Currently the Vertical Sleeve is by far the most common procedure performed by Dr. Bellanger, and is the procedure most often recommended for patients. A vertical sleeve gastrectomy (LSG) is a partial gastrectomy that involves resection of the majority of the body, fundus and antrum of the stomach, leaving approximately an 80 – 160 cc “tube” of stomach adjacent to the lesser curve. It is sometimes referred to as a Vertical Sleeve gastrectomy, or simply “The Sleeve”.
The general belief is that the weight loss following sleeve gastrectomy is primarily due to the restrictive effect of the size of the pouch but there are probably additional, yet undefined, effects on gastric emptying and GI hormones.
The sleeve procedure came to be when, in order to reduce morbidity and improve outcomes in the highest risk patient populations, some surgeons elected to stage the Laparoscopic Roux–en-Y Gastric Bypass (LRYGB) or Duodenal Switch (LDS) procedures into two separate procedures. A Laparoscopic Sleeve Gastrectomy is performed in the first stage. At a specified time interval or weight loss after undergoing LSG the patient then undergoes the second stage, the intestinal bypass portion of a LDS or LRYGB.
The clinical results of weight loss and co-morbidity resolution associated with the LSG procedure has prompted some surgeons to defer the second stage for some patients as well as offer LSG as a stand alone procedure for patients with lower BMI’s. Dr. Bellanger primarily uses the sleeve gastrectomy as a stand-alone procedure.
Current clinical evidence reflects short-term outcomes: Excess Weight Loss (EWL) at 12 months of 45% to 63% with significant comorbidity improvement or resolution. Some studies have shown three-year results of patients with BMI < 55 comparable to LRYGB, the long-term durability of the weight loss or co-morbidity resolution associated with the procedure has not yet been fully established.