Sleeve Gastrectomy for Weight Loss

(September 2008) - In addition to the Roux-en-Y gastric bypass and laparoscopic adjustable gastric band (lap band), Memorial Health Bariatrics now offers sleeve gastrectomy for weight loss.

Like the lap band, the sleeve is a purely restrictive procedure. The stomach is remodeled and a large portion is removed. The remaining stomach is shaped like a thin tube with a pouch at the bottom. The pouch holds the same amount of food as the pouch created by the lap band or the bypass. The stomach remains attached in its normal fashion to the intestines. The pylorus, a muscular valve at the bottom of the stomach, is left in place. This helps to prevent “dumping.”

Sleeve gastrectomy removes the portion of the stomach that stretches the easiest. However, the remaining portion can still be stretched over time, so measuring food portion is essential. As is the case with other forms of weight-loss surgery, careful eating habits and exercise patterns are vital for long-term success.

Sleeve gastrectomy does have some distinct advantages, including:

·Sleeve patients do not require adjustment after surgery.
·There is no implanted device to fail or become infected.
·Intestinal obstruction is very rare.
·There are not many issues with vitamin deficiency.

The exception is that sleeve patients cannot produce enough intrinsic factor to process vitamin B12, so those supplements are necessary for life.

As with any procedure, there are some risks to consider. Sleeve gastrectomy is irreversible and does carry a small risk of leaking in the early post-operative period.

Sleeve gastrectomy is not a new procedure. It is actually the first step in duodenal switch. However, duodenal switch patients had such great initial weight loss that the second stage of the procedure was often abandoned. This gave rise to the idea of using the sleeve as a stand-alone procedure.

Many insurance companies still consider it to be an unproven procedure, just as the lap band was considered unproven several years ago.

Unfortunately, this means it is not currently covered by most policies. However, as more long-term data becomes available, I’m confident the sleeve will acquire the coverage now seen for lap band and gastric bypass. We’re pleased to offer this additional weight-loss option.

Oliver Whipple, M.D., is a board-certified bariatric surgeon practicing at Memorial Health Bariatrics. He is specially trained to perform the Roux-en-Y gastric bypass procedure and the adjustable gastric band laparoscopically. This article first appeared in the Fall 2008 issue of The Path newsletter produced by Memorial Health Bariatrics.