Last updated: 11/24/2009
The primary alternative to vertical sleeve gastrectomy is weight control through proper diet, a safe and reasonable exercise program and possibly psychological/psychiatric interventions. In some cases pharmacological weight loss remedies may...
be tried as an alternative to surgery, but many approved drugs are associated undesirable side effect profiles.
The primary surgical alternative to vertical sleeve gastrectomy is adjustable gastric banding. This procedure involves placing a cuff around the stomach which physically limits the size of meal that can be ingested. While it does involve subsequent adjustment, either loosening or tightening, gastric banding is reversible while vertical sleeve gastrectomy is not. Both adjustable gastric banding and vertical sleeve gastrectomy need to be considered fully before either one is chosen.
The other surgical alternatives that exist are malabsorption and mixed bariatric surgeries. These include gastric bypass and duodenal switch procedures, or a combination approach involving vertical sleeve gastrectomy with duodenal switch. The malabsorption approaches are usually associated with higher complication rates and eventual side effects including dumping syndrome and vitamin deficiencies. While the weight loss achieved with these malabsorption surgeries can be profound, they require a detailed knowledge of complications up front so that patients can make an informed decision. Of note, in the very severely obese patient, malabsorption surgeries may not be an option due to the unfavorable/unacceptable complication rate.
Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach, following the major curve. The open edges are then attached together (often with surgical staples) to form a sleeve or tube with a banana shape. The procedure permanently reduces the size of the stomach. The procedure is performed laparoscopically and is not reversible.
Sleeve gastrectomy is usually performed on extremely obese patients, with a body mass index of 40 or more, where the risk of performing a gastric bypass or duodenal switch procedure may be too large. A two-stage procedure is performed: the first is a sleeve gastrectomy, and the second is a conversion into a gastric bypass or duodenal switch. Patients usually lose a large quantity of their excess weight after the first sleeve gastrectomy procedure alone, but if weight loss ceases the second step is performed.
For patients that are obese but not extremely obese, sleeve gastrectomy alone is a suitable operation with minimum risks. Some surgeons even prefer it over gastric banding, because it eliminates the need of having to insert a foreign body.The sleeve gastrectomy currently is acceptable weight loss surgery option for obese patients as a single procedure. Most surgeons prefer to use a bougie between 32 - 40 Fr with the procedure and the approximate remaining size of the stomach after the procedure is about 2 ounces.