I need to choose between sleeve gastrectomy and gastric bypass surgery, what do the medical experts think is most effective between the two? I don't know how to make this decision? Please help!
Sleeve Gastrectomy or Gastric Bypass Surgery?
Doctor Answers (4)
Sleeve Gastrectomy versus gastric bypass surgery
In my opinion, both procedures are effective for weight loss. Gastric Sleeve is less invasive, has less down time and quicker recovery time. You will need one night hospital stay. You will loss significant weight and there is usually no need for supplemental vitamins. With gastric bypass surgery, you could potentially loss more weight. It is more invasive, has longer down time and may require lifetime of supplements. The best procedure is the one that is selected based on your BMI, your underlying medical condition(s) and the procedure that your surgeon and his team are most comfortable with.
Sleeve or gastric bypass
Yes gastric sleeve surgery is often an easier and safer procedure to perform and the overall risk is lower than the gastric bypass. However, the gastric bypass has better published and follow up data for its effective weight loss. In addition, there are better revision options for the sleeve gastrectomy if the patient is unsuccessful. Having said that I have patients in both category that do as well and are equally successful, which bring home the underlying theme that surgery is just a tool and how you use it is the most important predictor of your outcome.
The typical information session for a bariatric patient can take from 1-2 hours of lecture and questioning by the audience to provide initial information on how to think about bariatric surgery. We then answer general questions from the audience and allow the audience to reflect on their concerns. Once you have made a determination that surgery is right for you - we will schedule you for a consultation with the physician and the nutritionist. During the consultation we make sure we have conveyed the information to you and you have understood the information. Once you have a clear understanding of the procedure you can make an educated decision on what is appropriate. You are changing your body make sure you understand the issues involved, find a doctor that can take time to explain and listen to you.
Sleeve Gastrectomy is preferable to Gastric bypass
Yes, it's true that studies show slightly better early weight loss with Gastric bypass than with sleeve gastrectomy; but that comes at a price of more than twice the rate of short-term complications (including death). Add in the long-term risk of internal hernia, anemia, and osteoporosis, which essentially NEVER occur with sleeve gastrectomy... and to me, there's no question that sleeve gastrectomy is a better option for most patients.
There are also other problems that are being discovered with gastric bypass, such as insulin hypersecretion, which may contribute to long-term weigh regain.
And finally, since both patients carry a risk of weight regain, it is important to note that sleeve gastrectomy has the most salvage options, from re-sleeve, to plication, to conversion to duodenal switch. There are no good options for patients who regain after gastric bypass.
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Choosing Between Sleeve Gastrectomy and Gastric Bypass
The gastric bypass is still considered the gold standard for bariatric surgery worldwide. There is greater weight loss, better control of co-morbidities, and lesser weight regain in most series of gastric bypass compared to the sleeve. Long term results of sleeve gastrectomy (Doctor Weiner in Germany has one of the largest data) show significant weight regain in sleeve patients after five years. Therefore, if one can find a really skilled surgeon who does a lot of bypasses, with low morbidity, the bypass would be the preferred procedure. Sleeves are a reasonable choice in patients who have significant anemia, are smokers, or have had previous intestinal surgery. Your surgeon, if he is skilled in both procedures, should be able to help you make the right decision.