Health Information

Vertical Sleeve Gastrectomy-Open

(Sleeve Gastrectomy—Open; VSG—Open)

Definition

Vertical sleeve gastrectomy (VSG) is a surgery to decrease the size of the stomach.
The Stomach
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This surgery involves re-shaping the stomach to reduce the amount of food it can hold.
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Reasons for Procedure

Body mass index (BMI) determines if a person is overweight or obese. A normal BMI is 18.5-25. This surgery is an option for people with:
  • BMI greater than 40
  • BMI 35-39.9 and a life-threatening condition or severe physical limitations that affect employment, movement, and family life
If lifestyle changes are made, the benefits of VSG include:
  • Weight reduction
  • Improvement in 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 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 done:
  • Physical exam and review of medical history
  • Blood test and other tests to check your health
  • Meetings with a registered dietitian
  • Mental health test and counseling
Prior to the procedure:
  • Talk to your doctor about your medications, herbs, and dietary supplements. You may be asked to stop taking some medications up to one week before the procedure, like:
    • Anti-inflammatory drugs
    • Blood thinners
    • Antiplatelets
  • You may be given antibiotics.
  • You may be given laxatives or an enema.
  • Arrange for a ride to and from the hospital.
  • 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 the surgery.

Description of the Procedure

An IV will be placed in your arm to give you fluids 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.
An 8-10 inch incision will be made to open the abdomen. Surgical staples will 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.
Staples or stitches will be used to close the incision.

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 4-6 days. If there are any problems, you will need to stay longer.

Post-procedure Care

At the Hospital
  • A small thin tube with a camera will be used to look down your throat and into your stomach to check for problems.
  • You will receive nutrition through an IV at first, but slowly start eating again.
While 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.
  • Walk every day.
  • Your doctor may recommend that you meet with a therapist to discuss emotional changes after surgery.
  • Follow your doctor’s instructions.
Return to normal activities in 2-3 weeks.
For good nutrition:
  • Eat a clear liquid diet for about one week or as advised by your doctor.
  • You will begin with 4-6 small meals per day. A meal is two ounces of food.
  • 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.

Revision Information