The sleeve gastrectomy is a newer operation, than the roux en-Y gastric bypass. It has been performed in large numbers in the last five to ten years and is now the most popular operation in America.
Weight loss in the short-term is good. Longer-term data is now available, with most patients maintaining good weight loss, seven or more years after surgery. Approximately 1 in 5 patients, will regain much of the weight lost and consider revision surgery, usually to a roux en-Y gastric bypass.
The operation is performed with laparoscopic surgery, with most patients needing to spend one or two nights in hospital, returning to work and normal activities, usually within two weeks.
Approximately, 80% of the stomach is removed, leaving the patient with a narrow tube made, from the remaining stomach, approximately one centimetre in diameter. The stomach no longer functions as a reservoir to store food, between meals, so portion sizes are much smaller. Partially removing the stomach, with its ghrelin hormone producing cells, interferes with normal appetite control, so patients are much less hungry and less interested in eating. By controlling appetite and limiting portion sizes, a patient’s daily calorie intake is reduced, resulting in steady weight loss.
Unlike the bypass, with the sleeve gastrectomy, there is no re-configuration of the patient’s intestinal anatomy; food follows the normal route through the intestine, with no sections bypassed. Although overall the weight loss with the sleeve gastrectomy, is a little less than the gastric bypass, there is less need for intensive vitamin and mineral monitoring in the future and no risk of internal hernias, which can be a concern with the bypass.
The main concern with a sleeve gastrectomy, is a staple line leak, which will usually occur, within the first few days or week of surgery. Overall, the chance of a leak occurring is about 1 in 100, but it can make patients very ill and be difficult to manage, with a few leaks taking many months to heal. Further surgery and rarely conversion to a roux en-Y gastric bypass, may be necessary to manage the leak.
Most patients will lose weight well, with a sleeve gastrectomy or a gastric bypass. It Is difficult to be sure, which patients are most at risk of weight regain, with the sleeve, but it is probably more common in less tall ladies and patients who continue to eat sweets, chocolate and other liquid calories, after the surgery. Unlike the bypass, dumping does not usually occur with the sleeve gastrectomy.
There are lots of pros and cons to be considered, when deciding between a sleeve gastrectomy and a roux en-Y gastric bypass. In my experience, a properly informed decision, can only be made after a comprehensive clinic assessment, by a specialist bariatric surgeon.