This surgery is based on the restrictive principle, i.d. on the narrowing of the upper gastro-intenstinal tract to limit the food income. The surgery consists of forming the prolonged narrow stomach "sleeve" which prevents the passage of the solid food in the area between the alimentary canal and the antrum.  

So, what's new about this surgery? Have bariatric surgeons finally found the radically new surgery solution? Or is this "the blast from the past?" To reply on all this question, we're to go into details of sleeve gasteroctomy and to look into its history.  

According to the surgery policy which has existed for a long time, super obese patients (who weight 180 kg and more) were offered the most effective surgery despite the big chance to develop metabolic disorders. While making biliopancreatic diversion for such patients, surgeons encountered inextricable technical difficulties related to moving intestines (a bowel and a velum) due to the great amount of the so-called visceral fatty tissue. After the first stage of the biopancreating diversion surgery (the partial removal of the stomach) surgeons often had to stop at that point, in order to avoid the needless delay of the surgery and progression of complicating diseases related to the long ALV and the general anaesthesia. After they had understood the problems that accompany the radical surgery for the super obese patients, some bariatric surgeons changed their strategy, by the initial splitting up of the biliopancreating diversion surgery treatment on two stages: gastric sleeve surgery and the small bowel moving surgery.  

At that, the second stage was supposed to be done after the partial weight-loss. Of course, in order to achieve the best effect of the first stage, surgeons tried to leave the smallest stomach possible after they had removed the body, the bottom and the part of its antrum. To achieve the best effect of such surgery was to develop only due to the difficulty of the food passage through the stomach, many surgeons tried to make the narrowest pipe possible from the remaining part of the stomach. So they got Sleeve and Sleeve Gastrectomy surgery.

How much surgeons were surprised when they discovered that the effect of the "first stage" superceded such "classic" bariatric surgery as the stomach diversion. According to much of the clinical data reported on the 10th International Endoscopic Surgery Congress in Berlin, the average effect of the weight loss with the sleeve gasteroctomy is 80-90% of the overweight. Nobody expected that. The second stage of the biliopancreatic diversion surgery wasn't needed, the intestines of operated patients were untouched and operated patients had no risk to contract protein, calcium, iron, vitamines and other microelements deficiency.

Let's have a look what new methods have been developed in the bariatric surgery technique after emerging of the Sleeve Gastrectomy. We can say that they are not very new: the vertical criss-crossing of the surgery in order to form the small stomach bag has already been used for the vertical banded gastroplasty, but this bag has been mich shorter and wider and that has required the additional application of the non-regulated ring at the place where the gastic pouch flows into the great part of the stomach. The partial removal of the stomach, as we've mentioned before, was previously made for the biliopancreatic diversion surgery. The new thing is only the greatest possible narrowing of the stomach lumen for its whole length from the alimentary canal to the antrum.

Only the very narrow "sleeve" along the small curve (the left side part of the stomach) remains, the bottom and the body which are to the right from the crossing line, are completely removed. For crossing and sewing of the stomach, as well as for other bariatric surgeries, special endosurgery staples and cartridges for them are used. At that, cartridges consuming is greater than for the stomach diversion.

What is the mechanism for the food delay, if there is no ring which provides for the dense local narrowing along the way of the food? If you remember some basics of the physics, it's very easy to understand the meaning of this phenomenon: resistance experienced by the liquid which flows through the pipe is in direct ratio of the pipe length and in inverse ration of its diameter. And Pascal Law is also applicable: the pressure of the liquid is equally spread for all sides of the vessel containing it.

Thus, the equally narrowed stomach is under equal pressure and cannot be stretched in some single place, as it happens after the vertical banded gastroplasty. The food, after it passes through the long and very narrow "pipe", overcomes the great resistant and, after it is delayed, provokes the stable feeling of saturation not matter how scarce it is.  

Its great effect doesn't mean that it should be done for everybody, leaving aside the whole long experience of the bariatric surgery. As with all other surgeries, this method has not only true advantages, but also some disadvantages as well.  

Disadvantages of the Sleeve Gastrectomy 
Due to the fact that the stomach is made as narrow as possible, the food passes very badly for the intial two or three months and it makes one feel very uncomfortable. Then the stomach pipe is somehow stretched and bad feelings are cured and appear not often than after the stomach banding. Contrary to the stomach banding, after which the same weight-loss method works, the sleeve gastrectomy surgery is more risky. This risk is related to the need to cross and remove the part of the stomach. To prevent complicating diseases, operated patients are to stay at hospital for 4 days (only 1 day after the stomach banding). Many patients (approximately 30%) who have overcome the sleeve gastrectomy, develop the heartburn related to destroying of the obturative valve mechanism of the alimentary canal and stomach passage as well as to the resting part of the antrum where the gastric acidy is high and if the heartburn has been experienced before the surgery. All patients who have overcome the sleeve gastrectomy, are prescribed with the medicine which lowers the productivity of the hyddrochloric acid in the stomach.

The pains syndrome in the early post-surgery period is more expressed after the sleeve gastrectomy surgery than after the stomach banding. It's explained by the bigger surgery trauma which is made during the surgery mobilizing and removing of the stomach. The clinic experience of performing and studying of the Sleeve Gastrectomy results worldwide, in comparison with other modern surgeries, is still very scarce. As we know, the initial delight for this or that scientific discovery always gives place to the more reserved attitude toward it, no matter how revolutionary this discovery seemed to be in the past.  

Advantages of the Sleeve Gastrectomy 
As it has already been mentioned before, the effect of the sleeve gastrectomy surgery is in average higher than of the stomach bonding. Perhaps, it's related to the lesser influence of the patient's self-discipline on the weight loss. Regulations are not neccessary in the post-surgery period. In this sense, the surgery looks like the stomach diversion - "you've done it and you've forgotten about it".  
There aren't any debrides in the body. If it's required, the sleeve gastrectomy can be relatively easily transformed into the stomach or biliopancreatic diversion. For that, one is only to add "the intenstines' stage" to the surgery. It's more difficult to do the stomach diversion after the stomach banding.

Thus, we suppose that the laparoscopic vertical prolonged excision gastroplasty will take the intermediate place between the stomach-banding and the stomach diversion in the surgery practise. The decision to make this surgery is to be made with caution, after the examination and mostly due to the patient's desire.