The Gastric Sleeve Procedure (also called Sleeve Gastrectomy, Vertical Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction, Logitudinal Sleeve Gastrectomy, Gastric Tube procedure and Vertical Sleeve Gastrectomy) was originally designed as the first stage of a two-stage procedure, with the intention to bring patients back to the operating room at a later date and perform and intestinal bypass to complete the second stage of the procedure. However, it was found that the patients who had undergone just the "sleeve" portion of the two-stage procedure lost a substantial amount of weight without the need for the second part of the planned operation. Several weight loss centers in Los Angeles began performing this operation, the sleeve gastrectomy, as a permanent weight loss procedure and, after modifying the original procedure they had performed, are now showing an even better weight loss than there was with the initial surgery.

Earlier forms of this procedure were done in Australia in 1993 by Dr. Jamieson and in England in 1996 by Dr. Johnston in 1996. The Gastric Sleeve Procedure was proposed approximately 4 years ago as an alternative to other bariatric surgery procedures and, after several modifications have been made to improve weight loss, is now being performed worldwide and at many centers in the United States. The operation is most commonly referred to as the Gastric Sleeve, the Vertical Sleeve Gastrectomy, or simply as "The Sleeve."

The Sleeve causes weight loss through much the same mechanism as the two other well-known weight loss procedures used commonly in the United States, by restricting the amount of food that a person can eat before becoming "full." By removing approximately 80% or more of the stomach, this procedure is a purely restrictive procedure. There is no bypass involved and therefore essentially no risk of malnutrition. The Sleeve is performed using minimally invasive techniques and is an excellent alternative to the other well established laparoscopic gastric bypass and the laparoscopic gastric band (Realize "Band System and Lap-Band" System). It can be used in any patient that qualifies for bariatric surgery and also for selected patients with a smaller amount of weight to lose who are not candidates for a gastric bypass.

How does sleeve gastrectomy work?

This procedure generates weight loss solely through gastric restriction (reduced stomach volume) and earlier satiety (feeling full with smaller amounts of food). The stomach is made smaller by dividing it vertically and removing approximately 80%. The procedure is not reversible. The remaining stomach is shaped like a narrow banana and is filled with approximately 3 ounces (100cc) of food. The goal is to preserve the function of the stomach while drastically reducing the volume. In comparing the Sleeve Gastrectomy to the Roux-en-Y gastric bypass, the gastric bypass will have a similar feeling of restriction but will also include dumping, which means an upset stomach after eating sweets or concentrated carbohydrates; the sleeve does not cause dumping. Also, the Roux-en-Y gastric bypass can be reversed if necessary. In comparing the gastric band to the sleeve, the gastric band involves using a device made of a plastic polymer to cause the feeling of restriction whereas there is no artificial device implanted with the sleeve procedure.

An important fact to remember is that there is no intestinal bypass with this procedure which avoids the potential long term complications such as marginal ulcers, vitamin deficiencies caused by malabsorption and intestinal obstructions. Finally, although patients report that some hunger and cravings can slowly return, an important study published in 2006 by Dr. Himpens from Belgium showed that even after three years the sensation of cravings if far less after sleeve gastrectomy than with the gastric band procedure and that many patients experienced a greater weight loss.

A final key piece of information is that the Vertical Sleeve Gastrectomy, or Gastric Sleeve, has been shown to be quite safe and quite effective for individuals with less than 100 lbs of weight to lose, meaning safe and effective for individuals with a lower BMI.

Low BMI individuals who qualify for sleeve gastrectomy procedure include:

1. Those who are concerned about the potential long term side effects of gastric bypass.
2. Those who are considering gastric band surgery but are concerned about having an artificial device attached to their stomach or who don't want to have to undergo band adjustments or are living in an area where they may have trouble finding a physician qualified to do the adjustments.
3. Those people who have unusual medical problems that make a bypass operation, or a band operation, more risky such as severe anemia, Crohn's disease, medical disease requiring frequent steroid use and other conditions.
4. People who must take ibuprofen or other anti-inflammatory medications. These medications are associated with a higher incidence of ulcer in gastric bypass patients and this doesn't seem to be the case with vertical sleeve gastrectomy