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Vertical Gastrectomy Procedures

The originally procedure, conceived by Dr. D. Johnston in England, was called The Magenstrasse and Mill Operation.

The stomach is stapled vertically and divided from the incisura angularis to reach the angle of His at the gastric fundus and Dr. Johnston’s procedure of leaving a long gastric tube that resembles the German highway Magenstrasse was rapidly called that way.

The Magenstrasse, or “street of the stomach“, is a long tube fashioned from the lesser curvature of the stomach, which conveys food from the esophagus to the antral Mill without the total partition of the stomach.

The normal antral grinding of solid food and neuro-hormonal antro-pyloric-duodenal regulation of gastric emptying and secretion are preserved.

It is now called the Vertical Sleeve Gastrectomy (VSG) but is also known as Vertical Gastroplasty. If a silastic ring or mesh is added to the technique is called Vertical Banded Gastroplasty (VBG) and was touted to help increase the restriction needed for a better Weight Loss.

If a silastic ring is added to the pouch of a Gastric Bypass is called as the Fobi- Capella Procedure.

This techniques (VSG and VBG) generates Weight Loss by restricting the amount of food that can be eaten (Purely Restrictive Procedure) without having any bypass of the intestines or malabsorption.

Both procedures are largely been abandoned due to poor long term results.

The more popular procedure known now days as Gastric Sleeve (much longer “street” than the Magenstrasse procedure) is done laparoscopically and it is considered a variation of the Vertical Gastrectomy but includes the removal of the remaining 80% of the stomach after its partition.

I met Dr. Gagner several years ago, a very friendly Canadian doctor that was living in NY and then moved later to Miami and he is considered among bariatric surgeons one of the fathers of the Gastric Sleeve (GS) as a primary procedure and told me that the success of the procedure was largely discovered by accident because no one expected the remarkable weight loss produced by the Gastric Sleeve and later medical scientific publications revealed that the driving force for the weight loss was the decreased level of Ghrelin Factor when removing the 80% of the stomach.

GASTRIC SLEEVE Advantages:

  • Stomach volume is considerably reduced to more than 100 cc but not as much like the pouch of the Lap band (15 cc) or the Gastric Bypass (30 cc).
  • The Sleeve motility functions gradually normal after 3 months of the operation so most food can be consumed but in smaller amounts.
  • It eliminates the portion that produces the Ghrelin Factor, the hormone that stimulates hunger.
  • By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are eliminated.
  • Very safe and effective as a Primary procedure, First Stage procedure for very high BMI patients or as a Revisional procedure.
  • Can be checked with a scope when needed.
  • Appealing option for people with existing anemia, Crohn’s disease, arthritis and numerous other conditions that make them too high risk for intestinal bypass procedures.
  • Success rate is 60-80% of excess weight loss.
  • Proven to work better on Type 2 Diabetes and on Metabolic Disease than other procedures because increases in the Incretins secretion which lower the sugar Insulin resistance.
  • It can be converted to almost any other weight loss procedure.

GASTRIC SLEEVE Disadvantages:

  • Poor patient cooperation will result in inadequate weight loss or weight regain like binging eaters.
  • Patients with a high BMI often need to have a second stage procedure later to lose all the remaining extra weight.
  • Two stages is safer and more effective than one operation for high BMI patients.
  • Soft and liquid calories from ice cream, milk shakes, chocolates, etc., can be absorbed and slows down the weight loss.
  • This procedure does involve stomach cutting and stapling and therefore leaks and other complications related to cutting and stapling may occur.
  • It is not a reversible procedure.
  • Considered investigational by some surgeons and insurance companies.

Arturo Rodríguez, MD.

     

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