Vertical gastrectomy, also known as parietal gastrectomy, reduction gastrectomy of the large curb, or Sleeve gastrectomy, consists of an operation that aims, if performed alone, to be restrictive in nature. It is easily performed by laparoscopy, and is associated with very few perioperative risks. More precisely, this operation represents the restrictive portion of the biliopancreatic derivation.
This procedure consists in the removal of the external part of the stomach by laparoscopy. A thin vertical gastric tube is left in place, which can only contain a restricted amount of food at a time, and will not distend itself as easily as the “normal” stomach. Furthermore, by removing what is called the greater gastric tuberosity, a source of hormone secretion is removed, which in turn controls hunger.
Derivation procedures practiced by laparoscopy on patients who are very obese, or on patients afflicted with multiple comorbidities, are associated with important difficulties as well as significantly high complication and mortality rates.
This is why many surgeons, who practice in large recognized Bariatric Surgery centers, have suggested to perform these derivations, whether gastric or biliopancreatic in nature, in a two-time fashion. These two sequential times will therefore enable the surgeon to perform the procedure by laparoscopy, and with significantly less risks.
Following a vertical gastrectomy, the patient will lose a considerable amount of weight, which will greatly facilitate the second surgical time, if necessary. Indeed, the weight-loss results associated with vertical gastrectomy are encouraging to date, and in many cases, this primary procedure will suffice. If, following a year, there is a weight-loss stagnation and the first procedure is judged to be insufficient for optimal weight-loss, a second procedure, such as a Roux-en-Y gastric derivation (gastric bypass) or a biliopancreatic derivation, can then be carried out in much more optimal conditions.
Vertical gastrectomy is a reasonable alternative to the gastric derivation because since there is no intestinal bypass, there are no risks of malabsorption complications, as well as less risk of ensuing anastomotic ulcers or dumping syndromes.
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