Bariatric Surgery: Vertical Sleeve Gastrectomy

Front view of stomach and first part of small intestine. Stomach has been cut to form small pouch at top. Rest of stomach is removed. Staples close off cut edges. Arrow shows path of food from small pouch to small intestine.

Bariatric surgery is a procedure that helps you lose weight. During vertical sleeve gastrectomy, approximately 80% of the stomach is removed. The part of the stomach that is removed is thinner than the rest of the stomach and stretches out when you eat to hold all the food. The part of the stomach that is not removed is a narrow "sleeve." This sleeve does not stretch very much and can hold only a few tablespoons of food. Food passes slowly through a narrow opening at the bottom of the stomach called the pyloric valve, and food empties out like it does before surgery.This procedure produces changes in hormones that reduce appetite. In the sleeve gastrectomy, the surgery is only on the stomach and is not on the small bowel. 

The procedure

This surgery can be done using one or two approaches:

  • For laparoscopic surgery, small incisions are made in your upper stomach. During the procedure, a tiny camera sending images to a monitor and thin surgical instruments are inserted through these small incisions. The surgeon operates by looking at the organs on a video monitor. Almost all sleeve gastrectomy procedures are now done laparoscopically. 

  • For open surgery (also called laparotomy), one larger incision is made in the middle of the upper stomach. The surgeon sees and works through this incision. Most cases are not done this way because the laparoscopic approach, if possible, involves smaller cuts, less tissue damage, and fewer problems. 

Using either type of approach, the stomach is cut lengthwise (up and down) with a stapling instrument. The larger part of the stomach is removed. The side of the remaining stomach (the sleeve) is closed off with staples made out of titanium.

This creates a narrower, smaller-volume stomach in the shape of a banana, or a sleeve. 

Special note: the gallbladder

Bariatric surgery is designed to cause a large amount of weight loss. Weight loss can cause gallstones. If you already have gallstones, the gallbladder may be removed during your surgery or at a later date to prevent gallbladder problems from developing. 

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