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The Vertical Sleeve Gastrectomy With Or Without Duodenal Switch

Donald Saunders

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Although the vertical gastrectomy, also referred to as the vertical sleeve gastrectomy or simply sleeve gastrectomy, is less commonly performed than many other types of weight loss surgery, there are nonetheless circumstances in which it is the preferred option for a patient.

Despite the fact that there have been many advances in weight loss surgery in recent years, particularly with the introduction of laparoscopic techniques and such operations as adjustable gastric banding, for many patients these are simply not an option.

For example, although the traditional Roux-En-Y operation, which combines both restriction of the stomach and bypass of the intestine, is still considered by many people to be the ideal form of gastric bypass surgery, giving good weight loss, reasonably low weight regain and relatively few complications, it is not always considered suitable for people who are excessively obese. In addition, it is very difficult to carry out the bypass in this type of surgery laparoscopically in excessively obese patients and many doctors consider that this carries too high a risk.

One alternative for patients with a very high BMI (typically in excess of 60) is the vertical sleeve gastrectomy with duodenal switch. Here however the operation is often performed as two separate procedures.

In the first instant a vertical gastrectomy is performed and this can normally be carried out laparoscopically even in very high BMI patients. This will often result in a weight loss of as much as 100 to 200 pounds (bear in mind that a very high BMI patient typically start with a weight in excess of 500 pounds) and, while this will still leave patients classed as being morbidly obese, this initial weight loss then makes it possible to carry out further surgery.

Thus, the second stage of the operation is the addition of the duodenal switch bypass which, at the patient's reduced weight, can often once more be performed laparoscopically.

Although there are differences between the vertical sleeve gastrectomy with duodenal switch and the Roux-En-Y gastric bypass operation there are also considerable similarities. The fact that the sleeve gastrectomy can be performed as a two-stage operation effectively means that excessively obese patients can now have the benefits of the traditional Roux-En-Y but can also enjoy the added benefits of modern laparoscopic operating techniques. provides information and advice on all aspects of gastric bypass surgery including the vertical gastrectomy and the vertical sleeve gastrectomy with duodenal switch.


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