Vertical Sleeve Gastrectomy (Gastric Sleeve)

In vertical sleeve gastrectomy (VSG), your stomach size is reduced to 15 percent of the original size to help you lose weight. The VSG was originally only done as the first part of a two-step procedure for the biliopancreatic diversion with duodenal switch (BPD-DS), but has recently been used as an entire bariatric procedure on its own.1

Vertical sleeve gastrectomy is also known as:

  • sleeve gastrectomy
  • gastric sleeve
  • greater curvature gastrectomy

The VSG is similar to the vertical banded gastrectomy, but instead of folding over the stomach, as in the VBG, the surgeon actually removes 80 to 85 percent of your stomach in the VSG. The surgeon uses the remaining portion of your stomach to make a tube-shaped sleeve that goes from the esophagus to your small intestine. After the procedure, the size of your sleeve is only 15 to 20 percent of the original size of your stomach. Finally, the surgeon stitches closed the sleeve in your stomach and uses a sealant to prevent leaks.

  1. Mechanick MD, Kushner RF…Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity, 2009;17(S1):S3-72.

Advantages and Disadvantages of the Gastric Sleeve

Advantages of the Vertical Sleeve Gastrectomy

  • Less risk of nutritional deficiencies compared to Roux-en-Y gastric bypass
  • A good choice for patients with BMI over 50, and usually can be laparoscopic
  • Relatively common in Mexico and Venezuela, so those are cheaper options if you're paying for the gastric sleeve yourself
  • Can be safer if you normally take anti-inflammatory medications for other conditions

Disadvantages of the Vertical Sleeve Gastrectomy

  • A relatively new procedure as a stand-alone procedure (since it used to only be used before a biliopancreatic diversion with duodenal switch, or BPD-DS), so not much information on long-term results
  • A newer procedure, so some insurance companies consider it "experimental" and don't cover the gastric sleeve, even when they cover the gastric bypass
  • Irreversible. You can never get your stomach back
  • Limited weight loss in lower-BMI patients
  • Drinking high-calorie liquids or eating soft high-calorie foods can prevent weight loss

Possible Complications/Risks of the Gastric Sleeve

  • Esophagitis (inflammation of the esophagus) or gastritis (inflammation of the stomach)
  • Leaks, which occur in 1 to 4% of patients1, result when the staples and patch that are supposed to seal your gastric sleeve do not seal completely. This can cause infections and peritonitis, or inflammation of the lining of your abdominal cavity
  • Strictures, or narrowing of the sleeve so food can't pass through
  • Vomiting and nausea
  • Intolerance to certain foods
  • Gastroesophageal reflux disease, or GERD, with severe heartburn
  • Dumping syndrome
  • Internal injury to your organs during surgery and leaking from the staples. If you get scarring inside your abdomen as you heal, the scar tissue can eventually block your bowel, or colon or large intestine, and cause constipation in the future
  1. American Society for Metabolic and Bariatric Surgery. Updated position statement on sleeve gastrectomy as a bariatric procedure. Revised 2011, October 28. Accessed September 7, 2012.

Weight Loss and the Vertical Gastric Sleeve (VSG)

The gastric sleeve is relatively new, but it appears to have results between the lap-band and bypass. The VSG is a top choice for morbidly obese (BMI over 40) and superobese (BMI over 50) patients. It's also:

  • 47% EWL after 12 months and 63 to 70% EWL at three years post-surgery1 2 3
  • about 50% EWL in one year, or a BMI loss of 12 points among patients whose starting BMI averaged 444
  • Long-term weight loss results appear promising: superobese patients in one study had an average of 46% EWL after 8 years

The vertical sleeve gastrectomy is restrictive and it affects your appetite hormones.

  • Restrictive: the small sleeve fills up quickly when you eat so that your brain is faster to recognize that you've eaten enough
  • Hormonal: changes some of the hormones that affect your hunger and satiety
    • Ghrelin: is produced by the stomach, increases hunger and is reduced after VSG
    • CCK: tells your brain that you're full after a meal, and increases after VSG
    • PYY: (neuropeptide YY) a hormone that reduces hunger and whose levels increase after VSG
    • GLP-1: (glucagon-like peptide 1) a hormone that reduces hunger and whose levels increase after VSG
  1. Baker MT. The history and evolution of bariatric surgical procedures. Surgical Clinics of North America. 2011;91(6).
  2. Himpens J. Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg. 2010; 252(2): 319-24.
  3. American Society for Metabolic and Bariatric Surgery. Updated position statement on sleeve gastrectomy as a bariatric procedure. Revised 2011, October 28. Accessed September 6, 2012.
  4. Peterli R, Steiner RE, Woelnerhanssan B, Peters T, Christoffel-Courtin C, Gass M, Kern B, von Flueee M, Beglinger C. Metabolic and hormonal changes after laparoscopic roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22(5):740-748.