size of it again. 
Will I need to take vitamins?
Vitamin deficiencies are rare with this procedure because there is no intestinal bypass. However, the procedure is very restrictive so most surgeons recommend that patients take a multivitamin, calcium and possibly a B12 vitamin after surgery.
Will I regain weight?
All patients undergoing weight loss surgery are at risk for weight regain. None of the operations can prevent this. Those patients who maintain good dietary habits and exercise patterns are more likely to keep the weight off than those who do not exercise and who snack frequently.
What will my diet be like after surgery?
The diet will progress over the first year. It usually starts with 2-4 weeks of liquid protein drinks and water.  Patients gradually progress to thicker food items and by two months are able to eat seafood, eggs, cheese and other regular foods. The diet generally recommended is low calorie (500 per day), high protein (70gm per day), low fat (30 gm per day) and low carbohydrates (40 gm per day). The calorie intake increases over the first year and by 12 months many patients have achieved their goal weight and consume between 900 and 1500 calories per day. This final calorie intake depends on level of activity, age and gender(men can usually consume more calories and maintain their weight).