• Vertical Sleeve Gastrectomy—Laparoscopic

    (Sleeve Gastrectomy—Laparoscopic; VSG—Laparoscopic)

    Definition

    Vertical sleeve gastrectomy (VSG) is surgery to decrease the size of your 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) is used to determine if a person is overweight or obese. A normal BMI is 18.5 to 25. This surgery is an option for people with:
    • BMI over 40
    • BMI 35-39.9 and a life-threatening condition or physical limitations that affect employment, mobility, and family life
    If lifestyle changes are made, the benefits of VSG include:
    • Weight reduction
    • Improvement in many 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 developing gallstones .
    Factors that may increase the risk of complications include:
    • Smoking
    • Recent or chronic illness
    • Diabetes
    • Old age
    • Heart or lung disease
    • Bleeding or clotting disorders
    Discuss these risks with your doctor.

    What to Expect

    Prior to Procedure

    You may have the following:
    • Physical exam and review of medical history
    • Blood test and other tests
    • 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 any medicines, herbs, and dietary supplements you are taking. 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
    Before the procedure:
    • You may be given antibiotics.
    • You may be given laxatives or an enema.
    • Arrange for a ride to and from the hospital. Arrange for help at home.
    • 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 surgery.

    Description of the Procedure

    A nurse will place an IV line in your arm to give you fluid and medicines. A breathing tube will be placed 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.
    Your doctor will make several small cuts in your abdomen. Gas will be pumped in to inflate your abdomen, making it easier for the doctor to see. A laparoscope and surgical tools will be inserted through the incisions. A laparoscope is a thin, lighted tool with a tiny camera. It sends images of your abdominal cavity to a monitor. Your doctor will operate while viewing the monitor.
    The doctor will use surgical staples to 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 mL (milliliters) of food, about 10% of what a normal adult stomach can hold. Incisions will be closed with staples or stitches.
    In some cases, the doctor may need to switch to open surgery.

    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. Pain medicine will be given after surgery.

    Average Hospital Stay

    The usual length of stay is 2-3 days.

    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, but then slowly start eating again.
    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
    • Get up and 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.
    • Take walks daily.
    • Your doctor may recommend that you meet with a therapist if you have emotional ups and downs after surgery.
    • Follow your doctor’s instructions.
    You should be able to return to normal activities in 2-3 weeks.
    For good nutrition:
    • Eat a clear liquid diet for about one week.
    • Begin with 4-6 small meals per day. A meal is two ounces of food.
    • Your diet will 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 http://asmbs.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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