Laparoscopic Vertical Sleeve Gastrectomy
The Newest Surgery Awaits Pay Decision
Having studied with famed bariatric surgeon Michel Gagner, M.D., Yves Manigat, M.D., is very familiar with Dr. Ganger's brainchild—the vertical sleeve gastrectomy.
According to Dr. Manigat, the "sleeve gastrectomy" name precisely describes what the surgery does.
"You remove 70-to-80 percent of the stomach and create a small tube which really is an elongated continuation of the esophageal tube," he said. "The pylorus sphincter is preserved and the stomach capacity is reduced to about 70 cc.
"This is irreversible and the only bariatric surgery where you remove a segment of the gastrointestintal tract; in all other surgeries you just rearrange the organs."
Dr. Manigat said Dr. Gagner initially conceived the sleeve procedure as the first step of a two-staged bariatric surgery. Creating the tube is a restrictive procedure drastically curtailing what the stomach can hold.
Dr. Gagner envisioned that once patients lost sufficient weight with the first step, the second stage would be rearrangement of the intestine to create a malabsorption to curtail what nutrients and calories the body will retain. That would be done with gastric bypass or duodenal switch surgery.
However, patients who underwent just the first stage—the sleeve portion—did so well that more and more surgeons used just that sleeve procedure as the total solution.
"Dr. Gagner found that the first step was sufficient in most cases and he is the biggest proponent of using it as a stand-alone procedure," said Dr. Manigat.
Dr. Manigat said that also has been his experience in performing the sleeve gastrectomy.
While he can and has performed the procedure with success, the physician said insurance companies have not yet decided to approve payment for sleeve gastrectomy operations. Once Medicare rules on reimbursement for the procedure insurance companies may follow suit, said Dr. Manigat.
To locate a Lourdes Health System bariatric surgeon by phone, call 1-888-LOURDES.
