Although the vertical gastrectomy, which is also often referred to as a sleeve gastrectomy, greater curvature gastrectomy, parietal gastrectomy or vertical gastroplasty, is not perhaps the most well known form of bariatric weight loss surgery it may well provide an excellent option for the super obese.
For individuals with a very high body mass index (typically quoted as being in excess of 55 or 60) bariatric surgery presents particular problems as the risks of surgery at this weight are often unacceptably high – especially when other medical conditions are present.
One answer however is to split surgery into two separate procedures using a laparoscopic vertical gastrectomy initially to reduce the patient’s weight to a level at which traditional gastric bypass surgery can then be performed with much lower risk. But just how successful is this approach?
At the moment data is somewhat thin on the ground and it may be some time before we have sufficient data to start drawing strong conclusions. However, the data which is available does suggest that the vertical gastrectomy will prove to be a good choice for the super obese.
Among several studies which have reported recently one is a study conducted at the Mount Sinai School of Medicine in which seven patients (4 men and 3 women with an average age of 43 and with BMIs of between 58 and 71) underwent a vertical sleeve gastrectomy, followed about a year later by a laparoscopic Roux-en-Y gastric bypass operation.
Prior to initial surgery the group had a mean weight of 398 lbs and BMI of 63. Following the initial vertical gastrectomy all of the patients progressed satisfactorily and immediately prior to their second surgery the mean weight of the group had dropped to 319 lbs with a mean BMI of 50. At this point the group are continuing to progress and the mean weight of the group is currently down to 277 lbs with a mean BMI of 44.
In this particular study 4 of the patients encountered complications (none of which were reported as being serious) including injury to the spleen, anastomotic stricture, nerve praxia, hernia and urinary tract infection.
Although the jury is still out initial results are encouraging and, as obesity continues to grow at an alarming rate in many western countries, the vertical gastrectomy may well find its place as the first of a two-part weight loss operative plan.
