Vertical Sleeve Gastrectomy—Laparoscopic

(Sleeve Gastrectomy—Laparoscopic; VSG—Laparoscopic)

by Sarah J. Kerr, BA

Definition

Vertical sleeve gastrectomy (VSG) is surgery to decrease the structure and size of your stomach. This restricts the amount of food you are able to consume.

The Stomach

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This surgery involves re-shaping the stomach to reduce the amount of food it can hold.
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

Body mass index (BMI) is used to determine if a person is overweight or obese. A normal BMI is 18.5 to 25. This surgery is an option for people with:

  • BMI over 40
  • BMI 35-39.9 and a life-threatening condition or physical limitations that affect employment, movement, and family life

If lifestyle changes are made, the benefits of VSG include:

  • Weight reduction
  • Improvement in many obesity-related conditions
  • Improved movement and stamina
  • Enhanced mood and self-esteem

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Stitches or staples may loosen
  • Pouch stretches or leaks
  • Bleeding
  • Infection
  • Reaction to anesthesia
  • Heart attack
  • Blood clots
  • Nausea, vomiting

Long-term complications include vomiting and developing gallstones.

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

  • Smoking
  • Drinking
  • Chronic disease such as diabetes

What to Expect

Prior to Procedure

Each bariatric surgery program has specific requirements. Your program will likely include the following:

  • Physical exam and review of medical history
  • Blood test and other tests
  • Meetings with a registered dietitian
  • Mental health test and counseling

Leading up to your procedure:

  • Talk to your doctor about your medications, herbs, and dietary supplements. You may be asked to stop taking some medications up to one week before the procedure.
  • Do not start any new medications, herbs, or supplements without talking to your doctor.
  • Arrange for a ride to and from the hospital.
  • Arrange for help at home as you recover.
  • You may be given antibiotics.
  • You may be given laxatives and/or an enema to clear your intestines.
  • The night before, eat a light meal. Do not eat or drink anything after midnight unless told otherwise by your doctor.
  • Shower or bathe the morning of your surgery.

Anesthesia

General anesthesia will be given through an IV. It will block pain and keep you asleep through surgery.

Description of the Procedure

Several small cuts will be made in your abdomen. Gas will be pumped in to inflate your abdomen, making it easier for the doctor to see. A laparoscope and surgical tools will be inserted through the incisions. A laparoscope is a thin, lighted tool with a tiny camera. It sends images of your abdominal cavity to a monitor. Your doctor will operate while viewing the monitor.

Surgical staples will be used to divide the stomach vertically. The new stomach will be the shape of a slim banana. The rest of the stomach will be removed. Your new stomach can hold 50-150 mL (milliliters) of food—about 10% of what a normal adult stomach can hold. Incisions will be closed with staples or stitches.

In some cases, the doctor may need to switch to open surgery.

Immediately After Procedure

The breathing tube and catheter will be removed.

How Long Will It Take?

About 2 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is 2-3 days.

Post-procedure Care

At the Hospital

You can expect the following:

  • A small tube with a camera may be used to look down your throat and into your stomach to check for problems.
  • You will receive nutrition through an IV, but then slowly start eating again.

In the hospital, you may be asked to:

  • Use a device called an incentive spirometer to prevent breathing problems
  • Wear elastic surgical stockings or boots to promote blood flow in your legs
  • Get up and walk daily

Your bowels will work more slowly than usual. Chewing gum may help speed the process of your bowel function returning to normal.

Preventing Infection

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chance of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision

At Home

You will need to practice lifelong healthy eating and exercising habits. After your surgery:

  • Do not lift anything heavy for at least 2 weeks.
  • You may have emotional changes after this surgery. Your doctor may refer you to a therapist.
  • You will meet regularly with your healthcare team for monitoring and support.

For good nutrition:

  • Eat a clear liquid diet for about 1 week.
  • Begin with 4-6 small meals per day. A meal is 2 ounces of food.
  • Your diet will progress from soft, pureed foods to regular foods.
  • Solid food must be well-chewed.
  • Get enough protein.
  • Do not eat too much or too quickly.
  • Avoid high-calorie foods.
  • Avoid dehydration by drinking fluids before or after meals.

Call Your Doctor

Contact your doctor if your recovery is not progressing as expected or you develop complications such as:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Persistent cough, shortness of breath, or chest pain
  • Worsening abdominal pain
  • Blood in the stool
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
  • Persistent nausea or vomiting
  • Pain and/or swelling in your feet, calves, or legs
  • New or unexpected symptoms

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

American Society for Metabolic and Bariatric Surgery
https://asmbs.org
National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov

CANADIAN RESOURCES:

HealthLink BC
https://www.healthlinkbc.ca
Weight Loss Surgery
https://weightlosssurgery.ca

References:

Bariatric surgery. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T483434/Bariatric-surgery . Updated October 23, 2017. Accessed December 22, 2017.
Bariatric surgery. Merck Manual Professional Version website. Available at:
...(Click grey area to select URL)
Updated December 2016. Accessed December 22, 2017.
Bariatric surgery. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/weight-management/bariatric-surgery. Accessed December 22, 2017.
Gastric sleeve or sleeve gastrectomy. UC San Diego Health website. Available at: https://health.ucsd.edu/specialties/surgery/bariatric/weight-loss-surgery/gastric-sleeve/Pages/default.aspx. Accessed December 22, 2017
Gastric sleeve surgery. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/departments/bariatric/treatments/gastric-sleeve. Accessed December 22, 2017.
Sleeve gastrectomy. Virginia Mason Medical Center website. Bariatric Surgery Center of Excellence website. Available at: https://www.virginiamason.org/sleeve-gastrectomy. Accessed December 22, 2017.
Weight management procedures. North Shore Medical Center website. Available at: https://nsmc.partners.org/weight_management/procedures. Accessed December 22, 2017.
3/23/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed... : Short V, Herbert G, Perry R, et al. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev. 2015;(2):CD006506.
Last reviewed November 2018 by EBSCO Medical Review Board Marcin Chwistek, MD
Last Updated: 3/23/2015

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