The vertical gastrectomy, or sleeve gastrectomy, is a restrictive weight loss surgery that has been studies since it's conception in 1993. By 2001 this procedure was modified, refined and offered as a solo procedure for both very high BMI and low BMI patients, mainly as an alternative to gastric banding (LapBand).

Until 2009 this procedure has been considered experimental and performed by few surgeons. However, given the tramendous success and safety of this procedure, Medicare has decided to cover this procedure starting January 1st, 2010. It is expected that many insurances will follow suit and offer coverage of this procedure in the next few months.

Although it is not a replacement for the "gold standard", Roux-en-Y gastric bypass, short term studies demonstrate that sleeve gastrectomy is superior to laparoscopic gastric banding in terms of resolution of comorbidities related to obesity and overall weight loss.

General Procedure

As with gastric bypass and laparoscopic banding this procedure is performed laparoscopically. This procedure generates weight loss through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from 3-5 ounces (90-150cc). The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded. Note that there is no intestinal bypass with this procedure, only stomach reduction.

Advantages of Vertical Sleeve Gastrectomy:

• Minimal change to stomach function while reducing the overall capacity of the stomach. This results in minimal food intolerances
• Eliminates the portion of the stomach that produces majority of the hormone that stimulates hunger (Ghrelin). This is a great advantage over LapBand surgery.
• Minimizes the chance of an ulcer occurring.
• Appealing option for people who are concerned about the complications of intestinal bypass procedures or who have existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedures.
• No foreign device placed in the body and no need for LapBand fills.

Disadvantages of Vertical Sleeve Gastrectomy:

• Potential for stomach to stretch and result in inadequate weight loss or even weight regain. This is more likely in procedures that do not bypass portions of the intestine
• No dumping syndrome and as such consumption of highly caloric food like ice-cream, milkshakes, chocolate, etc is possible which will lead to weight gain
• Because a portion of the stomach is removed, it is not reversible.
• No long term studies are yet available and such may not appeal to everyone.