Bariatric surgery is gaining in popularity, even during the COVID-19 pandemic. With bariatrics, patients can expect to lose excess weight to reverse the effects of obesity. Many also experience the reversal or remission of obesity-related comorbidities, like type 2 diabetes. While the gastric bypass happens to be the “gold standard” of bariatric procedures, the gastric sleeve (sleeve gastrectomy) is quickly becoming the preferred surgery among patients and doctors alike.
What is the Difference Between Gastric Bypass and Gastric Sleeve?
With gastric bypass surgery, a patient’s stomach is made into a small pouch before the stomach is rerouted directly to the intestines. The idea is to restrict the amount of food the patient can eat while also limiting the amount of nutrients that can be absorbed into the body.
The gastric sleeve, otherwise known as the laparoscopic sleeve gastrectomy (LSG), works without rerouting the digestive tract. This is very similar to the gastric bypass. With the sleeve, 80% of the patient’s stomach is cut away. This will restrict the number of calories the patient can consume. The hunger hormone, ghrelin, is also affected, making the patient feel less hungry and fuller faster during meals.
Both procedures can lead to long-term weight loss. Because the gastric sleeve comes with fewer risks,, it’s easy to see why it’s becoming more popular around the country.
Why is the Gastric Sleeve Considered a Lower Risk Bariatric Procedure?
The gastric sleeve is less risky and complex than other weight loss procedures, such as the gastric bypass. Because it is less complex, you will spend one day less in the hospital with LSG and are unlikely to experience long-term complications. Acid reflux is often the exception to the rule, which can be one of the sleeve gastrectomy’s unfortunate side effects.
What are the Risks of Gastric Bypass?
Patients who undergo gastric bypass have around a 5% chance of developing an ulcer. This side effect is not present in gastric sleeve patients.
Patients with bypass also have a near 2% lifetime risk of bowel obstruction. This risk is also something gastric sleeve patients don’t have to worry about.
And due to the rerouting of the digestive system, gastric bypass patients can experience vitamin and mineral malabsorption. It’s not uncommon for GB patients to develop iron deficiencies and anemia. While this same risk does come with the gastric sleeve, the risks are lower than patients who undergo bypass surgery.
Therefore, if you are considering bariatrics and you don’t require a bypass, the gastric sleeve is the simpler and safer way to go.
A recent JAMA study also showed that more patients require revision surgery after gastric bypass than they do when undergoing a gastric sleeve procedure.
Why Would a Patient Require Gastric Bypass?
With the complications mentioned above, it may seem daunting to get a gastric bypass. Understand that just because a procedure comes with the risk of complications does not mean that you will develop every single one or that they will be “severe” if they do manifest. Talk to your doctor about any concerns you may have.
Generally speaking, gastric bypass is recommended for patients with severe obesity (BMI of 40 and above) with one or more comorbidities, such as type 2 diabetes. Studies show that surgeries like gastric bypass can help with long-term weight loss and can even help to control type 2 diabetes. For some bypass patients, their diabetes goes into complete remission.
Can You Start with a Gastric Sleeve and Move to the Gastric Bypass?
Yes. This combination of procedures is not uncommon. Since acid reflux can be a side effect of the gastric sleeve, it’s been shown that gastric bypass helps treat acid reflux in gastric sleeve patients. By performing a gastric sleeve revision that involves a bypass, your doctor can help you lose more excess weight, while helping to control that pesky GERD.
How Much Weight Can You Lose with the Gastric Sleeve vs. Gastric Bypass?
The gastric sleeve can result in the loss of 60% or more of your excess weight. The gastric bypass can result in 70% or more excess weight loss. While the gastric bypass may lead to more long-term weight loss, the trade off is higher risk of complications.
With the gastric sleeve, you get the same amount of weight loss (with a 10% difference on average) and lowered risk.
How Does Your Bariatric Surgeon Determine the Course of Treatment?
Before your surgeon can recommend gastric sleeve or gastric bypass, a sit-down meeting must transpire. This is known as a consultation. It involves the patient and doctor engaged in conversation about the patient’s weight loss goals.
During this meeting, your doctor will ask about your struggles to lose weight through traditional means. Bariatrics are only prescribed for patients who experience weight loss that will not budge otherwise. This can be due to age, genetics, medication, illness, or following childbirth.
Your doctor will also ask about the presence of diabetes, acid reflux, and other obesity-related conditions such as sleep apnea, high blood pressure (sleep apnea), and arthritis of the joints and knees.
Just as bariatrics can help to reverse the effects of diabetes, surgeries like the gastric sleeve can also reverse many other conditions that come with being obese.
In some cases, the doctor may decide that neither the gastric sleeve nor the gastric bypass are appropriate. The doctor could recommend the duodenal switch instead.
What is a Duodenal Switch?
Like the gastric sleeve, the duodenal switch is gaining in popularity. It’s used as both a revision for the LSG and as an upfront operation for patients who are experiencing severe diabetes and who need to lose more than the average amount of excess weight. Similar to the sleeve and bypass, the switch is good for both weight loss and diabetes control.
What is the Duodenal Switch?
You can think of the duodenal switch as the gastric sleeve accompanied by an intestinal bypass. This implies that the surgery is a more aggressive form of gastric bypass, while also including the sleeve. Patients who undergo the duodenal switch wind up losing around 80% of their excess weight and 95% resolution of diabetes.
How Do You Know if You Qualify for Bariatric Surgery?
If you are 80-100 pounds overweight, you might qualify for weight loss surgery. If you are at least 80 pounds overweight, with one or more obesity-related conditions, you have an even higher likelihood of qualifying for surgery.
Having surgery can help you lose the excess weight and, in turn, give you higher self-esteem and improved quality of life. You will also be doing your part to save your life. Not only can obesity be hard on your health, but it is associated with a higher risk of early death.
By now you have learned more about the various bariatric procedures that are available. Of them all, the gastric sleeve is the safest, very effective, and can lead to long-term weight loss.
Draw the line in the sand today and choose health over obesity. Schedule a consultation with Dr. Babak Moeinolmolki at Healthy Life Bariatrics in Los Angeles, California. Dr. Moeinolmolki is considered one of the best bariatric surgeons in Los Angeles. The doctor is dually trained in bariatrics and post-bariatric body contouring. That means Dr. Moein can help you lose the excess weight and achieve your body shape goals afterward.