Marc Zerey, MD, is a board-certified physician specializing in bariatric weight loss and advanced laparoscopic surgical techniques. Dr. Zerey has published extensively including journal articles in American Surgeon, American Journal of Surgery, American Journal of Surgical Research and is an ASMBS Bariatric Surgery Center of Excellence designee. The Bariatric Surgery Center can be reached at (805) 898-3472.
The Sleeve Gastrectomy
by Marc Zerey, MD, CM, MSC, FRCSC, FACS
In the past few years, we've witnessed many changes in Bariatric Surgery. Ten years ago, the Lap- Band was on its way to becoming a household name and common sight on California freeway advertisements. The Lap-Band's safety profile and ability to perform laparoscopically made it very popular. The number of people undergoing gastric bypass also increased during that time as more surgeons became comfortable performing this procedure laparoscopically and insurance companies offered coverage. More recently, the vertical sleeve gastrectomy has been touted as the next "big thing" and is quickly replacing the Lap Band as the alternative to the gastric bypass.
The vertical sleeve gastrectomy is performed laparoscopically and reduces food intake by removing approximately 75% of the stomach and shaping it in a cylindrical "sleeve". This produces not only a smaller reservoir but it effectively restricts the flow of food to the intestines leading to earlier and longerlasting satiety. As a result, the patient will eat smaller portions and lose weight. Patients undergoing this procedure can reverse metabolic disorders such as Type 2 Diabetes, high blood pressure, and high cholesterol. There is no appliance or adjustments as with the Lap-Band and the gastrointestinal pathway is preserved so this avoids dumping syndrome and the absorption of vitamins, minerals, and nutrients are preserved. Drug metabolism remains unchanged which can be a concern with the gastric bypass. Finally, because the portion of the stomach that secretes hormones that stimulate appetite is removed, this may also curb a patient's hunger.
Although this procedure is gaining popularity and mediumterm data are encouraging, the long-term results are not yet known. There is concern that in a purely restrictive operation with no adjustability a patient can "stretch" their sleeve, gaining their weight back. Due to the lack of malabsorption, weight regain may also be easier with the sleeve than with the gastric bypass. There is also a probable higher leak rate and higher rate of bleeding than with the gastric bypass given the longer staple line. Finally, the sleeve gastrectomy is not reversible since part of the stomach is removed and not excluded as in the gastric bypass.
There is no single perfect surgical procedure for weightloss. They all have their individual pros and cons but in the informed and motivated patient, these procedures are excellent tools for helping you lose weight and achieve a healthier life. If you are considering weight-loss surgery, I invite you to attend an upcoming seminar discussing obesity and weight-loss surgery.
Patient Education Seminars: New Innovations in Weight-Loss Surgery
If you are 80 pounds or more overweight and have been unsuccessful with other weight-loss alternatives, you owe it to yourself to find out about innovative new treatments. Meet Dr. Marc Zerey at an informative seminar on weight-loss surgery.