Health & Medicine

Having most of stomach removed among surgical weight-loss options

According to the Centers for Disease Control and Prevention, two-thirds of Americans are overweight, and more than 100 million are obese. Morbid obesity is defined as having a body mass index, or BMI, greater than 35, or being at least 80 pounds overweight. Kentucky is the sixth-most obese state in the nation, with an obesity rate greater than 35 percent.

In addition to a decreased life expectancy, increased risk of heart disease and cancer, and overall decreased quality of life, morbid obesity is associated with multiple illnesses such as diabetes, high blood pressure, high cholesterol, obstructive sleep apnea, arthritis and fertility problems.

For select motivated patients, weight-loss (bariatric) surgery provides a tool that can result in improved quality of life and resolution or improvement in many of these medical problems. Most people are familiar with gastric bypass, and maybe even adjustable gastric bands such as the Lap-Band, but there is a relatively new procedure, the vertical sleeve gastrectomy, or VSG, that has revolutionized weight-loss surgery.

The vertical sleeve results in weight loss similar to gastric bypass without many of the complications of gastric bypass and without the need for a foreign body band or adjustments as with adjustable gastric banding. The name of the procedure is misleading in that no "sleeve" is placed. Rather, through small laparoscopic incisions, the outer 85 percent of the stomach is surgically removed, turning the stomach from a large storage reservoir into a small tube, about the size of a banana.

Patients are left with their own stomachs, but they hold only 10 percent of what a normal stomach would hold. The natural connections of the stomach to the esophagus and to the small intestine are left undisturbed. There is no rerouting of the intestines. The procedure takes about one hour, and patients usually stay in the hospital one to two days and may return to full activities within three weeks.

Initially, the sleeve was designed as a first-step procedure in high-risk patients. It has since been performed as a primary weight-loss surgery for about eight years.

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