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Laparoscopic Vertical Sleeve Gastrectomy

Laparoscopic vertical sleeve gastrectomy (VSG) is a restrictive procedure that can be an alternative to gastric banding, with no foreign body implantation. It can be done as a standalone procedure, or as a stage procedure for high risk patients.

Typically, the expected weight loss is approximately 45 – 70% of excess body weight, which is comparable to the gastric banding (Lap Band).  Though the degree of weight loss is more rapid and consistent within the first year.

Laparoscopic Sleeve Gastrectomy (VSG) versus Lap Band

The advantages of the VSG over the Lap Band are:

  1. It does not require the implantation of a foreign body such as a silastic ring used in gastric banding
  2. The procedure mechanically decreases the size of the stomach but also decreases the secretion of the hormone ghrelin which is responsible for the feeling of satiety (fullness).
  3. No erosion problem
  4. No band slippage resulting in prolapse associated with Lap Band

The disadvantage of VSG over Lap Band is:

  1. Small possibility of leak, resulting in infection
  2. It is not reversible.

The Operation
With this operation, the pylorus is preserved. The pylorus acts like a valve to slowly allowing food to go into the small intestine. There is no rearrangement of bowel, which means there is no dumping syndrome or marginal ulcer associated with gastric bypass.  Furthermore, the intestine is not bypassed so there is very little micronutrient deficiency.

Surgery is done with 5 to 6 small incisions. Typical hospital stay is overnight, and there is no nasogastric tube, but there is however a small drain which will be removed in 6 days in the office. Typical patient can return to work in a week, with little restriction.

Weight Loss Mechanism
The bulk of the stomach is resected, where the stomach is now fashioned into a tube with the volume about 100 cc. This decreases the volume of food intake, result in full sensation.  Decreased production of the hormone ghrelin,  which is also responsible for the feeling of fullness.

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