Sleeve Gastrectomy in Santa Rosa, California

We are pleased to announce the addition of Sleeve (Vertical) Gastrectomy to the procedures offered at Healthy Steps Weight Loss Center.  The sleeve gastrectomy is performed laparoscopically, just as our roux en-Y gastric bypass, and adjustable gastric band procedures are done.  It offers a combination of restriction, and hormonal mechanisms of action, filling a position  between the gastric bypass and gastric band.

The sleeve gastrectomy has historically been a component of the biliopancreatic diversion with duodenal switch.  Many centers were performing this operation in stages for super morbid obese patients too sick to tolerate the entire procedure at one time. These patients first underwent sleeve gastrectomy, which resulted in significant rapid weight loss and improvement in medical status.  This allowed the patients to then undergo the "duodenal switch" portion.  Some patients, however, did so well with just the sleeve gastrectomy that they never underwent the second stage.  These findings prompted researchers to examine sleeve gastrectomy as a stand-alone operation.  We now have several high quality early studies that report weight loss somewhere between 50-70% excess weight loss, at one to three years.  Five year data is emerging showing durability of this result.  Medical co-morbidities such as diabetes, sleep apnea, and hypertension improve as weight is lost.

 

To understand the procedure one must think of the stomach as having two parts.  One part, the "fundus" or "body", can stretch to the size of a football to accommodate storage of a meal while initial breakdown by stomach acid occurs.  This part also secretes a hormone called "ghrelin" which tells the brain one is hungry.  The other part of the stomach is called the "antrum".  This portion is involved in mixing, and pumping the food to the duodenum.  Sleeve gastrectomy involves removing most of the body of the stomach, but preserving the antrum.  After the procedure the patient can only hold a small amount of food at a time.   Additionally, there is a loss of ghrelin resulting in less hunger.

As above, there is very good three year data now published on this operation as a stand-alone procedure.  Complications are uncommon, but include leak from staple lines, stricture, esophageal reflux, and others.  Since there is no bypass segment, there are no malabsorption complications.  Since the stomach is otherwise intact there is less ulcer risk.  This may make it an especially good operation for patients on non steroidal anti inflammatory drugs "NSAIDs" needing to rapidly lose significant weight before a hip or knee replacement surgery.  An additional benefit is that the sleeve gastrectomy can be converted to a roux en Y gastric bypass if needed.  

Even though the sleeve gastrectomy has a long history as part of the duodenal switch, the lack of long term data as a solo operation makes it still classified as experimental by many insurance companies.  Because of this, we will offer this only to carefully selected patients who we will study carefully to evaluate results.   Although it is the "new kid on the block" we are excited to see this procedure mature.