Sep 08

Gastric Bypass Surgery Versus Gastric Sleeve Surgery

Two of the most common laparoscopic weight-loss surgeries are the gastric sleeve and the gastric bypass. The term, “gastric bypass”, is very self-descriptive. This is a type of bariatric surgery that literally bypasses part of the digestive system. The meaning of “gastric sleeve” surgery may be less obvious. It does not refer to a band or any other device that constricts the stomach but to a surgical procedure that reshapes the stomach to resemble a tube or a “gastric sleeve.” The gastric sleeve procedure reduces the stomach’s capacity to hold food, but it does not bypass any part of the digestive system.

gastric sleeve surgeryIf you are considering weight-loss surgery, you will need to understand the similarities and the differences between these two procedures. Gastric bypass surgery and gastric sleeve surgery will both result in a significant loss of excess weight. Because of this weight loss, your overall health picture may improve. You may significantly reduce your chance of developing weight-related conditions like diabetes, hypertension and osteoarthritis. Both procedures are normally done using laparoscopic surgery techniques which significantly reduce the chance of surgical complications.

During the gastric sleeve procedure, a part of the stomach is permanently removed, reducing the volume it can hold by as much as 85%. This reduces the volume of food that it can contain and causes the patient to feel full after eating a much smaller amount. Gastric sleeve surgery also removes the portion of the stomach that produces ghrelin, a hormone that stimulates feelings of hunger. The smaller capacity of the stomach and the reduced ghrelin production may both be involved in reduced food intake. Following gastric sleeve surgery, the stomach tends to function normally and food takes the same route through the gastrointestinal tract. The absorption of nutrients continues through the entire length of the intestines. Most foods can be consumed but in smaller amounts.

gastric bypass surgeryGastric bypass surgery is more involved. During a gastric bypass procedure, the stomach is divided into two parts. A new pouch is made in the upper, smaller part of the stomach and a new pathway is created by connecting the new pouch to the middle of the small intestine. The route that food takes through the digestive system now bypasses the lower part of the stomach and the upper part of the small intestine. The digestive tract is shortened making the patient rapidly lose a significant amount of excess weight. Unlike gastric sleeve surgery, the effect of a gastric bypass can be reversed, but this is rarely done. Gastric bypass is generally considered to be a permanent change.

After gastric bypass surgery, patients usually experience a rapid and dramatic loss of excess weight. The pouch formed in the upper part of the stomach is much smaller than the original stomach volume; therefore, the amount of food consumed is reduced. A large part of the digestive tract is bypassed, so the amount of calories and nutrients absorbed is diminished. This leads to rapid weight reduction but it also restricts the absorption of essential nutrients like vitamins, calcium and iron making supplements necessary. Gastric bypass patients may also experience dumping syndrome, a complication that causes abdominal discomfort, vomiting or diarrhea immediately after eating.

Both of these bariatric surgery procedures are carried out in the hospital and under a general anesthetic. They are now done using laparoscopic surgery techniques which greatly reduce the surgical complications seen with the older “open” surgery methods. Both laparoscopic gastric sleeve and laparoscopic gastric bypass require the attention and talent of a highly-skilled surgeon and surgical team. These types of weight-loss surgeries may last from one to three hours and require hospital stays of two to five days after the operation. Laparoscopy recovery is generally faster, less painful and has fewer complications than older surgical techniques.

In general, it is thought that the gastric bypass procedure will produce the fastest, most dramatic and effective weight loss, but it also carries a higher risk of dumping syndrome and causes reduced absorption of essential nutrients. Gastric bypass surgery should not be done on patients with conditions like Crohn’s disease or ulcerative colitis.

The main drawback of gastric sleeve surgery may be that it is a relatively new procedure compared to gastric bypass and the results have not been evaluated for as long a period. The weight loss experienced after a gastric sleeve is less dramatic but studies have shown that patients may lose a large portion (70-80%) of their excess weight over time. Although side effects can occur, they are less frequent than those seen with gastric bypass.

Both of these procedures can be effective in treating severely overweight patients. Deciding which of these bariatric surgeries is right for a given patient requires the expert knowledge and experience of doctors and surgeons in a hospital or bariatric clinic, such as Dr. Christian Birkedal. Each patient and every clinical situation is unique; factors such as age, the presence of medical conditions like diabetes, the patient’s BMI (body mass index) and surgical risk factors should all be evaluated.

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