Obesity has become a global health problem that contributes to a host of ailments and disabling diseases like type 2 diabetes, but there is hope. Patients visiting or calling Healthy Life Bariatrics often want to know which bariatric surgery is the most effective at treating morbid obesity. Out of all the surgeries we offer, gastric sleeve bariatric surgery is by far the best.
To help you understand why gastric sleeve is superior to other weight loss surgeries, it becomes important to look at the pros and cons of each procedure.
But first, what is bariatric surgery and how does it help with excess weight loss?
Bariatric Surgery Explained
Bariatric surgical procedures help patients lose weight by restricting the amount of food the stomach can hold. This, in turn, causes the malabsorption of nutrients. In some cases, the surgery can involve a combination of gastric restriction and malabsorption. For some patients, bariatric procedures can also cause hormonal changes.
Most weight loss surgeries performed today use minimally invasive techniques. Most specifically, the surgeries involve a laparoscope (laparoscopic surgery). A laparoscope is a tiny, elongated camera that is inserted into an incision in the abdomen. The surgeon is able to manipulate the camera and can view the interior of your abdomen by way of an accompanying monitor.
The most common bariatric surgery procedures are adjustable gastric band, gastric bypass, biliopancreatic diversion with duodenal switch, and sleeve gastrectomy (also referred to as gastric sleeve).
Each surgery has its own advantages and disadvantages. Let us look at those procedures now.
The Most Popular Bariatric (Weight Loss Surgery) Procedures
Adjustable Gastric Band
The gastric band is an inflatable band that is placed laparoscopically around the upper portion of the stomach. This creates a small pouch above the band and leaves the rest of the stomach below the band.
How the Procedure Works
Since the band restricts the volume of the stomach, patients eat less and feel fuller faster. The fullness depends on the size of the opening between the initial stomach pouch and the remainder of the stomach. The size of the stomach opening can be adjusted by the surgeon filling the band with saline. The sterile saline solution is injected through a port that is placed under the skin.
The surgeon will typically reduce the size of the opening over time. This is performed gradually with repeated saline fills.
The advantages of the gastric band include limited food consumption and 40% to 50% loss of excess weight. Unlike other bariatric procedures, there is no cutting of the stomach or rerouting of the intestines, and there is a shortened hospital stay, which is usually around 24 hours. In some cases, patients are discharged from the hospital on the same day as the surgery. The procedure is reversible, adjustable, and has the lowest rate of early postoperative complications. There is also a lowered rate of mortality among the approved bariatric procedures. In addition, the surgery has the lowest risk for vitamin and mineral deficiencies.
Disadvantages of the procedure include slower and less early weight loss when compared to other bariatric procedures and the need for a foreign device to remain in the body. There could be band slippage or erosion in a small percentage of patients and dilation of the esophagus could result if the patient overeats. Gastric band also has the highest rate of re-operation when compared to other bariatric surgeries.
The first procedure we will discuss is the gastric bypass, which is scientifically referred to as the Roux-en-Y Gastric Bypass. Many surgeons refer to this bariatric procedure as the gold standard of weight loss surgery, but later we will prove that gastric sleeve is far superior.
How the Procedure Works
There are two components to gastric bypass. The first involves the surgeon creating a small stomach pouch that is approximately one ounce or 30 milliliters in volume. The pouch is created by dividing the top of the stomach from the rest of the organ.
For the next step, the first portion of the small intestine is divided, then the bottom end of the small intestine is joined to the newly connected stomach pouch.
The surgeon then completes the procedure by connecting the top portion of the divided small intestine to the small intestine further down. This allows stomach acids and digestive enzymes to mix with food from the bypassed stomach and initial portion of the small intestine.
The gastric bypass works for weight loss by way of several mechanisms. First, the newly created stomach pouch means that the patient eats less food and absorbs fewer calories. Further, because there is less food digestion, and there is a segment of the small intestine that would normally absorb nutrients that no longer has food passing through it, there is less absorption of calories and nutrients. Finally, the rerouting of food produces changes in gut hormones that suppresses hunger, promotes satiety (feeling full), and reverses one of the primary mechanisms that induces type 2 diabetes.
The advantages of the procedure include long-term weight loss (approximately 60% to 80% weight loss due to the restriction of food and calories. Patients also experience favorable changes in gut hormones that reduce appetite and enhance satiety. For most patients, there is a typical maintenance rate of more than 50% excess weight loss.
Disadvantages include long-term vitamin and mineral deficiencies, a longer than average hospital stay, adherence to dietary recommendations, and the overall complexity of the operation, which can, in turn, lead to greater complication rates.
Biliopancreatic Diversion with Duodenal Switch
BPD/DS is a procedure that has two components. First, a smaller and tubular stomach pouch is created by removing a portion of the stomach similar to the sleeve gastrectomy. A significant portion of the small intestine is then bypassed.
How the Procedure Works
The first portion of the small intestine (duodenum) is divided past the outlet of the stomach. The last segment of the small intestine (distal) is then raised and connected to the outlet of the newly altered stomach. This results in food going through the new tubular stomach pouch where it then empties into the distal of the small intestine. Overall, around three-fourths of the small intestine is bypassed by the food stream.
The bypassed small intestine, which carries bile and pancreatic enzymes, which are responsible for the breakdown and absorption of fat and protein, is reconnected to the final portion of the small intestine so that it can eventually mix with the stream of food.
Like other bariatric procedures, BPD/DS helps to reduce the amount of food that is consumed. However, over time the effect of the surgery decreases, and patients are able to consume near the normal amounts of food they were able to consume before. Unlike other procedures, there is some amount of small bowel that I bypassed by the stream of food.
In addition, the food consumed does not mix with the bile and pancreatic enzymes until it gets far down the small intestine. This means that there is a significant decrease in the absorption of vitamins, nutrients, and calories (including protein and fat).
Finally, BPD/DS affects the gut’s hormones in a manner that impacts blood sugar control, hunger, and satiety.
Advantages of the procedure include 70% of weight loss or greater at the five year follow up appointment and the ability to eat near “normal” meals. The surgery reduces the absorption of fat by 70% or greater and there are favorable changes in gut hormones to reduce appetite and improve satiety. The procedure is also one of the most effective for combatting diabetes.
Disadvantages include higher complication rates and the risk of mortality when compared to other bariatric procedures and a longer hospital stay. There is also a greater potential to cause protein deficiencies and long-term deficiencies in several important vitamins and minerals, including iron, zinc, calcium, and vitamin D.
Sleeve Gastrectomy (Gastric Sleeve)
The gastric sleeve of laparoscopic sleeve gastrectomy is performed by removing 80% of the stomach’s capacity. The remaining portion of the stomach becomes a tubular pouch about the size and shape of a banana.
How the Procedure Works
The sleeve gastrectomy procedure works similarly to the gastric bypass by restricting the amount of food and calories the patient can consume. The greater impact, however, is the effect the surgery has on gut hormones that control hunger, satiety, and blood sugar.
Short term studies show that gastric sleeve and Roux-en-Y gastric bypass have similar effectiveness on weight loss and the improvement of diabetes remission.
There is also evidence that suggests the gastric sleeve is effective on improving type 2 diabetes independent of weight loss.
The advantages of gastric sleeve include fewer calories absorbed and significant weight loss. There are also no foreign objects involved and, unlike gastric bypass, there is no re-routing of the digestive system. The two-day hospital stay is short when compared to other surgeries, and there are favorable changes to gut hormones that help with reduced appetite, suppressed hunger, and improved satiety.
Disadvantages include the potential for long-term vitamin deficiencies and higher early complication rates. The procedure is also non-reversible.
Why is Gastric Sleeve the Superior Bariatric Surgery?
Gastric sleeve bariatric surgeries are becoming more popular than ever and for good reason. Gastric sleeve, also known as vertical sleeve gastrectomy or vertical gastrectomy, does not involve any rearranging of the gastrointestinal anatomy. This very fact limits many of the complications that can occur with other bariatric surgeries like the gastric bypass.
The surgery is highly effective at fighting against morbid obesity. In fact, the surgery has a success rate of around 85%. By opting for the surgery, patients can expect to lose about 60% of their excess body weight within a year following surgery.
The procedure involves anesthesia, so patients are completely asleep during the surgery. The surgery is also simpler than procedures like the gastric bypass and involves minimally invasive techniques when performed laparoscopically. The surgery uses incredibly small instruments. Because of this, patients tend to recover quickly since the surgical incisions are minuscule in nature.
One of the best aspects of surgery, aside from the significant loss of excess weight, is that many comorbidities like diabetes, sleep apnea, and cholesterol tend to improve soon after the surgery is completed.
Patients also appreciate that there are fewer dietary complications with gastric sleeve when compared to other surgeries like gastric bypass. These complications can otherwise cause patients to become ill when eating sugars and refined carbohydrates. There is also a reduced risk of vitamin deficiency post-surgery and there are no foreign objects implanted into the body like you might experience with gastric banding.
Finally, there is no dumping syndrome with gastric sleeve. This is a condition that can develop after some bariatric surgeries whereby food, particularly sugar, moves from your stomach into your small bowel too rapidly. Otherwise referred to as rapid gastric emptying, can cause abdominal cramps, diarrhea, bloating, vomiting, and dizziness. These issues do not seem to plague gastric sleeve patients.
Overall, gastric sleeve improves the patient’s quality of life and reduces hunger sensations and the desire to eat to excess.
Is Gastric Sleeve Bariatric Surgery Right for You?
Gastric sleeve is reserved for patients with a body mass index (BMI) of 40 or greater. Patients with a BMI of 35 can also be good candidates if they have accompanying obesity-related health conditions like type 2 diabetes.
If you suffer from morbid obesity and have previously been unsuccessful controlling your weight using diet and exercise programs, and you don’t have any alcohol or drug addictions, you might be an excellent candidate for this popular bariatric surgery.
At Healthy Life Bariatrics, Dr. Moeinolmolki has helped many patients improve the quality of their lives with gastric sleeve surgery. The first step is to schedule a consultation with Dr. Moein. During that consultation, you can get your questions answered, including whether insurance may pay for the surgery.
Bariatric surgery may not be for everyone, but it is an option to help you lose the excess weight. If you are thinking about bariatric surgery and gastric sleeve, in particular, call us to schedule your consultation with Dr. Moein at Healthy Life Bariatrics in Los Angeles, California.