The sleeve gastrectomy is a newer weight reduction procedure that combines mechanical restriction and neurohormonal effects to help patients achieve significant weight loss. The procedure is very straightforward. Eighty-five percent of the stomach is removed leaving a narrow stomach tube or “vertical sleeve” for the passage of food. There is no rearrangement of the intestines. The vagus nerves that innervate the stomach and pyloric valve that regulates outflow of food from the stomach are left intact.
The sleeve gastrectomy procedure evolved from a two part malabsorption procedure called the duodenal switch (DS). In the DS procedure, a fairly wide gastric sleeve was created, and the small intestine was rearranged to cause calorie malabsorption. Some surgeons opted to perform the DS in two stages for safety reasons. The sleeve was constructed first. Then after initial weight loss the intestinal rearrangement was performed. Some of the patients did so well after construction of the sleeve, that they did not need to go on the second part.
The original vertical sleeves had a diameter of about 20 mm. Surgeons subsequently found that their patients could lose more weight if the sleeve diameter was decreased to about 15 mm. There is controversy in among surgeons as to the best diameter for the sleeve. A consensus will evolve as more reports are published in surgical journals.