Gastric Sleeve Procedure
Gastric Sleeve procedure (Sleeve Gastrectomy) is the newest of the procedures which are widely covered by insurance in NJ. It has several synonyms: “The Sleeve”, “Vertical Sleeve Gastrectomy (VSG)”, or “Laparoscopic Vertical Sleeve Gastrectomy” (LVSG). It was first approved for coverage in NJ in 2009. The gastric sleeve surgery procedure has been performed in other parts of the US for as long as 10 years. The procedure can be performed as a same day, ambulatory surgery or have an overnight stay. Recovery to normal activity is rapid in most patients.
Gastric Sleeve surgery involves cutting the stomach from bottom to top and removing 75-80% of the stomach. The part which is removed is the flexible area. The banana shaped remainder, or “sleeve” is stiff and inflexible. This leads to a much smaller food capacity. A second effect occurs during the cutting process. When the upper stomach is cut, the appetite is affected and most patients lose their appetite for 2-3 months after surgery. The muscle at the bottom of the stomach is preserved and regulates how quickly the remaining stomach will empty.
The gastric sleeve procedure offers some benefits which are unique to certain groups. Patients who require daily medications which are known to commonly lead to ulceration or bleeding may be best served by this operation. Steroids, non-steroidal anti-inflammatory medications, methotrexate, penicillamine and anticoagulants may all complicate the post-operative surgical course after lap band or gastric bypass surgery. Because the gastric sleeve does not slow the medication from passing through the stomach, or divert its usual route through the intestinal tract, it may help to minimize the known side effects and complications associated with these medicines. The above mentioned medications are only a few of many medications which may have unintended changes in their effect, or associated complications after the current bariatric surgery procedures.
Most of this group of medications is used to control disease states that are NOT associated with obesity, or improved with weight loss. Their use does not end after weight loss occurs. Auto immune diseases like Rheumatoid Arthritis, Systemic lupus erythematosis and sarcoidosis will all likely require lifelong use of these medications. Atrial fibrillation, coronary artery stents, peripheral vascular disorders, stroke and blood clotting disorders will require continued use of blood thinners. The doses of these medications are affected by the absorption of fat soluble vitamins. Absorption of these vitamins can be greatly affected by other bariatric surgery procedures. After gastric bypass, bleeding from stomach or intestinal ulceration post operatively may become severe because of the blood thinner medications. Pre-surgical history of iron, calcium or other vitamin deficiencies may also make the gastric sleeve the preferred choice.
Examples of other circumstances where our surgeons may recommend the gastric sleeve procedure as a “safer” alternative include high risk bowel surgery patients with prior history of inflammatory diseases of the bowel (Crohn’s disease, sprue, etc…), prior colectomy, or large amounts of abdominal adhesion’s (history of trauma, or multiple operations). Patients who require other non-bariatric operations will be significantly more successful and less complicated after significant pre surgical weight loss. Examples include recurrent hernias of the abdominal wall affected by weight, joint (hip or knee) replacements, spine, or organ transplant surgery. Patient age is also a consideration. Adolescent patients may prefer gastric sleeve surgery due to the non-involvement of the intestine and capacity for future revision if needed. Patients over age 65 find reduced difficulties with post-operative recovery. The sleeve gastrectomy has also been used in patients who have had prior gastric operations. Failed lap band surgery and prior anti reflux operations (Nissen or Toupet fundoplications) are two notable examples.
The operation is not without its own risk. There is a very long staple line which must heal properly. This area can be associated with leaks or narrowed areas like any other weight loss surgery. Non-compliant behavior after surgery can lead to severe problems as in any bariatric procedure. The difference between the Gastric Sleeve procedure and other surgeries is that once this staple line area heals, it is not likely to cause future problems. Stomach ulceration, bleeding and medication related healing issues do not occur after the initial healing has been completed.
If you would like more information on the gastric sleeve procedure or would like to schedule a consultation, call us at 973-437-8700