The Vertical Sleeve Gastrectomy (VSG), often called “the sleeve,” is a restrictive bariatric procedure for treating severe obesity. It permanently reduces stomach volume, significantly limiting the amount of food an individual can consume. This surgery is a powerful tool for weight loss and is often associated with the improvement or resolution of numerous obesity-related health conditions.
Defining Vertical Sleeve Gastrectomy
Vertical Sleeve Gastrectomy is a surgical procedure that permanently changes the anatomy of the stomach. The surgeon removes approximately 75 to 80% of the stomach along its greater curvature, leaving a narrow, tube-like structure that resembles a banana or sleeve. This smaller stomach capacity restricts food intake, leading to a feeling of fullness after consuming much less food than before the operation.
The procedure is typically performed laparoscopically, which involves making several small incisions in the abdomen to insert specialized surgical instruments and a camera. This minimally invasive approach generally results in a shorter hospital stay and a quicker recovery time compared to traditional open surgery. While the primary effect is the physical restriction of food, VSG also produces significant hormonal changes that aid in weight loss.
The part of the stomach removed includes the fundus, the primary site of ghrelin production, often called the “hunger hormone.” Removing this section leads to a substantial decrease in circulating ghrelin levels shortly after surgery, which helps suppress appetite and reduce hunger. The anatomical changes also accelerate the movement of food into the small intestine, leading to beneficial changes in other gut hormones, such as GLP-1 and PYY, which further enhance satiety.
Qualification Criteria for VSG
A patient must meet specific, standardized medical requirements to be considered a candidate for VSG. The most common metric used for initial evaluation is the Body Mass Index (BMI), which is a measure of body fat based on a person’s height and weight. Generally, individuals qualify for the procedure if they have a BMI of 40 or higher, which is classified as severe obesity.
A person with a lower BMI may also qualify if they have significant weight-related health issues, also known as comorbidities. Specifically, a BMI between 35 and 39.9, combined with at least one major health condition like Type 2 diabetes, severe sleep apnea, or high blood pressure, often meets the standard for eligibility. In some cases, a person with a BMI as low as 30 to 34.9 may be considered if they have poorly controlled Type 2 diabetes.
Beyond the physical metrics, candidates must demonstrate a history of unsuccessful attempts at supervised weight loss using non-surgical methods. A comprehensive psychological and nutritional evaluation is also required to ensure the patient is prepared for the lifelong dietary and lifestyle changes. The patient must also show a commitment to regular follow-up care and medical monitoring.
Immediate Post-Surgical Recovery and Dietary Stages
The period immediately following VSG involves a brief hospital stay, typically lasting between one to three days, where pain management and hydration are closely monitored. The initial recovery focuses on allowing the newly stapled stomach to heal without stress, which necessitates a strictly controlled, staged diet progression. This dietary roadmap is critical for safe healing and for teaching the patient how to eat with their new, smaller stomach.
The initial recovery requires a strictly controlled, staged diet progression to allow the newly stapled stomach to heal safely.
- Clear liquids: Begins immediately after surgery, focusing on hydration with water, broth, and sugar-free gelatin.
- Full liquids: Starts after about one week, introducing nutrient-dense options like protein shakes and thin cream soups to meet protein requirements.
- Pureed stage: Occurs around two to four weeks post-operation, requiring foods to be blended to a smooth consistency, such as soft fish, scrambled eggs, and cottage cheese.
- Soft foods: Typically begins by the fourth to sixth week, allowing easily mashed items like well-cooked vegetables and ground lean meats.
Throughout all stages, patients must take small bites, chew thoroughly, and stop eating at the first sign of fullness to avoid discomfort.
Long-Term Health and Weight Management
VSG provides significant long-term health benefits. Patients often experience the resolution or substantial improvement of numerous obesity-related comorbidities, including Type 2 diabetes, which frequently goes into remission, and hypertension, often allowing for a reduction in medication. The procedure is highly effective, with patients typically achieving a loss of 60 to 70% of their excess body weight within the first year to 18 months.
Sustaining these results requires a permanent shift in lifestyle habits and a dedicated commitment to a structured nutritional plan. The small stomach size means patients must prioritize nutrient-dense foods, particularly lean protein, to meet their daily requirements within limited portion sizes. Eating quickly or consuming foods high in sugar and fat can lead to physical discomfort and may hinder long-term weight maintenance.
A fundamental requirement for long-term health is the lifelong adherence to a vitamin and mineral supplementation regimen. Although VSG is not considered a malabsorptive procedure, reduced food intake and changes in stomach acid production increase the risk of micronutrient deficiencies. Patients must consistently take a multivitamin, along with specific supplements like calcium, Vitamin D, and Vitamin B12, to prevent serious health issues such as anemia or bone disease. Regular blood tests and follow-up appointments with a bariatric team are necessary to monitor nutritional status and ensure continued success.