 Hello, I'm Angela Monroe and I am one of the bariatric coordinators with the Michigan Health Surgical Weight Management Program. When considering bariatric surgery, it's important to understand your surgical options. Listen to one of our bariatric surgeons discuss the sleeve gastrectomy option. So next we'll talk about the sleeve gastrectomy. So this is a laparoscopic procedure. This was actually the first stage of a two-stage procedure called the duodenal switch where patients with a really high BMI the plan was to do the sleeve gastrectomy first and then they would do the second part which was the duodenal switch at a later date. Well what they found for these patients is they often lost a fairly significant amount of weight with the surgery of the sleeve gastrectomy alone and many patients didn't have to go back and have that second procedure performed. So it kind of grew into its own surgery and so this is easily the most common surgery that's now performed in the U.S. for weight loss and part of that reason is because about four or five years most insurances started to cover it and so that's what really helped it catch on. So the mean excess weight loss at three years about 66 percent there's no foreign body no implanted medical device and the part of the reason the surgery works is it does change the hormone signaling that happens. There is a hormone in our body called Graylin that stimulates our appetite and at least in part it's released from this part of the stomach here what's called the fundus which has been removed during surgery. So we're turning the stomach into a long slender tube just like the sleeve of his shirt that's kind of how it gets its name there's not any plastic sleeve of material though. So when we have done the surgery this part of the stomach over here now has no blood supply to it so we have to take that part of the stomach out so that one part I mentioned the fundus is removed as well and so a lot of patients that have the surgery will say you know I don't have a constant hunger I used to feel beforehand. You'll also notice that if you follow the path that that food goes well it's going to go the exact same route that it did before we're not rerouting the intestines so the the risk of vitamin deficiencies or malabsorption is significantly reduced with this surgery compared to the gastric bypass. So essentially what this surgery does to be effective is it invokes restriction the amount of the stomach that we remove is about 80 to 85 percent of the volume so patients who used to consume lots and lots of calories at one sitting just aren't physically able to do so because of the much smaller volume of the stomach. If you would like to learn more about other surgical weight management options watch the videos on adjustable gastric banding and ruin my gastric bypass.