The vertical gastrectomy (also referred to as a sleeve gastrectomy, greater curvature gastrectomy, parietal gastrectomy or vertical gastroplasty) is not a particularly well known form of bariatric weight loss surgery but it could well provide an excellent option for the super obese.
Bariatric surgery presents particular problems for individuals with a very high body mass index (generally considered as being in excess of 55 or 60) as the risks of surgery at this BMI level are often unacceptably high – especially in cases where other medical conditions are present.
There is however one answer and that is to split surgery into two separate procedures using a laparoscopic vertical gastrectomy in the first instance to lower the patient’s weight to a level at which traditional gastric bypass surgery can be performed with very much lower risk.
So, how successful is this approach?
Data is a little bit thin on the ground at the moment and it could well be some time before we have enough data to allow us to draw any strong conclusions. Nevertheless, the data which we do have suggests that the vertical gastrectomy may well prove to be a good choice for the super obese.
One recent study conducted at the Mount Sinai School of Medicine involved 4 men and 3 women with an average age of 43 and with BMIs of between 58 and 71 who underwent a vertical sleeve gastrectomy which was followed about a year later by a laparoscopic Roux-en-Y gastric bypass operation.
Before their initial surgery the group had a mean weight of 398 lbs and a BMI of 63. After the vertical gastrectomy all of the patients made satisfactory progress and by the time of their second surgery the mean weight of the group had fallen to 319 lbs with a mean BMI of 50. At the time of writing the group is continuing to make good progress and the mean weight of the group is currently down to 277 lbs with a mean BMI of 44.
In this study 4 of the patients ran into complications (none of which were serious) and these included minor injury to the spleen, anastomotic stricture, nerve praxia, hernia and urinary tract infection.
It is too early of course to start drawing any concrete conclusions but the results so far are encouraging and, as obesity continues to rise alarmingly in many western countries, it may well be the case that the vertical gastrectomy becomes a standard part of a two-part weight loss operative plan.