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Gastric Sleeve:
Vertical Sleeve Gastrectomy
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The vertical sleeve gastrectomy (VSG) has been used in conjunction with other malabsorptive procedures in the past with good success. Recently an attempt to use this procedure as a "stand alone" technique has been gaining favor by bariatric surgeons. Several studies have shown that this procedure can be performed with less perioperative mortality than a gastric bypass procedure. The weight loss from a sleeve gastrectomy is felt to be better than an adjustable band initially but somewhat less than a gastric bypass. Please remember that this is considered an irreversible procedure as approximately 60% to 80% of the stomach is removed.  This procedure is not considered the best option for someone with significant reflux symptoms and may initiate or worsen these symptoms postoperatively.
The sleeve gastrectomy results in similar nutritional deficiencies as the adjustable gastric band procedures which is to say they are minimal. Better control of type II diabetes is also seen with the sleeve gastrectomy compared to other restrictive procedures. Regretfully many insurance companies regard this procedure as "experimental" and do not offer benefits.
Many patients ask which person is the best candidate for this procedure and most surgeons will reply that the patient who does not want an implantable device but is not a good candidate for the gastric bypass may find the sleeve gastrectomy the right choice. Knowledge of the benefits and restrictions of the procedure in question is the best tool for considering which procedure may be right for you. Most surgeons will help a patient decide the best choice but the ultimate decision is still made by the patient.
Advantages
When compared to adjustable banding procedures the VSG has faster, more effective weight loss, better type II DM control, less post-operative maintenance and similar nutritional deficiencies. Compared to the Bypass procedure the VSG has a lower national mortality rate.
Disadvantages
Higher incidence of post-operative reflux symptoms, Non-reversible nature. Associated vitamin B12 deficiencies. Less type II DM control and resolution when compared to the Bypass. Higher national mortality rates and operative risks when compared to adjustable banding procedures.
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