Vertical Sleeve Gastrectomy (VSG) Surgery: What to Know

Medically Reviewed By Saurabh Sethi, M.D., MPH
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Vertical sleeve gastrectomy (VSG) is a type of bariatric (weight loss) surgery. The procedure involves removing part of the stomach to make a sleeve-shaped tube and reduce stomach size. VSG is mainly a restrictive form of bariatric surgery. It restricts or reduces the amount of food you can eat. Sleeve gastrectomy, gastric sleeve, or laparoscopic sleeve gastrectomy are other names for this surgery.

This article discusses VSG surgery. It goes over who makes a good candidate, the risks, and the possible outcomes.

What is vertical sleeve gastrectomy surgery?

Woman enjoying a drink at a juice bar
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VSG surgery limits the amount of food you can eat by removing about 75% of your stomach. The stomach is J-shaped, with an expandable body out to the side. VSG removes most of the pouch to the side, leaving a mostly vertical tube. This tube, or sleeve, gives the surgery part of its name. Gastrectomy means removing the stomach.

Removing most of the stomach has more than a restrictive effect. It also reduces the stomach’s production of ghrelin. This so-called “hunger hormone” stimulates appetite. VSG lowers ghrelin levels, resulting in a change in metabolism. A change in metabolism can lead to:

  • decreased hunger
  • increased sense of fullness
  • standard blood sugar levels
  • weight loss

This surgery may be an option for people with obesity who have not had success with other programs. This includes eating plans, exercise, and medical weight loss.

On average, people who undergo VSG surgery lose 21% of their body weight by the third year.

Who is a candidate for weight loss surgery?

One of the goals of weight loss surgery is to treat obesity. Doctors define obesity using body mass index (BMI). BMI is more useful than weight alone because it relates weight to your height. A BMI of 30 or more falls into the obese category. However, not everyone with this BMI needs weight loss surgery.

Other goals for weight loss surgery include treating obesity-related health problems, such as type 2 diabetes, sleep apnea, and high blood pressure.

People who may qualify for weight loss surgery include adults who have:

  • BMI of 40 or higher
  • BMI of 35 or higher with serious obesity-related issues, such as heart disease or type 2 diabetes
  • BMI of 30 or higher with type 2 diabetes that is hard to manage with medication and lifestyle changes

Teenagers with obesity may also qualify using BMI and health-related problems. Pediatric experts will help determine who may qualify.

The inaccurate nature of BMI

BMI is a calculation of a person’s body fat based on their height and weight. However, studies show that it is a poor indicator of a person’s body fat percentage. It can be misleading because the measure does not account for overall body composition. Factors the BMI measurement overlooks include bone density, muscle mass, and other considerations.

For additional information, talk with your doctor about other body fat assessment methods.

Other considerations for candidates include:

  • being ready to commit to lifelong healthy eating, vitamin supplementation, physical activity, and medical follow-up
  • being unable to lose weight or maintain weight loss with nonsurgical programs
  • not having an endocrine cause of obesity, such as hypothyroidism
  • not having conditions that cause unacceptable surgical risks, such as severe illness
  • not having unmanaged mental health problems, including alcohol or drug misuse

Who to see for bariatric surgery?

Bariatric surgeons and general surgeons perform weight loss surgery, including VSG. Often, bariatric surgeons are general surgeons with a specialty in bariatrics. Bariatrics is a branch of medicine that focuses on the causes, prevention, and treatment of obesity. 

Learn more: Tips for finding the right doctor for weight loss surgery

How is vertical sleeve gastrectomy surgery performed?

VSG surgery takes place in a hospital under general anesthesia. Typically, doctors use a minimally invasive approach with a laparoscope. They make several small incisions to perform the procedure. Laparoscopic surgery generally has fewer short-term risks afterward, such as bleeding. Additionally, laparoscopic surgery usually has a quicker recovery period.

VSG is a relatively simple surgery. It involves using a surgical stapler to close off and remove the large, expandable part of the stomach. VSG surgery takes about 1–2 hours. This short surgery time often means it is safer for people with heart or lung problems. 

For some people, VSG surgery is the first part of a multi-stage surgical plan. Follow-up surgery may include gastric bypass or duodenal switch.

VSG surgery is not reversible.

Learn more: What to expect on the day of weight loss surgery.

Life after weight loss surgery

Weight loss surgery may or may not require a hospital stay. Either way, there are some things to know about life after weight loss surgery.

Activity

Activity is an important part of recovery. It helps your body heal and prevents complications. Your care team will encourage you to walk soon after surgery, as it can help speed your recovery.

Regular physical activity will need to be part of your lifelong commitment to healthy living.

Diet

After weight loss surgery, patients are on a liquid diet for several weeks. Gradually, you will transition to a soft diet and then solid food. A lot of your diet will be protein.

You will also need to drink extra fluids. This can be a challenge with a smaller stomach. Sipping fluid throughout the day can help meet this need.

Eventually, most people can eat a wide variety of foods.

Learn more: Tips for rebuilding your diet after weight loss surgery.

Medications and vitamin supplements

All weight loss surgeries require lifelong vitamin supplementation. However, you may find your doctor is able to stop or decrease the dose of some medications.

The medications you continue to take may need to be in chewable or liquid forms for some time. The same is true of vitamin supplements.

What are the risks and potential complications?

VSG surgery is one of the safer weight loss surgery options. It has a short surgery time and does not involve cutting the small intestine. Overall, the risk of major complications from VSG surgery is 5–10%.

Complications from any surgery include anesthesia reactions, bleeding, blood clots, and infection. With weight loss surgeries, there are also some common risks to all of them afterward. These include:

With VSG, the following complications are also possible:

  • gastroesophageal reflux, which can cause heartburn and nausea
  • leakage of the staple line
  • stricture, which is a narrowing of the sleeve and requires dilation to open it

Contact your doctor immediately for any concerns, such as bleeding, fever, increase in pain, wound redness, swelling, or drainage. Additionally, notify your doctor if you have persistent nausea, vomiting, or trouble swallowing.

What does vertical sleeve gastrectomy surgery cost?

In general, weight loss surgery costs $15,000–25,000. There are several variables that affect the cost, including the type of surgery and where you live. The cost can be higher if you develop complications. 

The amount you end up paying will depend on your insurance coverage. For insurance to cover the procedure, you will likely have to meet the criteria for it. This usually follows the National Institutes of Health (NIH) BMI guidelines:

  • BMI of 40 or higher
  • BMI of 35 or higher with serious obesity-related issues, such as heart disease or type 2 diabetes
  • BMI of 30 or higher with type 2 diabetes that is hard to manage with medication and lifestyle changes

You may also have to go through nonsurgical programs first or show that you have already tried them without success. Be sure to check to see if you need to use certain doctors or facilities.

Summary

VSG is a restrictive form of weight loss surgery that removes most of the stomach. This limits the amount of food you can eat. It also reduces the level of the hunger hormone, ghrelin.

VSG is a relatively simple and safe surgery. It may be an option for people who meet BMI criteria and who have not had success with other weight loss programs. 

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Medical Reviewer: Saurabh Sethi, M.D., MPH
Last Review Date: 2022 Apr 14
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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