VSG

Vertical sleeve gastrectomy (VSG) is a bariatric procedure in which a large portion of the stomach is removed, creating a narrow, tube-shaped stomach that holds a markedly smaller volume, typically about 15-20% of the original stomach. It is most commonly performed laparoscopically and does not involve rerouting of the intestines.

Mechanism and purpose: The surgery primarily restricts food intake by reducing stomach capacity. It also lowers the production of ghrelin, a hormone associated with hunger, which can contribute to decreased appetite. Because no intestinal segment is bypassed, the procedure does not intentionally cause malabsorption, though nutritional deficiencies can occur if follow-up care is inadequate.

Indications and evaluation: VSG is offered to adults with obesity, generally for those with a body mass index (BMI) of 40 or higher, or BMI of 35-39.9 with obesity-related comorbidities such as type 2 diabetes, hypertension, or sleep apnea. A multidisciplinary assessment, including medical, nutritional, and psychological evaluation, is typically required before proceeding.

Procedure and recovery: During the operation, the surgeon removes about 60-80% of the stomach along the greater curvature, leaving a vertical sleeve. The procedure is usually performed under general anesthesia and commonly takes 1-2 hours. Recovery involves a staged diet progression from liquids to higher-protein foods, with close follow-up to monitor weight, hydration, and nutrition.

Outcomes and risks: Weight loss results vary, but many patients achieve substantial excess weight loss within 1-2 years and see improvement in obesity-related conditions. Risks include surgical complications (bleeding, infection, leaks at the stapled edge) and gastrointestinal effects such as gastroesophageal reflux. Nutritional deficiencies (iron, vitamin B12, calcium, vitamin D, others) can occur and require lifelong supplementation and monitoring.