VSG: No Longer Investigational

Partial gastrectomies have been performed to treat medical conditions, such as stomach cancer, for many decades. The vertical sleeve gastrectomy procedure has been used successfully for weight loss (as demonstrated by medical studies) since 1976. The Duodenal Switch (DS) has also been performed for many years and is approved by most Blue Cross plans. The VSG is simply the restrictive portion of the DS without the “switch”, or malabsorptive, portion of the surgery. DS is often done as a two-stage procedure -- the VSG is performed first with a follow up malabsortive procedure performed at a later date (generally after an improvement in health and initial reduction in weight). An interest in the VSG as a standalone procedure appears to have started when reported data began to show a pattern -- a success rate similar to DS or RNY but with a lower rate of complications. So the thinking became, “Why do the riskier second procedure when the sleeve gastrectomy appeared to be working so well on its own?”

While any surgery carries risks, the VSG is not riskier than other weight loss procedures; in fact statistics indicate that it is safer. Documented studies show that it will generate between 60 to 80% of Excess Body Weight Loss (EBWL) in 6 to 12 months and many patients have achieved 90 to 100% EBWL during the same time periods with weight loss of 100lbs to 200lbs. The complication rate of the RNY is 6.5%, and it’s considered the “gold standard.” Compare that to the complication rate of only 1.5% for the VSG in the last 10 years and with similar or better weight loss results. Studies also indicate a lower complication rate for VSG than for the Lap Band which is generally touted as the safest WLS available.

As a result, a significant number of medical experts on the issue of bariatric surgeries are in agreement that the VSG is quickly gaining acceptance when compared to the RNY and is likely to become the surgery of choice for weight loss, Among them Dr John R. Romanelli, MD FACS in his article Laparoscopic Sleeve Gastrectomy: The newest front in the battle against Obesity, published in WLS Lifestyles, fall of 2006.

As of 2008, there were 35 published studies involving over 2,400 patients clearly pointing to the VSG as a procedure with a high success rate and low incidence of side effects. The largest was a 5 year study (ongoing) presented in 2007. That study, “Laparoscopic Vertical Sleeve Gastrectomy for Morbid Obesity: a Report of a Five-Year Experience with 750 Patients” presented by Lee, Cirangle and Jossart concludes that:

“Laparoscopic VSG demonstrates comparable weight loss to the RGB after three years with 0% mortality. Long term morbidity is almost nonexistent compared to the RGB.”
(see http://www.ssat.com/cgi-bin/abstracts/08ddw/O4.cgi)

Perhaps these studies and statistics were known by Federal BCBS when they decided to consider VSG a covered procedure in 2008? Certainly the data must have something to do with the explosion in the number of doctors who perform VSG – about 15 surgeons considered themselves VSG experts two years ago. Today a conservative count of surgeons who offer VSG would set that number at 3 times as many. And anyone visiting online weight-loss surgery communities such as ObesityHelp.com or even LapBandTalk.com can find an ever-increasing number of patients who’ve had the VSG and are reporting back on great weight loss or weight management results and an amazingly few number of side effects.

As many insurers follow in Federal BCBS’ footsteps and offer VSG as a covered procedure, and as the studies verifying both the efficacy and safety continue to be published, it’s hard to imagine that it won’t eventually overtake RNY and Lap Band in popularity. The VSG also costs less than a Lap Band – and not just the initial procedure -- but a VSG sidesteps the ongoing costs of lap band fills and unfills. There are no adjustments or ongoing medical interventions necessary for the VSG patient. In the long run, I believe that the VSG will prove itself to be a real winner for patients and insurers alike. It cannot and should not be considered experimental or investigational.