Vertical sleeve gastrectomy (VSG) is a type of bariatric surgery. The procedure, which decreases the size of a person’s stomach, aims to promote weight loss and improve overall health in people who have a body mass index (BMI) of 40 and above.
Doctors may also recommend the surgery for those who have a BMI of 30 and above as well as certain obesity-related conditions.
VSG involves reducing the stomach to a small proportion of its original size. Decreasing the size of the stomach means a person will feel full and satiated after eating significantly smaller food portions than usual.
This article describes what VSG is and who qualifies for the procedure. It also outlines the surgery itself, including the potential benefits, risks, and associated financial costs.
VSG, or laparoscopic sleeve gastrectomy (LSG), is a surgical procedure that significantly reduces the size of the stomach. The process involves
A VSG can assist with weight loss in people who are overweight. Following the procedure, weight loss may occur due to two reasons:
- Reducing the size of the stomach means people feel satiated after eating significantly reduced food portions.
- The fundus secretes the hormone ghrelin, which is partially responsible for the feeling of hunger. Removing the fundus
decreases ghrelin, which may reduce a person’s appetite.
A doctor may consider a person for VSG using the
- The person has a BMI of 40 or above.
- The person has a BMI of 35 or above and an obesity-related condition, such as:
- high blood pressure
- diabetes mellitus
- severely limiting musculoskeletal problems
- The person has a BMI of 30–35 and uncontrollable type 2 diabetes or metabolic syndrome.
- The person is experiencing difficulties in losing a sufficient amount of weight nonsurgically.
- The person’s mental health does not exclude them from the procedure.
- The person’s physical health is sufficient for them to undergo surgery.
VSG can help people lose weight within a short time.
The potential benefits
People may also experience significant improvements in a range of obesity-related diseases, including:
- type 2 diabetes
- nonalcoholic fatty liver
- heart disease
- obstructive sleep apnea
Although people may experience these benefits with other methods of weight loss surgery, VSG has some specific advantages, including:
- The procedure is straightforward and has a shorter operating time than other procedures.
- The surgery preserves the sphincter at the bottom of the stomach and
- In some cases, the procedure can act as an initial step before more drastic weight loss procedures, such as gastric bypass surgery.
- Surgeons can perform VSG in certain individuals with high-risk medical conditions.
As with any surgery, VSG carries the following risks:
A VSG may also carry specific risks, such as:
- leakage from the newly-formed stomach
- severe gastroesophageal reflux
- regaining lost weight
Overall, VSG is a fairly safe procedure. A
A VSG is a nonreversible procedure. With this in mind, people must be willing to make lifelong adaptations to accommodate their reduced stomach size.
However, many individuals who undergo bariatric surgery to reduce their stomach size regain weight over the long term. A
Experts do not understand fully the reasons why people tend to regain weight following bariatric surgery. One possibility is that the remaining stomach pouch enlarges over time. This, combined with difficulties in following an appropriate diet and exercise plan, could result in weight gain. Therefore, for VSG to be successful in the long term, individuals need to commit to permanent lifestyle changes.
Before VSG surgery, a person will receive general anesthesia, so they will be asleep throughout the procedure and be unable to feel any pain.
The VSG procedure takes around 60–90 minutes. The surgery involves the below steps.
- The surgeon creates two to five small incisions in the abdomen.
- They then insert a tiny camera, called a laparoscope, and surgical instruments into the abdomen via these incisions. The camera links to a video monitor that allows the surgeon to see inside the person’s abdomen as they perform the surgery.
- The surgeon pumps gas into the abdomen to expand the space, allowing them to perform the surgery.
- They remove a large portion of the stomach pouch and join the remaining portion with surgical staples. They then leave a long, vertical tube of the stomach intact. They also leave the sphincter muscles unaltered — these allow food to enter the stomach at the esophagus and exit the stomach into the small intestine.
- The surgeon removes the laparoscope and other tools and closes the incisions with stitches.
Since weight loss surgery can increase a person’s risk of developing gallstones, a surgeon may sometimes recommend removing the gallbladder before or during the VSG surgery, with a procedure called a cholecystectomy.
Most people stay in hospital for 1–2 nights following VSG surgery to ensure there are no serious complications. A person can go home once their surgeon has told them it is safe to do so and has scheduled a follow-up appointment.
After the surgery, an individual needs to follow a special liquid diet for several weeks. Over the following weeks and months, they can gradually move on to soft foods and eventually solid foods.
Drinking plenty of fluids is vital to avoid kidney problems, nausea, and constipation. A person must also consume around 60–100 grams of protein each day to prevent weakness and muscle loss.
The first follow-up appointment usually takes place within 2–3 weeks of the surgery. During this session, the surgeon will check the wounds to ensure they are free from infection and are healing sufficiently. They may also refer the person to a dietitian for long-term nutritional advice.
The total costs of VSG may vary considerably. A
One of the studies in the review cited a cost of $5,865 for bariatric surgery in 1998. However, the authors adjusted this for inflation and stated a cost of $8,244 for 2016.
Some medical expenses a person is likely to incur include:
- hospital admission
- laboratory testing
- operating room fees
- postsurgical costs
- medication costs
Most major insurance companies cover weight loss surgery, including VSG procedures. However, some policies may exclude weight loss surgery. Therefore, a person considering VSG will need to review their policy documents before confirming their surgery.
VSG is a keyhole surgical procedure that reduces the size of the stomach. A doctor may recommend the technique to assist weight loss in people who have a BMI of 40 or above or have a BMI of 30-35 or above and certain obesity-related conditions.
VSG is a straightforward procedure with minimal recovery times. However, the technique carries certain risks, such as stomach leakage, severe gastric reflux, and long-term weight regain.
For VSG to be successful in the long term, a person must commit to certain lifestyle changes, such as following a nutritious diet and performing regular exercise.
Some insurance policies will cover the cost of bariatric procedures such as VSG. Therefore, a person should read through their policy documents carefully before committing to such a procedure.