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Vertical Gastrectomy Patients
High BMI patients (BMI > 50-60): In America and Germany, this procedure was first
performed laparoscopically in very high BMI patients to try to
reduce the overall risk of weight loss surgery. Once a patients
BMI goes above 60Kg/M2, it is increasingly difficult to perform
a Roux en Y gastric bypass or a Duodenal Switch laparoscopically.
In addition, a Roux en Y gastric bypass tends to yield
inadequate weight loss for patients with a BMI greater than
60Kg/M2. The Duodenal Switch is very effective for high BMI
patients but unfortunately it can also be quite risky and may by
safer if done open. The Vertical Gastrectomy is a reasonable
solution to this problem. It can usually be done
laparoscopically in patients weighing over 500 pounds. The
stomach restriction that occurs allows these patients to lose
more than 100 pounds and in many patients more than 200 pounds.
This weight loss allows significant improvement in health and
effectively "downstages" a patient to a lower risk group. Once
the patients BMI is lower (35-40) they can return to the
operating room for the "second stage" of the procedure, which
can either be the Duodenal Switch, Roux en Y gastric bypass or
even a Lap BandŽ. Currently, results of the second stage are
very limited.
Low BMI patients (BMI 35-45 Kg/M2):
This procedure was also started in England over 5 years ago as a
stand alone weight loss procedure for anyone with a BMI greater
than 35 Kg/M2 (Johnston D. Obesity Surg 2003; 13:10-16). It
proved to be quite safe and quite effective even at 5 years. 10%
of the patients did fail to achieve a BMI below 35 at 5 years
and these tended to be the heavier patients. The same ones we
would expect to go through a second stage as noted above. Low
BMI individuals who should consider this procedure include:
Those who are concerned about the potential long term side
effects of an intestinal bypass such as intestinal obstruction,
ulcers, anemia, osteoporosis, protein deficiency and vitamin
deficiency.
Those who are considering a Lap BandŽ but are concerned about a
foreign body.
Those who have other medical problems that prevent them from
having weight loss surgery such as anemia, Crohn's disease,
extensive prior surgery, and other complex medical conditions.
People who need to take anti-inflammatory medications may also
want to consider this. Usually, these medications need to be
avoided after a gastric bypass because the risk of ulcer is
higher.
Vertical Gastrectomy: How it Works
This procedure generates weight loss soley through gastric
restriction (reduced stomach volume). The stomach is restricted
by dividing it vertically and removing more than 85% of it. This
part of the procedure is not reversible. The stomach that
remains is shaped like a banana and measures from 2-5 ounces
(60-150cc) depending on the surgeon performing the procedure.
The nerves to the stomach and the outlet valve (pylorus) remain
intact with the idea of preserving the functions of the stomach
while reducing the volume. By comparison, in a Roux-en-Y gastric
bypass, the stomach is divided, not removed, and the pylorus is
excluded. The Roux-en-Y gastric bypass stomach can be
reconnected (reversed) if necessary. Note that there is no
intestinal bypass with this procedure, only stomach reduction.
Advantages of the Vertical Gastrectomy Weight Loss Surgery
The stomach is reduced in volume but tends to function normally
so most food items can be consumed, albeit in small amounts.
Eliminates the portion of the stomach that produces the hormones
that stimulates hunger (Ghrelin).
No dumping syndrome because the pylorus is preserved.
Minimizes the chance of an ulcer occurring.
By avoiding the intestinal bypass, the chance of intestinal
obstruction (blockage), anemia, osteoporosis, protein deficiency
and vitamin deficiency are almost eliminated.
Very effective as a first stage procedure for high BMI patients
(BMI>55 kg/m2).
Limited results appear promising as a single stage procedure for
low BMI patients (BMI 35-45 kg/m2).
Appealing option for people with existing anemia, Crohn's
disease and numerous other conditions that make them too high
risk for intestinal bypass procedures.
Can be done laparoscopically in patients weighing over 500
pounds.
Disadvantages of the Vertical Gastrectomy Weight Loss Surgery
Potential for inadequate weight loss or weight regain. While
this is true for all procedures, it is theoretically more
possible with procedures that do not have an intestinal bypass.
Higher BMI patients will most likely need to have a second stage
procedure later to help lose the rest of the weight. Two stages
may ultimately be safer and more effective than one operation
for high BMI patients. This is an active point of discussion for
bariatric surgeons.
Soft calories such as ice cream, milk shakes, etc can be
absorbed and may slow weight loss.
This procedure does involve stomach stapling and therefore leaks
and other complications related to stapling may occur.
Because the stomach is removed, it is not reversible. It can be
converted to almost any other weight loss procedure.
Considered investigational by some surgeons and insurance
companies.
Vertical Gastrectomy: Risks and Complications
As with any surgery, there can be complications. This list can
include:
Deep vein thrombophlebitis 0.5%
Non-fatal pulmonary embolus 0.5%
Pneumonia 0.2%
Acute respiratory distress syndrome 0.25%
Splenectomy 0.5%
Gastric leak and fistula 1.0%
Postoperative bleeding 0.5%
Small bowel obstruction 0.0%
Death 0.25%
Post-Op Dietary Plan for Vertical Gastrectomy Weight-Loss
Surgery Patients
As with all surgical weight-loss programs, it is imperative that
VG patients adhere to a strict postoperative diet. Patients must
stick to a liquid-based diet for 2 weeks after surgery; 4-6
weeks after the operation, patients graduate to a 600-800
calorie/ day solid diet. Once goal weight is achieved, usually
1-2 years after surgery, most patients can consume about
1000-1200 calories per day.
Long-Term Weight-Loss Results
On average, patients who undergo Vertical Gastrectomy surgery
experience a 60-80% loss of excess weight. |
