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Sleeve Gastrectomy (Gastric Sleeve): Comprehensive Guide to Procedure, Outcomes, and Lifelong Management

Vertical sleeve gastrectomy (VSG) is a restrictive bariatric procedure removing ~75–80% of the stomach, creating a tubular gastric sleeve (100–150 mL). It is now the most common bariatric surgery worldwide.

Procedure

  • Laparoscopic (5 ports); longitudinal resection along greater curvature using stapler (4.8 mm staples, triple-staggered).
  • Bougie calibration (32–40 Fr) ensures consistent sleeve diameter.
  • No intestinal rerouting → no malabsorption (unlike RYGB).
  • Operative time: 60–90 min; hospital stay: 1–2 days.

Mechanisms of Action

  1. Restriction: Small sleeve limits meal volume; early satiety via gastric distension receptors.
  2. Neurohormonal: Fundus resection ↓ ghrelin (hunger hormone); ↑ GLP-1, PYY (satiety hormones); improved insulin sensitivity.
  3. Gastric emptying acceleration: Faster nutrient delivery to distal bowel enhances incretin effect.

Weight Loss Outcomes

  • %EWL (Excess Weight Loss): 55–70% at 1–2 years; ~50% at 5+ years.
  • %TWL (Total Weight Loss): 25–30% at 1 year.
  • Superior to band; slightly less than RYGB at 5 years but with fewer nutritional complications.

Comorbidity Resolution

  • T2DM remission: 60–70% (lower than RYGB's 80% but significant).
  • Hypertension: 60–70% improvement/resolution.
  • OSA: 80%+ resolution.
  • NAFLD/NASH: Histologic improvement.

Risks and Complications

  • Early: Staple line leak (1–2%), bleeding, stricture (2–5%), VTE, abscess.
  • Late: GERD (new/worsened 20–30%), sleeve dilation, nutritional deficiencies (B12, Fe, D, folate—less than RYGB), incisional hernia.

Eligibility

  • BMI ≥40, or ≥35 with comorbidities.
  • Failed nonsurgical attempts.
  • No severe GERD/Barrett's (relative contraindication).
  • Commitment to follow-up and supplementation.

Postoperative Protocol

  • Diet: Clear liquid → full liquid → pureed → soft → regular (6–8 weeks).
  • Supplements: Daily multivitamin, calcium citrate, B12, D, iron (menstruating women).
  • Labs: 3, 6, 12 months, then annually.
  • Behavioral: Mindful eating, protein priority (60–80g/day), hydration, exercise.

VSG offers excellent risk-benefit profile but requires lifelong adherence. Choose an MBSAQIP-accredited program.

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