Bariatric, or weight-loss surgery, continues to be the most reliable long-term solution for treating morbid obesity and its associated conditions, such as type 2 diabetes, obstructive sleep apnea and hypertension.
Bariatric surgery is now embraced by most physicians and is a covered benefit for qualified patients by many insurers, including Medicare and Medicaid.
Over the years, several weight-loss procedures have been tried and abandoned. During the last decade, the big advance in the field was conversion from large open incisions to minimally invasive techniques that result in less pain, shorter hospital stays and fewer complications.
The most recent and exciting advance in the field has been a shift to the laparoscopic/robotic vertical sleeve gastrectomy (VSG). This technique results in fast, reliable weight loss without rerouting the intestines or placing any foreign devices.
Since its inception in the early 2000s in Europe, VSG rapidly became the most common bariatric procedure in the United States (2013) and worldwide, giving patients the same results as a gastric bypass but with a much better short- and long-term safety profile.
Despite the name, there is no “sleeve” or device placed. In this minimally invasive procedure, the outer, stretchy storage part of the stomach is removed. Patients’ stomachs are converted from a large 1.5-liter bag to a banana-sized tube that only holds 10 percent of what their normal stomach used to hold.
The procedure takes about an hour and patients go home the next day. Weight loss and improvement in associated medical problems, such as diabetes, are equivalent to gastric bypass. The average weight loss at six months is around 100 pounds. There is less chance of weight regain than with gastric bypass, as the valve that maintains fullness (the pylorus) is not bypassed.
Understandably, previous bariatric surgical procedures have been overshadowed by this new procedure. Lap bands essentially have been abandoned because of issues with less-than-expected weight loss and foreign body complications. Gastric bypass has lost its tremendous popularity due to its significant short- and long-term complications (vitamin deficiencies, marginal ulcers, bowel obstructions, etc.) and high rate of weight regain.
VSG offers a safe, reliable, minimally invasive and proven procedure with less risk, better weight loss, and fewer short- and long-term complications than other procedures.
Dr. G. Derek Weiss, a bariatric surgeon with Baptist Health Medical Group Bariatric Surgery, is medical director of bariatric surgery at Baptist Health Lexington.