Gastric Sleeve Surgery (Vertical Sleeve Gastrectomy or Vertical Gastrectomy)
Gastric sleeve surgery is used either by itself or as a first step in a two-step surgery. It has shown some very promising results as a stand-alone procedure, but some analysts remain skeptical.
- Could GS surgery be right for you?
- What’s the difference between GS and other bariatric surgery procedures?
- Results of Surgery including average weight lost and impact on co-morbidities
- Complications & Risks
- The Procedure (explanation and videos)
- Recovery
- Life after GS surgery
- Cost of Surgery
- Bariatric doctors specializing in GS
Could Gastric Sleeve Surgery Be Right for You?
For patients with a body mass index over 50, the gastric sleeve (GS) is sometimes used as a “first step” to get the weight down before moving forward with a more complicated procedure such as the duodenal switch or gastric bypass surgery. It has been performed on patients ranging from 12 to 79 years of age.
"As a stand-alone procedure, gastric sleeve surgery has been impressive..."
Other patients receive it as a stand-alone surgery because the risks presented by other procedures are just too high.
And as a stand-alone procedure, gastric sleeve surgery has been impressive…
- It is less expensive and has fewer complications than other types of bariatric surgery
- It appears to have similar weight loss results
- It appears to have a comparable impact on obesity health problems
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In addition, if you are on anticoagulation medication, compared with gastric bypass, gastric sleeve surgery is probably a better choice to reduce the risk of marginal ulcers.
So why doesn’t everyone try this bariatric surgery option first?
It has two big downsides…
- It’s not typically covered by insurance (yet), as it is still considered experimental because…
- There are limited long-term studies. As you’ll read further down the page, the short-term studies are numerous and extremely convincing. While there have been a few long-term studies to back them up, many surgeons and insurance companies still aren’t convinced.
If you don’t have insurance, you’re open to evaluating a surgery without a significant amount of long-term proof and/or you are extremely obese and may need a two-step procedure to reduce your risks, keep reading.
Otherwise, evaluate other types of bariatric surgery to find a better fit.
The Difference between the Gastric Sleeve and Other Bariatric Surgery Procedures
As mentioned above, gastric sleeve surgery is much less complicated than many other types of bariatric surgery…
- Your digestive system is not rearranged, unlike the duodenal switch, gastric bypass, or mini gastric bypass surgery.
- Also unlike these other surgeries, is primarily restrictive in nature (works by making you feel full sooner).
- There are no foreign objects implanted in your body as with the lap band.
As a result, the gastric sleeve may have fewer complications, including…
- A reduced risk of malnutrition or vitamin deficiency
- Avoiding dumping syndrome, among other side effects, compared to the malabsorptive procedures
- A reduced risk of long-term gastroesophageal reflux disease (GERD) compared to other restrictive procedures.
In addition, since such a large part of the stomach is removed, following gastric sleeve surgery you may have less of the hormones that make you feel hungry (for more on this, see our Obesity and Genetics page).
Finally, gastric sleeve surgery is often used as second option if lap band surgery doesn’t work.
The gastric sleeve also has a couple of negatives compared to some of the other bariatric surgery types…
- It is irreversible – once your stomach is shrunk there is no way to change it back to the original size (not necessarily a bad thing).
- The operation to reduce your stomach size creates a relatively long staple line which presents an increased risk of staple line leaks and bleeding.
The following studies directly compared gastric sleeve surgery to other forms of weight loss surgery. In support of the information we have already reviewed above, the studies suggest that…
- Weight loss could be as good as or better than gastric bypass and the duodenal switch and gastric sleeve surgery could be less risky.
- The feeling of hunger may be lower after GS than with the gastric band (lap band) or gastric bypass.
- More long-term research is needed to confirm that GS is effective as a stand-alone procedure.
- Gastroesophageal Reflux Disease (GERD) may be worse after GS than after gastric banding in 1 year following surgery, but the reverse may be true after 3 years.
| Summary of Findings When Comparing Gastric Sleeve Surgery to Other Procedures | Year of Study | |||
|---|---|---|---|---|
| References: A, B, C, D, E, F *For simplicity, all acronyms and procedure names have been changed to a common name (i.e. LAGB and Laparoscopic Adjustable Gastric Banding were changed to Lap Band Surgery). |
||||
| Laparoscopic
Gastric Bypass Surgery vs Gastric Sleeve |
||||
| PYY levels increased similarly after either procedure.
The markedly
reduced ghrelin levels in addition to increased PYY levels after
gastric sleeve,
are associated with greater appetite suppression and excess weight loss
compared with gastric bypass surgery.A (Editors’s note: both ghrelin and peptide YY effect appetite. See our Obesity and Genetics page for more details) |
2008 | |||
| Lap
Band Surgery vs Gastric Sleeve |
||||
| Weight loss and loss of feeling of hunger after 1 year and 3 years are better after gastric sleeve than lap band surgery. Gastroesophageal Reflux Disease (GERD) is more frequent at 1 year after gastric sleeve and at 3 years after lap band surgery. The number of re-operations is important in both groups, but the severity of complications appears higher in gastric sleeve.B | 2006 | |||
| Weight loss and loss of feeling of hunger after 1 year and 3 years are better after gastric sleeve than lap band. GERD is more frequent at 1 year after gastric sleeve and at 3 years after lap band. The number of re-operations is important in both groups, but the severity of complications appears higher in gastric sleeve.C | 2006 | |||
| Gastric sleeve may become the ideal operation for staging in patients with body mass index (BMI) >55, for treating morbidly obese patients with severe medical conditions, as an excellent alternative to adjustable bands in lower BMI patients, or for conversion of lap band patients.D | 2005 | |||
| Multiple Procedures vs Gastric
Sleeve |
||||
| The gastric sleeve operation is able to achieve significant weight loss comparable to the gastric bypass and duodenal switch operations but with the low morbidity profile similar to that of lap band placement.E | 2007 | |||
| Gastric sleeve has been highly effective for weight reduction for morbid obesity even as the sole bariatric operation. Gastric dilatation was found in only 1 patient in this short-term follow-up. Weight regain following gastric sleeve may require conversion to gastric bypass or duodenal switch. Follow-up will be necessary to evaluate long-term results.F | 2006 | |||
For further comparison of gastric sleeve surgery to other procedures, see our Types of Bariatric Surgery page.
Results of Surgery
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The two sections above reviewed many of the benefits and drawbacks of the gastric sleeve.
In addition to benefits we’ve already covered (better weight loss and reduced risks), the gastric sleeve has a significant positive impact on health risks associated with obesity, especially…
- Diabetes
- Hypertension (high blood pressure)
- Hyperlipidemia (high levels of fat in the blood)
We will get into the exact amount of weight loss you can expect in a bit.
"Gastric sleeve surgery could be one of the bariatric surgery waves of the future."
First, following are 7 studies that have shown the gastric sleeve to be effective. We discovered and included two studies that found similar results after 2 and 3 years, but more long-term research is needed (when reading below, remember that “laparoscopic sleeve gastrectomy” or LSG is another name for gastric sleeve surgery)…
| Summary of Findings | Year | ||
|---|---|---|---|
| References: G, H, I, J, K, L, M *For simplicity, all acronyms and procedure names have been changed to a common name (i.e. Laparoscopic Sleeve Gastrectomy or LSG was changed to gastric sleeve). |
|||
| Our data have shown that gastric sleeve is a highly effective and safe procedure for achieving weight loss, improving co-morbidities, and improving the quality of life in patients with type 2 diabetes mellitus and morbid obesity during a long-term period.G | 2009 | ||
| Gastric sleeve is reproducible and seems to be an effective treatment to achieve significant weight loss after 12 months follow-up. Gastric sleeve can be used as a standalone operation to obtain weight reduction. Management of postoperative gastric fistula remains a major issue.H | 2009 | ||
| Gastric sleeve is a feasible and safe treatment for super morbid obesity, but evaluation of long-term outcome is necessary to determine whether it is a durable procedure in terms of effectiveness. We expect that patients with a body mass index (BMI) of <50 are good candidates for gastric sleeve as a definitive treatment, and, if those with a BMI of ≥50 hope for further weight loss, a second-step procedure may be required.I | 2008 | ||
| The good early results obtained with the above-outlined surgical technique in 120 consecutive patients undergoing gastric sleeve indicate that it is a safe and effective procedure for morbid obesity. However, long-term results are still pending.J | 2008 | ||
| Laparoscopic gastric sleeve is a safe one-stage restrictive technique as a primary procedure for weight loss in the morbidly obese with an acceptable operative time, intraoperative blood loss, and perioperative complication rate.K | 2008 | ||
| Gastric sleeve is a safe and effective surgical procedure for the morbidly obese up to 2 years. Excess body weight loss seems to be acceptable at 2 years postoperatively.L | 2008 | ||
| Gastric sleeve is a rapid and less traumatic operation, which thus far is showing good resolution of comorbidities and good weight loss if a narrower channel is constructed than for the duodenal switch. There are potential intraoperative complications, which must be recognized and treated promptly. Like other bariatric operations, there are variations in the technique used. The gastric sleeve is being performed for superobese and high-risk patients, but its indications have been increasing. A second-stage bariatric operation may be performed if necessary, with increased safety. Long-term results of gastric sleeve and further networking are anxiously awaited.M | 2007 | ||
So it appears that the gastric sleeve as a stand-alone procedure could be one of the bariatric surgery waves of the future. But exactly how much weight can you expect to lose?
Within the first year, patients in the following studies lost as little as 33% and as much as 70% of their excess weight. Over the longer term (up to 3 years), the excess weight lost was between 64% and 75%…
| Studies | # of GS Patients in Study | Weight Loss (% of Excess Weight Lost at...) |
Year |
|---|---|---|---|
| References: N, O, P, Q, R | |||
| Study N | 23 | 3 Years – 74.58% | 2009 |
| Study O | 135 | 6 months – 38.6% 1 Year – 49.4% |
2009 |
| Study P | 16 | 6 months – 55.5% 1 Year – 69.7% |
2008 |
| Study Q | 130 | 3 months – 33.1% 6 months – 50.8% 1 Year – 62.2% 18 months – 64.4% 2 Years – 67.9% |
2008 |
| Study R | 80 | 1 Year - 57.7% 3 Years - 66% |
2006 |
Complications & Risks of Gastric Sleeve Surgery
The relatively simple gastric sleeve procedure results in an extremely low mortality rate (0.19% on average)1. However, complications can arise especially in higher-risk patients.
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The most common serious complications include (see our Bariatric Surgery Complications page for more information about each)…
- Bleeding – 1.2% of patients
- Leaks – 2.2% of patients
- Stenosis/Strictures - 0.6% of patients1
Gastroesophageal reflux disease (GERD) is a common minor complication, with about 1 out of 5 patients experiencing it after 1 year. However, the prevalence of GERD plummets to about 3% after three years.2
Following are the mortality and complication rates from 7 separate studies (click here to skip past chart)…
| Studies | # of GS Patients in Study | Mortality/Complication Rate | Year |
|---|---|---|---|
| References: S, T, U, V, W, X, Y | |||
| Study S | 135 | Mortality - 0% Complication - 5.1% (all gastric fistula (PGF)) |
2009 |
| Study T | 261 | Mortality - 0.7% Complication - 8.4% |
2009 |
| Study U | 120 | Mortality - 0% Complication - 0% |
2008 |
| Study V | 148 | Major complications: 2.7% | 2008 |
| Study W | 53 | Complication - 9.4% | 2008 |
| Study X | 118 | Mortality - 0.85% Complication - 15.3% |
2007 |
| Study Y | 216 | Mortality - 0% Complication - 6.3% |
2007 |
In many cases, the patient is completely to blame for complications. Properly educating yourself and your family and following through on that education is key to lowering your risks after surgery.
See our Bariatric Surgery Complications page to learn what you need to do to succeed over the long run.
When deciding whether the complication and mortality risks associated with surgery are “worth it”, it’s smart to evaluate the risks associated with not having surgery. See our Life After Weight Loss Surgery, Obesity Health Problems and Cause and Effect of Obesity pages for more on this.
The Gastric Sleeve Surgery Procedure
The gastric sleeve surgery procedure is mainly restrictive in nature, meaning that it works by making you feel full sooner than before the surgery. It can usually be performed laparoscopically and takes between one and two hours on average.
To perform the operation, the bariatric surgeon will remove the fundus (the part of the stomach to the left and above the level of the opening of the esophagus3) along with most of the stomach. The 10-20% of the banana-shaped stomach that remains continues to connect the esophagus to the top of the small intestines exactly the way it did before surgery.
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The average hospital stay following surgery is two to three days. The following is a computer animated explanation of the surgery followed by a video of the actual procedure being performed…
Computer Animated Video Explaining Gastric Sleeve Surgery
(click here to skip past video of actual procedure being performed)
Video of Actual Gastric Sleeve Surgery Being Performed
Recovery following Gastric Sleeve Surgery
Your doctors will run a number of checks before releasing you from the hospital, including a check to make sure there are no postoperative staple line leaks. They’ll also want to make sure that your wounds are healing properly and will want to get you started on your transitional diet as soon as possible.
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Your new stomach will be sensitive, especially at first, so you’ll be on a liquid diet for a couple of weeks before slowly transitioning back to solid foods.
After you leave the hospital, you should have a follow up visit one week later then every few months thereafter to make sure everything is progressing the way it should. Malabsorption is much less likely than with other procedures, but your nutritionist or dietician will still want to monitor you to make sure you’re getting the bariatric vitamins you need, especially B12.
It may be possible to return to work within a couple of weeks, but you should plan on two to four weeks just to play it safe.
Life After Gastric Sleeve Surgery
As we’ve reviewed, the gastric sleeve is one of the least complex forms of bariatric surgery and has some of the lowest mortality and complication rates.
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You may experience a few of the same issues as you would after other weight loss surgeries such as diarrhea, constipation or difficulty swallowing. Since your stomach is bigger than the gastric bypass pouch and maintains the connection between the stomach and small intestine that is lost after the gastric bypass, these issues should be less prevalent.
Our Life after Weight Loss Surgery page explains the dramatic changes experienced after all types of bariatric surgery, and it will cover what you need to know about life after gastric sleeve surgery. However, do keep one caveat in mind:
While many surgeons and researchers believe in this surgery and evidence supporting it is mounting, more long-term research is needed to better understand how life will be impacted from 3 years after surgery and beyond.
Our Bariatric Diet section explores how and what you should eat following surgery along with long-term dietary changes.
Gastric Sleeve Surgery Cost
The cost of gastric sleeve surgery in the United States ranges anywhere from $10,000 to $20,000.
As a stand-alone procedure, many insurance companies don’t cover gastric sleeve surgery because they still consider it experimental. However, insurance companies are beginning to change their stance.
Following are the insurance companies that may agree to cover the sleeve (assuming you already have insurance through them)…
- Aetna, Inc.
- Blue Cross and Blue Shield Federal Employee Plan (FEP)
- Note: One of our visitors was unable to get the sleeve approved by this plan. See her Federal Blue Cross Blue Shield Denied My Gastric Sleeve Surgery page for the details.
- Oxford Health Insurance from United Healthcare Network
- United Healthcare
Even if you’re not covered by one of these plans, it’s still worth checking with your insurance company. For example, some Blue Cross/Blue Shield organizations throughout the U.S. will cover gastric sleeve surgery in certain high-risk patients such as those with a BMI over 50 or 60 or patients who have serious co-morbidities.
We expect more insurance companies to start adding gastric sleeve surgery to their policies soon and will update you as they do. (Sign up for the Bariatric Surgery Blog (RSS feed) or The Bariatric Examiner free monthly newsletter to be notified).
See one of the following pages for more information about paying for surgery…
- Financing bariatric surgery
- Bariatric surgery insurance ( including VBG, DS, gastric bypass, gastric sleeve and lap band insurance )
- Bariatric surgery in Mexico or abroad
Bariatric doctors specializing in Gastric Sleeve Surgery
While it is starting to look like gastric sleeve surgery will be one of the primary bariatric procedures of the future, there is just no way to be certain until more research is in.
To play it safe, when searching for a bariatric surgeon to perform gastric sleeve surgery you should find a surgeon who is proficient in “second step” procedures that typically follow GS… namely the duodenal switch or gastric bypass.
See our Bariatric Doctors page to learn how to find, interview and choose the best surgeon.
In addition to the methods we recommend on that page, you can also search for surgeons in your area using our directory of bariatric surgeons (includes all surgeons designated as Centers of Excellence as well as recommedations from other visitors):
For additional research, search for your topic of interest...
Back to Bariatric Surgery Source Home Page from Gastric Sleeve Surgery
References
- Varela JE, et al. Correlations between intra-abdominal pressure and obesity-related co-morbidities. Surgery for Obesity and Related Diseases 5 (2009) 524–528.
- Himpens J, Dapri G, Cadiere GB. A Prospective Randomized Study Between Laparoscopic Gastric Banding and Laparoscopic Isolated Sleeve Gastrectomy: Results after 1 and 3 Years. Obesity Surgery Vol 16, No 11 / Nov 2006 pgs 1450-6.
- Fundus definition from The Free Dictionary available at: http://thefreedictionarycom.ourtoolbar.com/.
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