For certain patients, in particular those with a body mass index greater than 60, the sleeve gastrectomy may be the first part of a 2-stage operation. The 2-stage operation may have substantial advantages for specific individuals.

What Are the Advantages of the "Sleeve?"
The sleeve gastrectomy has a number of advantages over other bariatric procedures:

What is a 2-Stage Operation?

Certain patients may have a body shape that makes their surgery more technically difficult. For example, patients with a BMI over 60 -- particularly those who carry their weight in their belly area -- may be at increased risk for bariatric surgery. If you fall into this category, you may benefit from a 2-Stage bariatric surgery.

In the staged approach, a multi-step operation like the gastric bypass or the duodenal switch is broken down into 2 simpler and safer operations. In the first stage, a sleeve gastrectomy is performed. This allows to lose 80 to 100 pounds or more, which will make the second part of the operation substantially safer.

The second stage operation is usually performed 8 to 12 months after the first. The "sleeve" stomach is converted into a formal gastric bypass or duodenal switch. This will permit additional weight loss and will provide a much more permanent result than sleeve gastrectomy alone.

Both stages of the surgery can be performed laparoscopically, giving the advantage of shorter recovery, shorter incisions, fewer incision-related problems and less pain.

Are There Any Disadvantages?

The sleeve may be an excellent option for you if your BMI is over 60, or if you have medical problems that would put you at excessive risk for a gastric bypass or duodenal switch (BPD-DS). However, the sleeve is usually considered to be a temporary treatment for obesity, until the second stage of the surgery is performed. Some people perceive the need for 2 separate operations as a disadvantage, despite the health benefits.

Am I a suitable candidate for the Sleeve?

We believe you would be most likely to benefit from the sleeve if:

The sleve gastrectomy is an operation to limit how much food you can eat by significantly reducing the size of your stomach (by 75% or more). The left side of your stomach is surgically removed, resulting in a new stomach which is roughly the size and shape of a banana. It is carried out laparoscopically, under a general anaesthetic, like the band, with 5 or 6 very small incisions, and is therefore much less traumatic than open surgery, with a shorter healing time and less risk. Since this operation does not involve any "rerouting" or reconnecting of the intestines, it is a simpler operation than the Gastric Bypass or the Duodenal Switch, and you’ll suffer none of the side effects experienced by bypass patients because your digestion is unaltered.

Although your stomach will be much smaller, its function remains the same and you will still be able to absorb all the vital nutrients you need without having to take supplements. You will note that there is no intestinal bypass with this procedure, only stomach reduction.  The lack of an intestinal bypass avoids potentially costly long term complications such as marginal ulcers, vitamin deficiencies and intestinal obstructions. 

The portion of your stomach which is removed is responsible for secreting Ghrelin, which is a hormone that is responsible for appetite and hunger. By removing this portion of your stomach rather than leaving it in place, the level of Ghrelin is reduced to almost zero, resulting in a significant reduction or loss of appetite.  An excellent study by Dr. Himpens in Belgium demonstrated that the food cravings in Vertical Sleeve Gastrectomy patients 3 years after surgery are much less than in Lap Band patients and this probably accounts for the comparatively greater weight loss.
The removed section of the stomach is actually the portion that “stretches” the most.  The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food.  Not only is your appetite reduced, but very small amounts of food will give you early and lasting feelings of fullness!

Most patients lose around 50% of their excess weight within the first 12 months after a sleeve gastrectomy.

The sleeve gastrectomy has a number of advantages over other bariatric procedures, and it may be a better solution for you than the Adjustable Gastric Band. Unlike the band, a sleeve gastrectomy does not require the implantation of an artificial device inside your abdomen, or frequent adjustment (filling and emptying saline solution by injection through a port under your skin)  Dr Himpens and his colleagues in Brussels have published 3 year results comparing 40 Lap-Band patients to 40 Laparoscopic Vertical Sleeve Gastrectomy patients.

The Vertical Sleeve Gastrectomy patients had a superior excess weight loss of 57% compared to 41% for the Lap Band group.