Laparoscopic Vertical Sleeve Gastrectomy

A Restrictive Procedure

How is it done?

Graphic depiction of the vertical sleeve gastrectomyVertical sleeve gastrectomy, also known as parietal gastrectomy or just Sleeve gastrectomy consists of an operation that aims, if performed alone, to be restrictive in nature. It is performed by laparoscopy and consists of the restrictive portion of the biliopancreatic diversion +/- duodenal switch bariatric surgical procedure (BPD/DS). The VSG procedure is often utilized as a first-stage bariatric procedure to reduce surgical risk in high-risk patients by induction of weight loss and this may be its most useful application at the present time (BMI > 60 kg/m2). During this procedure, the surgeon creates a small, banana-shaped stomach by removing about 85% of the stomach as shown at left. The sleeve is larger than the gastric pouch created during Roux-en-Y Gastric Bypass. The actual surgery takes about 50 minutes. Weight loss following sleeve gastrectomy results from eating less because of the much smaller stomach. Removing the part of the stomach that produces the hunger hormone (ghrelin) or some other unidentified factor(s) also contributes to the weight loss. Weight regain due to noncompliance of mandatory behavioural changes or a desire for more weight loss in very obese patients may require additional surgery in 1-2 years time, such as gastric bypass or biliopancreatic diversion with duodenal switch.

What Are the Benefits?

According to the American Society for Metabolic and Bariatric Surgery, patients after VSG lose 50-60% of their extra weight in the first 2 years after the surgery*. Disclaimer: Individual results may vary. Unlike the gastric bypass or BPD/DS that have excellent weight loss results after 20+ years of follow-up, there is no data on weight loss with VSG alone beyond 9 years. Studies are ongoing. Your results may vary! More recent research shows that VSG is a viable alternative for those patients who feel the gastric bypass is “too much” surgery and the Lap Band is not for them due to long term failures and complications. Studies are ongoing. In addition to this weight loss, if you have any of these conditions, they will improve or resolve after the surgery:
  • Type 2 Diabetes
  • High blood pressure
  • Sleep apnea
  • Abnormal lipids/cholesterol
  • Asthma
  • Low back pain
  • Weight-bearing arthritis of the hips, knees, ankles, and feet
  • Skin fold dermatitis
  • Urinary stress incontinence
  • Acid reflux
  • Metabolic Syndrome
Finally, the health benefits gained with weight loss surgery can reduce your risk of death.

What are the Risks?

The worst that can happen is that you die from the operation. Please note that the death rate while waiting to have bariatric surgery is higher than the risk of the surgery itself! The chance of dying in the first 30 days of surgery (this is how medicine defines a “surgical death”) depends on your body mass index (BMI), your sex, the number and type of obesity associated health conditions that you have, and the experience of the bariatric surgeon and the bariatric team.

General Risks

  • Because you eat less food than normal and thus you consume less vitamins, minerals and iron, deficiencies in these essential substances may occur. Lack of calcium has caused metabolic bone disease in some patients, resulting in bone pain, loss of height, humped back and fractures of the ribs and hipbones. Women, already at risk for osteoporosis that can occur after menopause, should be aware of the potential for heightened bone calcium loss.
  • A chronic anemia due to vitamin B12 deficiency may occur.
  • All of the deficiencies mentioned above, however, can be managed through proper diet and vitamin supplements.
  • Lack of adequate weight loss and the potential need for subsequent conversion to another procedure is a likely to require additional surgery.

Specific risks based on our team’s personal experience with laparoscopic vertical sleeve gastrectomy at our private hospital.

Short Term (within 30 days of Surgery)
Death* 0%
Minor bleeding 1.5%
Liver/spleen laceration 1.4%
Staple line leak 3.2%
Site of specimen extraction infection 0.9%
Deep vein thrombosis 0.2%
*selected cases with BMI<69, ASA<4, OSMRS<4
Long Term (for the rest of your life)
Stricture of the stomach 2.0%
Stomach pouch ulcers (peptic ulcers) 1.4%
Hernia at the port sites (small holes used for the surgery) 0.8%
Formation of gallbladder stones (10 years) 17.3%
Need for additional surgery ?
Vitamin/mineral deficiencies 1%
Anemia 5%

What are the situations where this surgery should not be done?

  • Complex medical conditions:
    • Cardiac: severe heart failure, unstable coronary artery disease
    • Pulmonary: end stage lung disease
    • Hepatic: portal hypertension
  • Active cancer
  • Extremely limited mobility
  • Untreated psychiatric disorders, substance abuse including alcohol, or narcotic dependency
  • Genetic disorders e.g. Prader-Willi Syndrome
  • Untreated endocrine disorders e.g. Cushing’s Syndrome
  • Psychological instability
    • Inability to cope with the changes in diet and life modification after surgery
    • Refusal to be assessed by psychologist or psychiatrist