The sleeve gastrectomy was initially developed in the early part of this century as an operation to “bridge” the super-obese patient to a gastric bypass or bilio-pancreatic diversion. The idea was to achieve enough weight loss to allow the technically more demanding second stage to be performed more safely. It was observed that the sleeve gastrectomy could achieve very significant weight loss and it came to be used as a weight loss operation in its own right, in a wider range of patients. We now have more than a decade of good quality research/publications to look at, and the sleeve gastrectomy has now become the operation of choice for most patients requiring bariatric surgery.
The (laparoscopic/keyhole) sleeve gastrectomy is as safe as the LAGB and is a more effective operation. Like all weight-loss surgery, it can produce significant improvement in complications of obesity such as high blood pressure (hypertension), type 2 diabetes mellitus, and elevated cholesterol and lipids. The effect on diabetes is so strong that the surgery is now proposed as a front-line treatment of diabetes, in patients who are on the point between overweight and obese (BMI 30).
As always, the weight loss achieved in an individual patient may be more or less than the population average.
This link will take you to the IFSO page on sleeve gastrectomy.
There are various forms of gastric bypass surgery. The Roux-en-Y gastric bypass (RYGB) is a laparoscopic/keyhole operation that has long been popular in the USA and is therefore one of the most common weight loss operations around the world. It is an effective surgical options but it does come with a higher complication rate, both in the early phase and down the track from the surgery. It is a technically demanding operation and it still may be done as open surgery, especially in re-operative cases (ie when converting from a previous, unsuccessful, operation). In Australia, the bypass is often done as a “salvage” procedure when another surgical approach has failed (whether due to inadequate weight loss, or due to a complication).
As always, the weight loss achieved in an individual patient may be more or less than the population average.
This link will take you to the IFSO page on RYGB.
Re-operative surgery
Some patients will require a second (or subsequent) weight loss operation. Possible reasons include:
- failure to lose weight.
- a complication of the surgery.
- excessive weight loss.
The approach to each patient will be different, depending on a variety of factors which may include:
- condition of the tissues in the operative field (scarring and infection may be present).
- the symptoms that have actually motivated the patient to come along for consideration of further surgery, and what he/she wants to achieve with possible further surgery.
- the individual patient’s general fitness for surgery.