Deciding between bariatric surgeries is difficult but exploring how these operations amplify weight loss can help navigate which laparoscopic procedure is best for you. Both the regular gastric sleeve and the mini gastric sleeve are mainstream surgical treatments that can lead to successful weight reduction.
The Mini Gastric Sleeve is literally a mini version of its predecessor Gastric Sleeve. They are similar in creating a restriction and decreasing hunger hormone, leading to fat loss. The mini-sleeve reduces the stomach volume by 40% versus 80% in the traditional gastric sleeve. Unlike sleeve gastrectomy, the mini sleeve gastrectomy is reserved for patients with a BMI range in the 30’s who need a jump start in their weight loss journey.
Here we will cover critical elements of each procedure related to metabolic efficiency, weight loss expectations, candidacy requirements, and long-term success rates.
How Mini Sleeve Works
Like a reinforced gastric sleeve, a moderate portion of the stomach is cut and removed laparoscopically in a mini-sleeve. The remaining stomach is then stapled and sutured to create a smaller pouch to decrease appetite and suppress hunger.
Under anesthesia, using a single incision, the surgeon access the stomach.
How Gastric Sleeve Works
The word “gastrectomy” means cutting part of the stomach off. In the gastric sleeve, also known as vertical sleeve gastrectomy (VSG), a generous portion of the stomach is removed and discarded along its greater curvature. Gut hormones are dramatically disrupted due to the smaller banana-shaped pouch. Patients feel stuffed much quicker, and food cravings gradually diminish. The body’s sensitivity to ghrelin, insulin, and leptin hormones is restored.
Single or tiny incisions are made through the abdominal wall to reach the stomach.
Differences & Similarities
The mini-gastric sleeve is commonly referred to as a “loose sleeve,” while the traditional gastric sleeve is known as a “tight sleeve.”
Key Mini-Sleeve Differences
- 35-45% of stomach tissue extracted
- Shorter surgery time
- Faster recovery
- 50% less tissue damage around the stomach???
- Single-incision (SILS)
Key Sleeve Differences
- 80-85% of stomach removed
- Lowest food intake
- New stomach is a very slim tubular sleeve
- Stomach capacity is about 200 ml
- Single-incision (SILS) candidate
- More weight loss reported
Similarities
Mini and regular sleeve surgeries lead to weight loss with the exact mechanism: restriction and hormonal changes. No major anatomy modifications in either procedure – the pyloric valve remains intact, and no rerouting of the intestine. Both operations utilize a bougie to guide the surgeon in gastric resection. However, different bougie sizes are based on surgeon preference.
Which procedure is best for me?
The mini sleeve is a great starting point for someone who wants to lose weight without severely affecting the stomach size and the body’s hormonal balance. It also gives the patient more freedom to choose a revisional procedure in case of weight loss stalls or plateaus. On the other hand, gastric sleeve surgery is a more determining option to lose weight and keep it off as a more significant percentage of the stomach is eliminated.
Mini gastric sleeve is more appropriate for disciplined people who maintain an active, healthy lifestyle.
Candidates best suited for
Mini Gastric Sleeve
- Minimum BMI of 28+
- Could potentially kick-start weight loss faster for physically active individuals
- Revision compatible with re-sleeve, Endoscopic Sleeve Gastroplasty (ESG), RNY bypass, and duodenal switch
Gastric Sleeve
- Minimum BMI of 30+
- Major obese related complications
- Revision compatible with RNY bypass or duodenal switch
Mini Gastric Sleeve | Gastric Sleeve | |
|---|---|---|
| Method | Restrictive | Restrictive |
| Stomach | Remove 30-40% (1-2 oz.) | Remove 80-85% (2-3 oz.) |
| Anatomy | No Change | No Change |
| Duration | 30 min | 45 min |
| Hospital | 1 to 2 days | 1 to 2 days |
| Time Off | 5 – 10 days | 1 to 2 weeks |
| Recovery | 2 – 3 weeks | 3 – 4 weeks |
| Advantage | Simpler Low Risk | Common Low Risk More %EWL FDA approved |
| Disadvantage | Newer Non-FDA approved Less %EWL | Hair loss Hormonal imbalance Increases GERD/reflux |
| Weight Loss | 20 – 40% EWL | 60 – 75% EWL |
| Post-Op | 3 to 5 Meals/Day 800-1200 Cal High-Protein | 3 to 5 Meals/Day 800-1200 Cal High-Protein |
| Candidacy | BMI of 28+ “1st” Procedure | BMI of 30+ “1st” Procedure |
(%EWL) = % Excess Weight Loss
Summary
Whether you need to drop a few pounds or have substantial excess weight, mini sleeve and gastric sleeve are the proper tools to help transform your life with a healthy diet and exercise routine. VSG provides more sustained excess weight loss, whereas Mini VSG will have a quicker recovery time with less anticipated excess weight loss.
Both procedures can be quickly revised to other more aggressive methods like RNY bypass. However, there is a chance of resleeving the gastric mini sleeve revision laparoscopically or endoscopically.