Vertical Sleeve Gastrectomy

Conveniently located to serve the areas of Napa, Sonoma, Marin and the Bay Area

The vertical sleeve gastrectomy is a weight loss procedure that involves the removal of the outer 80-90% of the stomach. One of our most important hunger hormones, Ghrelin, is produced in this part of the stomach. Patients undergoing this procedure will, therefore, experience a significant reduction in hunger. In addition to the decreased hunger, the reduced size of the stomach will result in an early sense of satiety.

Please see the video below for a detailed illustration of the procedure.

About

Imagine getting rid of that ravenous hunger. Imagine feeling satisfied after only a few bites of food. Imagine losing up to 75% of your excess body weight in 1 year. Wouldn’t that be nice?

The vertical sleeve gastrectomy can turn this fantasy into reality. By removing the outer 80-90% of your stomach, you will feel significant restriction whenever you eat food. This will slow you down and give you a feeling of a full stomach more quickly. The part of the stomach that is removed with the assistance of a stapling device is an important production center for Ghrelin, our hunger hormone. As a result patients will experience a feeling of satisfaction in between meals as opposed to their usual lingering hunger. Food will no longer “mill” in the stomach, but instead, it will pass through more rapidly, leading to an earlier sequence of satiety hormone release from the gut. Patients lose significant amounts of weight in relatively little time. To summarize, patients will lose weight through several mechanisms including restriction, decreased hunger and early satiety.

The vertical sleeve gastrectomy is a stapling procedure in which the surgeon will staple off and remove the outer 80-90% of the stomach, thereby creating a narrow, banana-shaped and sized stomach. The removed portion of the stomach is biochemically active, responsible for the production of our main hunger hormone, Ghrelin. Patients will, therefore, lose weight by several mechanisms including decreased hunger, early satiety, decreased food capacity, rapid food transit with resulting negative hunger feedback mechanisms. Average weight loss at 1 year following vertical sleeve gastrectomy is ~65% excess body weight (weight in excess of ideal body weight).

While the name may suggest placing something in the stomach, such as a sleeve, nothing will be placed inside of the stomach. The staples used to fashion your stomach into a narrow banana-shaped/sized stomach, will remain. The staples are made of titanium but will not set off alarms at the airport! Your body will overgrow the staples and they will not bother you in the future. In fact, you will be completely unaware of their presence from the beginning.

Sleeve gastrectomy live video. Warning: GRAPHIC CONTENT.

Benefits

The vertical sleeve gastrectomy produces substantial weight loss within one year of surgery with ~65% excess body weight loss.

This procedure is considered a metabolic operation with profound hormonal changes noted within weeks of surgery. These changes may lead to resolution of metabolic problems such as diabetes, high cholesterol, and high blood pressure. Vertical sleeve gastrectomy has shown to reduce patient’s chance of sleep apnea, stroke, infertility, gastroesophageal reflux disease, and heart disease.

These changes may be sustained with a dedication to an active, balanced lifestyle. The mindfulness and emotional awareness that Whole Health practitioners help to develop in our patients will optimize the effect of surgery. These tools will be applicable to all aspects of your life with no limit to the possible benefits.

Good candidates

As with all weight loss surgery, patients qualify for the vertical sleeve gastrectomy based on the 1991 NIH consensus conference criteria. Patients with a body mass index (BMI) greater than 35 with one or more weight-related medical problem and those with a BMI of 40 or greater (click here to calculate your BMI), will qualify for surgery. Choosing between surgeries will be based on a number of factors that will be discussed at your consultation. Your surgeon will help you decide whether the vertical sleeve gastrectomy is best suited to your goals, medical problems, and lifestyle during your consultation and on completion of your workup.

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Consultation

All patients are seen in consultation with one of our weight loss surgeons and our dietitian. The surgeon will discuss all available procedures, the associated anatomical changes, the expected weight loss, the expected lifestyle changes and the preoperative workup. Our dietitian will help you learn the immediate post-operative diet and diet progression. She will also provide invaluable tools such as how to read food labels, make healthy food choices and design a healthy diet that is sustainable and fits with your lifestyle.

Recovery from a Vertical Sleeve Gastrectomy

Depending on the extent of their surgery, patients will want to take between one to four weeks off from work to recover from their vertical sleeve gastrectomy.

Patients are advised to rest as much as possible following their sleeve gastronomy, but also to integrate sporadic, short walks into their day. This will help maintain healthy blood flow. Instructions will also be given regarding breathing exercises and other methods of staying healthy during recovery. Patients should avoid doing any strenuous exercise for the first few weeks of their recovery until your surgeon instructs you that it is safe to resume this level of activity. Patients will also want to avoid mild lifting that can put strain on their incisions. This includes lifting household items, pets, or small children.

Patients will slowly integrate solid food back into their diet over the weeks following their vertical sleeve gastrectomy. Many patients do not have an appetite for a short period after their sleeve gastrectomy. The sensation of hunger usually returns within seven to ten days. Patients will likely need to adjust their eating habits from two to three larger meals a day to four to six meals a day to comfortably accommodate food and receive adequate nutrition.

Proper hydration and water consumption will be very important.

For the first week, patients will need to follow a liquid-only diet. Patients will also be allowed to consume broth, jello, decaf tea or coffee, and sugar-free popsicles. Do not consume caffeinated, sugary, or carbonated drinks. Within ten to fourteen days, patients will want to consume roughly 20 grams of protein a day, but still avoid caffeine, high-fat foods, or chunks, such as vegetables in soup. Any protein powders should be sugar-free. Patients can integrate pureed, soft food over their second and third week of recovery. Safe foods to consume during this period include Greek yogurt, thinned oatmeal, baby food, mashed sweet and regular potatoes, and scrambled eggs.

Do not consume the skin or seeds of fruits or vegetables.

After four weeks, patients can begin integrating more soft foods, like soft vegetables and lean meats. Over weeks four, five, and six, patients will want to consume between 60 to 80 grams of protein. Avoid high-sugar foods at this time, as well as bread, high-fat foods, raw vegetables, pasta, and white rice. Foods like eggs, softened vegetables, low-fat deli meats, certain types of fish, and soups with minimal chunks will be good, filling sources of protein. Patients will want to consult with their surgeon about their readiness to consume one to two cups of coffee at this point of their recovery.

Constipation may occur. Patients are advised to take a daily fiber supplement during their recovery period. If you have not had a bowel movement for a few days, you can speak to your doctor about receiving a mild laxative.

Patients will receive counseling and a personally-tailored nutrition plan to help them maintain their vitamin intake. Our staff at Whole Health Weight Loss Institute will also work with you to create a workout regimen that fits your lifestyle and encourages your best, safest, long-term weight loss results.

Patients will return for follow-up appointments throughout their recovery. We will monitor every patient’s healing progress, as well as provide accessible guidance on their nutrition and weight-loss journey.

Risks

The extensive experience of our surgeons makes technical failures unlikely and most structures can be handled with endoscopic dilation of the stomach.

The two most common short and long-term complications of the sleeve gastrectomy are stricture (narrowing of the stomach) and GERD (heartburn). In the case of stricture, patients may experience this complication as a result of poor blood flow to the healing stomach. This may also occur due to the intrinsic shape of a patient’s stomach (more L shaped than J shaped) or the new stomach shape as a result of surgery. In rare instances, patients with severe unremitting strictures may require conversion to a Roux-en-Y gastric bypass. Heartburn may occur in as many as 24% of patients. This problem is able to be managed with antacids in ~98% of patients. In rare cases, patients with unremitting, intolerable heartburn will require conversion to a Roux-en-Y gastric bypass or duodenal switch.

As no part of the intestine is bypassed with the vertical sleeve gastrectomy, dumping syndrome does not occur.

Patients who undergo the vertical sleeve gastrectomy do not experience “dumping syndrome”. Dumping syndrome is a condition that occurs with the Roux-en-Y gastric bypass when patients eat a concentrated sweet or candy. It is characterized by nausea, palpitations, sweating and urgent diarrhea (dumping). It is caused by a surge in insulin as simple sugars go directly into the lower small intestine, followed by an immediate drop in blood sugar leading to the aforementioned symptoms.

Micronutrient deficiencies are also rare with the sleeve gastrectomy. As most nutrients are absorbed in the early part of the small intestine and no part of the small intestine is bypassed with this procedure, we expect calcium, iron and vitamin levels to remain normal. Of note, decreased intake of certain foods rich in B-vitamins (niacin, thiamine, etc) such as bread, rice, pasta and potatoes, may lead to deficiencies of these vitamins with time. Moreover, factors produced by the stomach are necessary for absorption of some vitamins (e.g. intrinsic factor for absorption of vitamin B12). The removal of some of the production centers for these factors may lead to deficiencies as well. We will track these micronutrient levels to replace any deficiencies.

Overall, the vertical sleeve gastrectomy is well-tolerated with the lowest short and long-term complication rate of all weight loss procedures.