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Vertical Gastrectomy most effective for morbid obesity
 According to a year long study, while all types of
obesity-related surgery are risky and a last option for most
obese people,
particularly older patients, vertical gastrectomy is preferred over three other
methods (especially for those over 50).
The stomach is the digestive organ that is
connected between the esophagus and the small intestine. Food enters the stomach
through the esophagus where it is broken down and then transferred to the small
intestine where the nutrients are absorbed. Vertical gastrectomy (surgical
removal of all or part of the stomach.) removes up to 95 percent of the stomach
and leaves behind a thin tube-like stomach roughly 2 ounces (60 milliliters) in
volume.
The other three types of surgery in order of the
average amount of weight loss that resulted were
Roux-en-Y gastric bypass, in which most of the stomach is sectioned off by a
line of staples and part of the small intestine bypassed to inhibit the
absorption of calories; duodenal switch, in which a large
portion of the stomach is removed and the small intestine rearranged; and
lap-band surgery, in which a silicone band is placed around the upper section of
the stomach to shrink the stomach's size and slow the exit of food.
The Vertical Gastrectomy is a reasonable solution
to morbid obesity (BMI greater than 60Kg/M2). 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 LapBandŽ.
 The Vertical Gastrectomy procedure is also called
vertical Sleeve Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy,
Gastric Reduction and even Vertical Gastroplasty. The excess stomach volume is
removed, not left in place. This possibly eliminates most Ghrelin hormone
production and helps to reduce the sensation of
hunger that people have.
In this gastric restrictive procedure the stomach
is segmented along its vertical axis. To create a durable reinforced and
rate-limiting stoma at the distal end of the pouch, a plug of stomach is removed
and a propylene collar is placed through this hole and then stapled to itself.
Because the normal flow of food is preserved,
metabolic complications are rare.
Vertical banded gastroplasty may be performed using an open or laparoscopic
approach.
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. 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.
Complications include esophageal reflux, staple
line disruption, and dilation or obstruction of the stoma, with the latter three
requiring reoperation. Dilation of the stoma is a common reason for weight
gain. While this procedure was once the most common kind of gastric restrictive
procedure performed in this country, it has fallen out of favor due to a high
reoperation rate.
Post-Op Dietary Plan for Vertical Gastrectomy Weight-Loss Surgery Patients
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.
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