Aetna - VSG

Sleeve Gastrectomy:

Sleeve gastrectomy is a 70 to 80 percent greater curvature gastrectomy (sleeve resection of the stomach) with continuity of the gastric lesser curve being maintained while simultaneously reducing stomach volume (CMS, 2005).  It is often the first step in a two-stage procedure when performing RYGB.  A decision memorandum from the Centers for Medicare and Medicaid Services (CMS) found that the data supporting open or laparoscopic sleeve gastrectomy are generally sparse and not adequate to draw conclusions. The CMS concluded, therefore, that these procedures are not reasonable and necessary for Medicare beneficiaries. A systematic evidence review prepared for Clinical Evidence concluded that the effectiveness of sleeve gastrectomy for morbid obesity is unknown (Arterburn, et al., 2007).

The American Society for Metabolic and Bariatric Surgery's position statement on sleeve gastrectomy as a bariatric procedure stated that "[t]he ASMBS recognizes performance of sleeve gastrectomy may be an option for carefully selected patients undergoing bariatric surgical treatment, particularly those who are high risk or super-super-obese, and that the concept of staged bariatric surgery may have value as a risk reduction strategy in high-risk patient populations.  It is suggested that surgeons performing sleeve gastrectomy prospectively collect and report outcome data for this procedure in the scientific literature.  In addition, it is suggested that surgeons performing sleeve gastrectomy inform patients regarding the lack of published evidence for sustained weight loss beyond 3 years and provide them with information regarding alternative procedures with published long-term (greater than or equal to 5 years) data confirming sustained weight loss and comorbidity resolution based upon available literature at this time".