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Vertical Sleeve Gastrectomy—Laparoscopic

(Sleeve Gastrectomy—Laparoscopic; VSG—Laparoscopic)

Definition

Vertical sleeve gastrectomy (VSG) is surgery to decrease the size of your stomach.
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:

What to Expect

Prior to Procedure

You may have the following:
  • Physical exam and review of medical history
  • Blood test and other tests
  • Meetings with a registered dietitian
  • Mental health test and counseling
Prior to the procedure:
  • Talk to your doctor about any medications, herbs, and dietary supplements you are taking. You may be asked to stop taking some medications up to one week before the procedure, like:
    • Anti-inflammatory drugs
    • Blood thinners
    • Antiplatelets
Before the procedure:
  • You may be given antibiotics.
  • You may be given laxatives or an enema.
  • Arrange for a ride to and from the hospital. Arrange for help at home.
  • The night before, eat a light meal. Do not eat or drink anything after midnight.

Anesthesia

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

Description of the Procedure

An IV line will be placed in your arm to give you fluid and medications. A breathing tube will be placed through your mouth and into your throat. This will help you breathe during surgery. You will also have a catheter placed in your bladder to drain urine.
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 two 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
  • 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
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
For a smooth recovery:
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Do not drive or lift anything heavy for at least two weeks or until advised by your doctor.
  • Take walks daily.
  • Your doctor may recommend that you meet with a therapist to help you deal with emotional changes after surgery.
  • Follow your doctor’s instructions.
You should be able to return to normal activities in 2-3 weeks.
For good nutrition:
  • Eat a clear liquid diet for about one week.
  • Begin with 4-6 small meals per day. A meal is two 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

Call your doctor if any of these occur:
  • 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 and/or vomiting
  • Pain and/or swelling in your feet, calves, or legs; sudden shortness of breath or chest pain
  • New or worsening symptoms
If you think you have an emergency, call for medical help right away.

RESOURCES

American Society for Metabolic and Bariatric Surgery http://asmbs.org

Weight Control Information Network http://www.win.niddk.nih.gov

CANADIAN RESOURCES

Canadian Obesity Network http://www.obesitynetwork.ca

Weight Loss Surgery http://www.weightlosssurgery.ca

References

Bariatric surgery. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 2, 2013. Accessed December 8, 2013.

Gastric sleeve. University of California, San Diego Health System website. Available at: http://health.ucsd.edu/specialties/surgery/bariatric/weight-loss-surgery/gastric-sleeve/Pages/default.aspx. Accessed December 8, 2013.

Laparoscopic sleeve gastrectomy. Cleveland Clinic website. Available at: http://weightloss.clevelandclinic.org/Sleevegastrectomy.aspx. Accessed December 8, 2013.

Sleeve gastrectomy. Virginia Mason Medical Center. Bariatric Surgery Center of Excellence website. Available at: https://www.virginiamason.org/SleeveGastrectomy. Updated October 2010. Accessed December 8, 2013.

Sleeve gastrectomy. Yale New Haven Health website. Available at: https://www.greenhosp.org/upload/docs/FactSheets/English/bariatrics%5Fsleeve.pdf. Updated May 2011. Accessed December 8, 2013.

Weight loss surgery. North Shore Medical Center website. Available at: http://nsmcweightloss.org/web/surgical%5Fprocedures.aspx. Accessed December 8, 2013.

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