Vertical Sleeve Gastrectomy (VSG) is a common bariatric surgery designed to treat severe obesity and associated health problems. VSG involves permanently reducing the size of the stomach to promote significant weight loss. It is one of the most frequently performed weight-loss surgeries worldwide due to its effectiveness. The surgery helps patients achieve long-term weight management when traditional diet and exercise methods have been unsuccessful. VSG can improve or resolve numerous weight-related medical conditions, such as type 2 diabetes and high blood pressure.
The Surgical Procedure
The Vertical Sleeve Gastrectomy is typically performed using laparoscopy, a minimally invasive approach. The surgeon makes several small incisions in the abdomen through which specialized surgical instruments and a camera are inserted. This technique results in less post-operative pain and a shorter recovery time compared to traditional open surgery.
During the operation, the surgeon uses surgical staples to divide the stomach vertically. Approximately 75% to 85% of the stomach is removed, including the fundus. The remaining stomach tissue is reshaped into a long, narrow, tube-like structure, often described as the size and shape of a banana.
The procedure is purely restrictive, limiting the amount of food that can be consumed at one time. Unlike gastric bypass surgery, VSG does not involve rerouting or bypassing any part of the small intestine. The pyloric valve, which controls the emptying of stomach contents, remains intact. This preservation allows for the normal regulation of food passage and helps prevent certain post-surgical complications.
Mechanism of Weight Loss
Weight loss following VSG is driven by two interconnected physiological changes. The most immediate effect is the physical restriction of food intake. The new, smaller stomach holds significantly less food, limiting the calories consumed per meal. This reduction in stomach volume forces patients to consume smaller portions, leading to a feeling of fullness much sooner.
The second mechanism involves substantial hormonal shifts. The portion of the stomach removed, primarily the fundus, is the main site for producing the hunger-stimulating hormone Ghrelin. Removing this area significantly decreases circulating Ghrelin levels after surgery. This hormonal change contributes to a noticeable reduction in appetite and hunger sensations, helping patients adhere to their new dietary regimen.
The procedure also impacts other gut hormones, such as Glucagon-like peptide-1 (GLP-1) and Peptide YY (PYY), which regulate satiety and blood sugar. These changes contribute to the rapid improvement or remission of metabolic conditions like type 2 diabetes, often occurring before significant weight loss is achieved. The combination of physical restriction and hormonal changes makes VSG an effective tool for sustainable weight reduction.
Patient Eligibility and Preparation
Candidates for Vertical Sleeve Gastrectomy must meet specific medical guidelines. Generally, a patient qualifies if they have a Body Mass Index (BMI) of 40 or higher (extreme obesity). Eligibility also applies if their BMI is 35 or higher and they suffer from at least one severe weight-related health problem. These co-morbidities often include high blood pressure, obstructive sleep apnea, or type 2 diabetes.
Individuals with a BMI as low as 30 may be considered if they have significant metabolic disease difficult to control with conventional treatment. Before approval, patients must complete a preparation phase involving extensive nutritional counseling to ensure understanding of necessary lifelong dietary changes.
A psychological evaluation is mandatory to assess the patient’s mental readiness for the surgery and the lifestyle adjustments that follow. Many insurance providers require documentation of a pre-operative, medically supervised weight loss program, sometimes lasting three to six months. These steps confirm the patient is committed to the long-term behavioral changes required for successful outcomes.
Recovery and Post-Operative Care
The immediate recovery phase typically involves a hospital stay of one to three days. Medical staff monitor the patient for complications, such as leakage or internal bleeding. Pain management is controlled, and patients are encouraged to begin walking shortly after surgery to aid recovery and prevent blood clots.
A crucial component of post-operative care is the staged dietary progression, which allows the stomach to heal. The diet begins with clear liquids for the first few days, followed by full liquids, such as protein shakes, for one to two weeks. Patients then advance to pureed foods before slowly introducing soft foods and eventually solid food, typically around four to six weeks post-surgery.
Lifelong adherence to specific nutritional habits is necessary, including taking daily vitamin and mineral supplements to prevent deficiencies. Patients must prioritize hydration, aiming for 48 to 64 ounces of non-carbonated, sugar-free fluids daily. Eating must be done slowly, with food chewed thoroughly, and patients must stop at the first sign of fullness to protect the stomach sleeve.