Sleeve Gastrectomy
The Gastric Sleeve operation (technically called the “Vertical Sleeve Gastrectomy”) is an appealing new procedure that seems to combine the reliable weight loss and low maintenance of the gastric bypass with the simplicity of gastric banding.
The Gastric Sleeve was originally derived from a more complex procedure called the Biliopancreatic Diversion with Duodenal Switch (BPD-DS). Surgeons who planned to perform a BPD-DS on some of their very high-risk patients chose to perform the part of the operation consisting of stomach removal as a first stage, and they planned to return 1-2 years later to complete the operation. Those surgeons observed that many patients who had the large reservoir capacity of the stomach removed had excellent sustained weight loss, and the idea of the gastric sleeve as a “standalone” procedure came into being.
About the Gastric Sleeve Operation
In the Gastric Sleeve procedure, the surgeon uses a surgical stapling device to remove the large reservoir section of the stomach called the greater curve. When completed, the operation leaves a narrow tubular section of stomach to carry food into the intestine, which is not disturbed. Folks are sometimes confused that the "sleeve" part of the name means that something is wrapped around the stomach to give it a tubular shape, but in fact there is no wrapping material and the name comes from the tubular shape of the newly reduced stomach.
The long tubular stomach fills easily with small amounts of food, so that patients find it is easy to eat small amounts of food and feel fully satisfied. With much smaller eating, patients lose substantial weight. Weight loss appears to be almost as brisk as the Gastric Bypass, but not as much weight loss on average.
The Gastric Sleeve is appealing because the surgery does not involve moving intestines from one place to another like the Gastric Bypass. The Sleeve surgery does not create any changes in nutrient absorption, though New Dimensions recommends supplements and lab follow up because of the dramatically lower food intake.
The Sleeve is also appealing in comparison to the Gastric Band, because there is no plastic belt in the body and because there is not any requirement for frequent follow up and Band adjustment.
The Sleeve was originally conceived as a simple operation for very high risk patients, but it is also gaining acceptance as an operation for patients on the lighter end of the weight scale, even down to a BMI of 30. The Sleeve is commonly utilized as a conversion procedure in cases where the gastric band is not working, and in our experience patients who change from the Band to a gastric sleeve are usually very satisfied with the change.
Risks of the Gastric Sleeve
During the surgery, the surgeon creates a long tubular stomach pouch. The entire side of that pouch is a staple line or “seam” which can potentially leak or bleed. It is also possible for the narrow pouch to kink or fold, or become blocked in some other way because it is quite narrow.
It remains possible that, over the years, the narrow tubular stomach pouch may expand and the patient’s food capacity may return. Initial research results are encouraging, but the fact is that the real long term outcome of the Gastric Sleeve weight loss will not be known until 2015 or later.
Other issues
Until recently, patient access to the Sleeve was low because insurance companies usually did not recognize this relatively new surgical procedure. In September 2009, United Healthcare in our area became one of the first to recognize the Sleeve as a valid procedure that should be covered as a medically necessary procedure. Likewise, Blue Cross began coverage in October 2009. We are very hopeful that other health insurers will follow this example so that all of our patients can make their procedure choice on medical grounds instead of having some options eliminated by lack of coverage.