Vertical Sleeve Surgery (VSG)

 

Vertical Sleeve (VSG) Mexico

 

 

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What is a "Sleeve Gastrectomy"?

The Sleeve Gastrectomy is an operation in which the left side of the stomach is surgically removed. This results in a new stomach which is roughly the size and shape of a banana. Since this operation does not involve any "rerouting" or reconnecting the intestines, it is a simpler operation than the gastric bypass or the duodenal switch. Unlike the Lap-Band® procedure, the sleeve Gastrectomy does not require the implantation of an artificial device inside the abdomen avoiding the need for fills. Because the new stomach continues to function normally there are far fewer restrictions on the foods which patients can consume after surgery, however the quantity of food eaten will be considerably reduced. This is seen by many patients as being one of the great advantages of the sleeve Gastrectomy, as is the fact that the removal of the majority of the stomach also results in the virtual elimination of hormones produced within the stomach which stimulate hunger. For patients with a body mass index greater than 60, the sleeve gastrectomy may be the first part of a two-stage operation.

Some patients have a body shape that can make a bariatric surgery more technically difficult – particularly those patients who carry their weight in their belly. If you fall into this category, you may benefit from a two-stage bariatric surgery. In the staged approach, a multi-step operation like the gastric bypass is broken down into two simpler and safer operations. In the first stage, a sleeve gastrectomy is performed. This allows a patient to lose 80 to 100 pounds or more, making the second part of the operation substantially safer. Low BMI individuals who should consider this procedure include: Those who are concerned about the potential long term side effects of an intestinal bypass such as intestinal obstruction, ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency. 

Those who are considering a Lap-Band® but are concerned about a foreign body inside the abdomen. Those who have medical problems that prevent them from having weight loss surgery such as anemia, crohn's disease, extensive prior surgery, and other complex medical conditions. People who need to take anti-inflammatory medications may also want to consider this. Usually, these medications need to be avoided after a gastric bypass because the risk of ulcer is higher.

What advantages does it have?

  • It does not require disconnecting or reconnecting the intestines
  • It is a technically simpler operation than the gastric bypass or the duodenal switch
  • There is no foreign body inside your body
  • It does not need adjustments or fills 
  • It may be a safer operation for patients with a body mass index (BMI) more than 60. It may be used as the first stage of a 2-stage operation.

Risks and Complications

  • As with any surgery, there can be complications. This list can include:
  • Deep vein thrombophlebitis 0.5%
  • Non-fatal pulmonary embolus 0.5% 
  • Pneumonia 0.2% 
  • Acute respiratory distress syndrome 0.25% 
  • Splenectomy 0.5% 
  • Gastric leak and fistula 1.0% 
  • Postoperative bleeding 0.5% 
  • Small bowel obstruction 0.0% 
  • Death 0.25%

Patients with Lap-Band® complications

If you are a patient with a previous Lap-Band® procedure and you're experiencing problems such as reflux, esophagitis, band erosion, band slippage, port site infection you may be a candidate for "revision" surgery. This means removing the Lap-band® System and performing a VSG (Gastric Sleeve) procedure. Patients in this category are very concerned about regaining their already lost weight and they will greatly benefit with the gastric sleeve procedure. At this point the Gastric Sleeve will not only let them maintain their weight, but will let them continue losing more weight. It might also be a good option if patients have a problem with their lap band requiring revision, have already lost a lot of weight and don't want a full bypass. The weight loss seems to be a little better and more rapid than the lap band (60 - 70% EWL) over two years. However there is still no long term data to support this claim.

What kind of maintenance is there with the VSG?

VSG procedures differs from Lap-band surgery because it is free of “maintenance”. Meaning, you will not need any band adjustments or “fills”, nor will you have any erosions or slippage because you have no band. The VSG does not need regular checking (blood work, vitamin screening, etc.) as with the Roux en Y Gastric bypass or Duodenal switch because you have no mal-absorption.

How much protein per day should I be eating?

Studies show that you should take between 40 to 70 grams of protein daily, especially in the first 6 to 12 months post-op.

What kind of diet will I be on Post-op? Do you send me information?

We take our patients by the hand step by step. We will inform you pre surgery what will be required of you. This includes your post-op diet guide, any special instructions you may need as well as aftercare directions.

Should I be taking a Vitamin every day?

Although there are no reported vitamin deficiencies, we recommend a multivitamin (chewable) to our patients once daily. 

Will I lose my hair?

Hair loss is the result of bad eating habits. You can prevent it by eating enough protein and taking your vitamin supplement.

Will I have nausea?

There are people who are very sensitive to the anesthesia. These people tend do be a bit more nauseated than others. The manipulation of the stomach during surgery may also produce some nausea in some patients. The post-operative VSG patient that does present with nausea, is around 15-20%. Nausea does subside in the next few hours post-op. All of our patients receive medications to prevent nausea in the recovery room.

Will this fix my heartburn?

Probably. Heartburn or acid reflux (GERD) is directly related to being overweight (there are other causes of GERD). Once you start losing those pounds you should notice that the heartburn starts to disappear. We give each patient who undergoes the VSG a treatment to reduce the acid production in the stomach, which also reduces the heartburn.

What are the long-term results of VSG?

Since it is a quite new procedure, there are no long-term studies (10 years) yet. But studies have shown that the VSG has similar results to the Lap-Band or Roux en Y but without their complications at 5 years.

Can I drink alcohol?

Yes, but it is not recommended. Alcohol has many calories and will not help on your progress with your weight loss. Alcohol intoxication will also hit you a lot faster with the VSG than other surgeries. 

How much time off work will I need?

After a bariatric procedure done through laparoscopy you will be able to do your regular activity once you get home. Drive in 3 to 4 days and return to work in 5 to 7 days. Some people who have desk-jobs return to work immediately. We restrict our patients on “heavy” weight lifting for 30 days.

What kind of staples do you use? Will they sound off the alarm if I cross the metal detector in an Airport?

We use titanium staples made my Autosuture in the United States. We use these because they have 3 rows of staples. That gives the patient an added sense of security. We also sew over the staple line making our leakage rate % very low.

How would I know if I had a leak?

Our leakage rate is at 0.32% with over 400+ patients. But say you did have a leak, symptoms would be fever, abdominal pain, tachycardia (elevated heart beat), intolerance to liquids, etc. For this reason, a barium swallow is done the day after surgery to check for any leaks that may appear.

What kind of follow-up do I need with my primary care doctor/lab tests?

We give all our patients the “paperwork” needed for follow-up. You take home your surgery report, lab test, chest X-ray, etc. So if any other doctor in the states is going to be seeing you he will know exactly what was done inside you and what to expect. VSG patients don’t need to be attended to by doctors as regularly as Lap-Band or Roux en Y patients. Our coordinators keep in touch with all of our patients via email or telephone to ensure you are doing well and to answer any questions you may have post-operatively.