Lap Sleeve Gastrectomy

Lap Sleeve Gastrectomy (a.k.a. vertical sleeve gastrectomy or Lap VSG) is a relatively new, primarily restrictive weight loss surgery. Lap VSG involves removing the majority of your stomach to make it smaller without re-routing any of the intestines. Food passes through the stomach and your intestines in the "normal" fashion.

During the operation we make a smaller, thinner stomach using standard surgical staplers. We keep the inner curve of the stomach, also called the "lesser curve" while the remainder, roughly 80% of the stomach, is removed through a 1.5 cm laparoscopic incision. At rest, the diameter of the new stomach is about the size of a quarter.

How does Lap VSG work?

After Lap VSG, patients generally feel less hungry and are satisfied with a small meal. Like all weight loss surgeries, the exact mechanism of how this happens isn't completely understood. Some of it is simply due to having a smaller stomach. However, this is clearly not the only reason behind the weight loss. Despite having a larger pouch compared to laparoscopic gastric banding, patients lose more weight faster after Lap VSG than after gastric banding. Some scientists and surgeons think that removing the majority of the stomach changes GI tract hormones causing some of the weight loss.

Weight Loss after Lap VSG

Multiple studies have shown weight loss after Lap VSG is better and faster than after laparoscopic adjustable gastric banding. Some reported results at 3 years after surgery are comparable to laparoscopic gastric bypass. Most surgeons agree that weight loss after Lap VSG appears to be significantly more than after adjustable gastric banding but slightly less than after laparoscopic gastric bypass. We anticipate average weight loss of between 65 and 75% of excess body weight at 2 to 3 years after Lap VSG, based on our experience with weight loss surgery and current reports of Lap VSG patients. However, Lap VSG is a relatively new weight loss surgery and there are no reported studies where patients have been followed for more than 5 years after their surgery.

Eating after Surgery

Lap VSG changes the way you eat. It generally helps to plan for these changes prior to surgery. Most patients will be on clear liquids for the first week after surgery, then full liquids and pureed diet for an additional 2 weeks after the operation. After 3 weeks, you can begin to eat soft solid foods. After 4 weeks, you may resume regular consistency, with 3 or 4 small meals per day. You will not be able to eat as much as you did before the surgery but generally can eat all the same foods as before. After Lap VSG, permanent changes in your eating habits will lead to the most successful weight loss.

Lap VSG: inpatient or outpatient surgery?

To reduce the cost of Lap VSG, some surgeons perform the operation as outpatient surgery in their own private surgery center. Patients are discharged to home or a hotel, sometimes with a private nurse, then seen the next day in the clinic with an outpatient upper GI study. We do not recommend this approach.

Like most bariatric surgeons in the United States, we recommend laparoscopic sleeve gastrectomy as an inpatient procedure with an overnight stay in the hospital or an accredited surgery center. This allows our patients to get IV fluid overnight and prevent dehydration, to get IV pain and anti-nausea medicines if needed for comfort, to obtain an upper GI study the day after surgery prior to drinking any fluids, and minimizes the risks of complications. Although serious complications are infrequent after Lap VSG, when they do happen it usually is in the first 24 hours after surgery. We feel that it is safest to have our patients under close observation by medical professionals who can recognize and help prevent complications.

We recommend that Lap VSG be done as an inpatient procedure with an overnight stay in a hospital or an accredited surgery center.
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Pros and Cons of Lap VSG Advantages of Lap VSG include:

Compared to gastric banding, there is no permanent foreign body, no subcutaneous port, and no need for adjustments with a bariatric surgeon.
Compared to laparoscopic gastric bypass, there is no re-routing of the intestines, no "dumping" and less risk of ulcers or bowel obstruction.

Disadvantages of Lap VSG include:

There is no long-term experience with Lap VSG. We can't be certain about the long term results.

Other things to keep in mind include:

Lap VSG is being covered more frequently by health insurance: Up until recently, most health plans considered Lap VSG as an "experimental" procedure and did not cover it, even if they covered other weight loss procedures. This appears to be changing. As of May 2010, major insurance plans covering Lap VSG included CIGNA, Aetna, and United Health.
Lap VSG isn't reversible: We remove part of the stomach during the operation so you cant "undo" the gastrectomy. However, there really isn't a good reason that you would want to reverse the operation.
Pregnancy is safe after Lap VSG: The major concern regarding pregnancy after weight loss surgery is folic acid deficiency that increases the risk for neural tube defects like spina bifida. This can occur after any type of weight loss surgery or even on a low carbohydrate Atkins diet if a woman isn't taking vitamins.
Vitamins requirements are no different than most people take: After Lap VSG patients take a multivitamin for the rest of their life. We also recommend calcium supplements for everyone. Some patients, primarily young women still having monthly periods, take iron supplements. This is no different than most recommendations for patients who have not had weight loss surgery. The only extra vitamin requirement may be a B-12 supplement.