Vertical Sleeve Gastrectomy (Gastric Sleeve Surgery)

What is a vertical sleeve gastrectomy (VSG)?

Vertical sleeve gastrectomy, also known as laparoscopic sleeve gastrectomy (LSG), is a type of minimally invasive metabolic surgery that converts the stomach into a long and narrow tube.

The procedure:

• Reduces the stomach by about 75% to limit the amount of food the stomach can hold.
• Removes the ghrelin, a part of the stomach where the hunger hormone is produced. The removal leads to hormonal changes that assist with weight loss and relieves conditions associated with being overweight, such as high blood pressure or heart disease.

The procedure is done laparoscopically, using small incisions in the body, which reduces risks compared to open surgery. This surgical method also results in less wound pain, fewer complications, a shorter hospital stay and faster recovery.

Why do you need a vertical sleeve gastrectomy?

Vertical sleeve gastrectomy falls under the category of bariatric (weight-loss) surgery. Bariatric surgeries are more effective than lifestyle, dietary and medical interventions to manage obesity and obesity-related disorders such as:

• Heart disease
• High blood pressure
• Hyperlipidaemia (high cholesterol)
• Obstructive sleep apnoea (caused by blockage of the upper airways)
• Type 2 diabetes

Obesity is defined as a body mass index (BMI) of 30, and it is usually linked with co-occurring conditions that lower life expectancy. Bariatric surgeries are currently the best method to reduce weight quickly and, more importantly, to sustain weight loss.

To qualify for bariatric surgery, you need to meet either of these requirements:

• A BMI over 37.5 and have no other co-occurring conditions
• A BMI over 32.5 and have one or more obesity-related disorders

Your doctor will determine whether you are a suitable candidate for bariatric surgery. Learn more about bariatric surgery, also known as metabolic surgery.

Vertical sleeve gastrectomy versus gastric bypass (Roux-en-Y)

Vertical sleeve gastrectomy differs from gastric bypass (Roux-en-Y), which is another type of weight-loss surgery. Your doctor will recommend the type of surgery that is most suitable for you.

Who should not undergo a vertical sleeve gastrectomy?

Vertical sleeve gastrectomy may not be suitable for those whose BMI is below the requirements for surgery, or who are too ill to undergo surgery.

Another option may be the use of a gastric balloon.

What are the risks and complications of vertical sleeve gastrectomy?

This procedure is generally considered safe and effective. Like all surgical procedures however, there are some general risks, such as:

• Infection
• Blood clots
• Excessive bleeding
• Allergic reaction to anaesthesia

In vertical sleeve gastrectomy, some specific, but uncommon, risks also include:

• Leaks from the cut edge of the stomach
• Gastrointestinal obstruction
• Hernias
• Gastroesophageal reflux (GERD)
• Low blood sugar (hypoglycaemia)
• Malnutrition
• Vomiting

How do you prepare for a vertical sleeve gastrectomy?

Before the operation, your doctor will review your medical history and you may have to undergo some scans and tests.

Leading up to the surgery, you may also be asked to start a physical fitness regime.

Once your procedure is scheduled, your doctor will advise you on how to prepare. In general, you need to fast 6 – 8 hours before the procedure.

Note: If you are taking any medication or herbal supplements, you should inform your doctor. You may need to adjust or stop taking some medication before the procedure (e.g. aspirin, blood thinners).

What can you expect in a vertical sleeve gastrectomy?

Vertical sleeve gastrectomy is performed under general anaesthesia, so you will be asleep during the operation. You may be admitted for a few days for observation.

Estimated duration

The procedure lasts about 1 – 2 hours.

During the procedure

Vertical sleeve gastrectomy is typically performed laparoscopically, using small incisions through which instruments can be inserted.

During the procedure:

• Small incisions will be made to allow surgical tools to access the stomach cavity.
• A large part of the stomach will be removed, leaving a narrow "sleeve".

After the procedure

You will be transferred to a recovery room for monitoring. Depending on your procedure, you may need to stay for a few days in the hospital. Post-operative pain is normal and will be managed with medication.

Care and recovery period for a vertical sleeve gastrectomy

Most people take 4 – 6 weeks to resume normal activities after a vertical sleeve gastrectomy.

In the initial recovery period, there will be a special diet plan to follow. This will help you adapt to your new stomach. In the first few days after surgery, you will consume a liquid diet. You will then transition to pureed foods and soft foods. After about 6 weeks, you may start to consume normal meals.

Your doctor may also advise you to:

• Eat small amounts slowly and chew well
• Avoid food that may cause blockages
• Take multivitamins such as calcium supplements

Long-term care after vertical sleeve gastrectomy

To gain the most from vertical sleeve gastrectomy and continue to reduce your risk of chronic disease, you will need to make long-term lifestyle changes.

You will also likely need frequent medical check-ups to monitor your health in the first several months after surgery.

Your doctor will help you manage some of the physical side-effects due to rapid weight loss, such as:

• Body aches
• Lethargy
• Feeling cold easily
• Dry skin
• Hair thinning and hair loss
• Mood changes

Vertical sleeve gastrectomy is quite effective; you can expect about 60% of excess weight loss over a period of 1 – 2 years. This can be maintained for at least 5 – 10 years. Close follow-up with your doctor is the most important factor for maintaining good weight loss over a longer period of time.