• Vertical Sleeve Gastrectomy—Open

    (Sleeve Gastrectomy—Open; VSG—Open)

    Definition

    Vertical sleeve gastrectomy (VSG) is a surgery to decrease the size of the stomach.
    The Stomach
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    This surgery involves re-shaping the stomach to reduce the amount of food it can hold.
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Body mass index (BMI) determines if a person is overweight or obese. A normal BMI is 18.5-25. This surgery is an option for people with:
    • BMI greater than 40
    • BMI 35-39.9 and a life-threatening condition or severe physical limitations that affect employment, mobility, and family life
    If lifestyle changes are made, the benefits of VSG include:
    • Weight reduction
    • Improvement in obesity-related conditions
    • Improved mobility and stamina
    • Enhanced mood and self-esteem

    Possible Complications

    Complications are rare. But no procedure is completely free of risk. Complications may include:
    • Stitches or staples may loosen
    • Pouch stretches or leaks
    • Bleeding
    • Infection
    • Reaction to anesthesia
    • Heart attack
    • Blood clots
    • Nausea, vomiting
    Long-term complications include vomiting and gallstones .
    Factors that may increase the risk of complications include:
    • Smoking
    • Recent or chronic illness (eg, kidney, heart, or lung disease)
    • Diabetes
    • Old age
    • Bleeding or clotting disorders
    Discuss risks with your doctor.

    What to Expect

    Prior to Procedure

    You may have the following done:
    • Physical exam and review of medical history
    • Blood test and other tests to check your health
    • Attempts to lose weight (about 10%) through medically-approved diets
    • Meetings with a registered dietitian
    • Mental health test and counseling
    Prior to the procedure:
      Talk to your doctor about your medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:
      • Aspirin or other anti-inflammatory drugs
      • Blood thinners
    • You may be given antibiotics.
    • You may be given laxatives or an enema.
    • Arrange for a ride to and from the hospital.
    • The night before, eat a light meal. Do not eat or drink anything after midnight.

    Anesthesia

    General anesthesia will be given through an IV (needle) in your hand or arm. It will block pain and keep you asleep through the surgery.

    Description of the Procedure

    A nurse will place an IV line in your arm to give you fluids and medicines. The doctor will place a breathing tube through your mouth and into your throat. This will help you breathe during surgery. You will also have a catheter placed in your bladder to drain urine.
    The doctor will make an 8-10 inch incision to open the abdomen. Surgical staples will divide the stomach vertically. The new stomach will be the shape of a slim banana. The rest of the stomach will be removed. Your new stomach can hold 50-150 milliliters (mL) of food, about 10% of what a normal adult stomach can hold.
    Staples or stitches will be used to close the incision.

    Immediately After Procedure

    The breathing tube and catheter will be removed.

    How Long Will It Take?

    About two hours

    How Much Will It Hurt?

    Anesthesia will prevent pain during surgery. You will be given pain medicine after surgery.

    Average Hospital Stay

    The usual length of stay is 4-6 days. If there are any problems, you will need to stay longer.

    Post-procedure Care

    At the Hospital
    • The doctor may use a small tube with a camera to look down your throat and into your stomach to check for problems.
    • You will receive nutrition through an IV at first, but slowly start eating again.
    While in the hospital, you may be asked to:
    • Use a device called an incentive spirometer to prevent breathing problems
    • Wear elastic surgical stockings or boots to promote blood flow in your legs
    • Walk
    At Home
    For a smooth recovery:
    • Ask your doctor about when it is safe to shower, bathe, or soak in water.
    • Do not drive or lift anything heavy for at least two weeks or until advised by your doctor.
    • Walk every day.
    • Your doctor may recommend that you meet with a therapist if you have emotional ups and downs.
    • Follow your doctor’s instructions.
    Return to normal activities in 2-3 weeks.
    For good nutrition:
    • Eat a clear liquid diet for about one week or as advised by your doctor.
    • You will begin with 4-6 small meals per day. A meal is two ounces of food.
    • Progress from soft, pureed foods to regular foods.
    • Solid food must be well-chewed.
    • Get enough protein.
    • Do not eat too much or too quickly.
    • Avoid high-calorie foods.
    • Avoid dehydration by drinking fluids before or after meals.

    Call Your Doctor

    Contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
    • Pain that you cannot control with the medicines you have been given
    • Blood in the stool
    • Pain, burning, urgency, or frequency of urination, or persistent bleeding in the urine
    • Persistent nausea and/or vomiting
    • Severe abdominal pain
    • Pain and/or swelling in your feet, calves, or legs
    • Cough, shortness of breath, or chest pain
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Society for Metabolic and Bariatric Surgery https://www.breastsurgeons.org/

    Weight Control Information Network http://www.win.niddk.nih.gov/

    CANADIAN RESOURCES

    Canadian Obesity Network http://www.obesitynetwork.ca/

    Weight Loss Surgery http://www.weightlosssurgery.ca/

    References

    Bariatric surgery. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 2010. Accessed November 22, 2010.

    Gastric sleeve. University of California, San Diego Health System website. Available at: http://health.ucsd.edu/specialties/obesity/surgery/gastric-sleeve.htm . Accessed November 22, 2010.

    Laparoscopic sleeve gastrectomy. Baylor College of Medicine website. Available at: http://debakeydepartmentofsurgery.org/home/content.cfm?proc%5Fname=Laparoscopic+Sleeve+Gastrectomy&content%5Fid=272 . Updated November 2010. Accessed November 22, 2010.

    Sleeve gastrectomy. Cleveland Clinic website. Available at: http://weightloss.clevelandclinic.org/WhatisBariSurg1.aspx . Accessed November 22, 2010.

    Sleeve gastrectomy. Virginia Mason Medical Center. Bariatric Surgery Center of Excellence website. Available at: https://www.virginiamason.org/home/body.cfm?id=6214 . Updated October 2010. Accessed November 22, 2010.

    Sleeve gastrectomy. Yale New Haven Health website. Available at: http://www.greenhosp.org/pe%5Fpdf/bariatrics%5Fsleeve.pdf . Updated January 2010. Accessed November 22, 2010.

    Walsh J. Sleeve gastrectomy as a stand alone bariatric procedure for obesity. California Technology Assessment Forum website. Available at: http://www.ctaf.org/UserFiles/File/2010%20Oct/Vertical%20Sleeve%20Gast%20final%20draft.pdf . Updated October 2010. Accessed November 22, 2010.

    Weight loss surgery. North Shore Medical Center website. Available at: http://nsmcweightloss.org/web/surgical%5Fprocedures.aspx . Accessed November 22, 2010.

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