Mini Gastric Bypass or Sleeve?

Question

My BMI is 35 and I have had PCOS and insulin resistance for the last 10 years, which combined with hypothyroidism makes it impossible for me to lose weight. I don’t binge or emotionally eat and I don’t have a sweet tooth. My medication :30mg Citalopram, 300mg Quetiapine, 100mg Levothyroxine. My GP promised to monitor Quetiapine and other ladies on it have mentioned reduced dosages after as they were more happy in their own skin. I don’t want to switch to another med.

Ali Solmaz, MD · Answer

Choosing between a Mini Gastric Bypass (MGB) and a Sleeve Gastrectomy (SG) depends on several factors, including your medical history, weight-loss goals, and lifestyle preferences. Given your history of PCOS, insulin resistance, hypothyroidism, and the impact of your current medications, both procedures have potential benefits, but they work differently and may align with your needs in distinct ways.
The Mini Gastric Bypass is particularly effective for individuals with metabolic conditions like insulin resistance and PCOS. It combines restriction (reducing the size of the stomach) with malabsorption (rerouting a portion of the small intestine), leading to significant improvements in insulin sensitivity and hormonal imbalances. For individuals with a BMI of 35 and comorbidities, MGB is often favored for its metabolic benefits, as it may lead to quicker resolution of insulin resistance compared to a sleeve. However, the malabsorptive aspect of MGB requires strict adherence to lifelong vitamin and mineral supplementation to avoid deficiencies.
The Sleeve Gastrectomy is a simpler, purely restrictive procedure that removes about 70–80% of the stomach, including the portion that produces ghrelin, the hunger hormone. While it does not involve intestinal rerouting, SG has proven effective in managing PCOS and aiding weight loss. It may be a suitable choice if you want to avoid the malabsorption aspect of bypass surgery, especially given your need to remain on specific medications like Quetiapine and Citalopram, as some medications can be affected by malabsorption.
Your decision should also take into account your long-term ability to manage dietary changes, supplementation, and follow-up care. Both procedures can be highly effective, but MGB might offer superior benefits for addressing insulin resistance and hypothyroidism-related weight challenges. However, the simpler nature and lower risk of nutritional deficiencies with SG might make it more suitable for your personal and medical circumstances.

Pablo Garcia, MD · Answer

Hey, thank you for your questionI think it would help you if you choose a gastric sleeve, i recommend you that process because it has a positive metabolic effect, many comorbidities such as diabetes, cholesterol and sleep apnea improve soon after the surgery, less risk of vitamin deficiences post-surgery, desire to eat decreases and more.. there are some cons like in every surgery process but the sleeve has a succesful rate among patients.Hope my answer helped you!

Ariel Ortiz, MD, FACS · Answer

I would recommend you consider the Gastric Sleeve surgery because it has a positive metabolic effect, similar weight loss to the bypass, and we have seen resolution of metabolic issues very quickly after the surgery.  The Sleeve also has fewer risks and complications.  We have seen quite a few "Sleeve Babies" after the sleeve due to improvement with PCOS issues as well.

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