Gastric Sleeve

A laparoscopic sleeve gastrectomy (LSG) is a restrictive procedure that permanently reduces the stomach’s size by separating and removing approximately 80% of this organ from the body. The remaining stomach is then stapled and formed into a tubelike structure that resembles a banana that connects to the intestines, which, contrary to the gastric bypass, are left intact.

This procedure works by several mechanisms. First, the new stomach pouch holds a considerably smaller volume than the normal stomach helping it to significantly reduce the amount of food and beverage (and thus calories) that can be consumed. However, the more significant impact seems to be the effect the surgery has on gut hormones that impact several factors, including hunger, satiety, and blood sugar control. Unlike the gastric bypass, the gastric sleeve is a more straightforward operation that does not involve intestinal rerouting or malabsorption. This procedure uses only the patient’s natural tissues and does not affect the absorption of calories and nutrients in the intestines.

Short-term studies show that the gastric sleeve is as effective as the (Roux-en-Y) gastric bypass in terms of weight loss and improvement or remission of diabetes. There is also evidence that suggests the sleeve, similar to the gastric bypass, is effective in improving type 2 diabetes independent of weight loss. Recommended by the American Society for Metabolic and Bariatric Surgery, the gastric sleeve combines many of the gastric band and gastric bypass benefits, but without a foreign object and possible complications of the gastric band.

Gastric Bypass

In (Roux-en-Y) gastric bypass, the surgeon creates a small pouch at the top of the stomach, leaving it as the only part of the stomach that receives food. The small intestine is then bypassed with a shorter distance below the main stomach and connected to the new pouch. However, the main part of the stomach continues to make digestive juices, and a portion of the intestine, still attached to the main stomach, is reattached farther down, allowing the digestive juices to flow to the small intestine. Food flows directly from the new pouch into this part of the intestine and allows food to skip the large excluded stomach and the first part of the small intestine.

This operation works in several ways. Like most bariatric procedures, the newly created stomach pouch is considerably smaller, limiting the amount you can comfortably eat and drink at one time, which translates into fewer calories consumed. Additionally, because there is less digestion of food by the smaller stomach pouch and a segment of the small intestine that would normally absorb calories and nutrients that no longer has food going through it, there is less absorption of calories and nutrients (malabsorption). Most importantly, the rerouting of the food stream produces changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms by which obesity induces type 2 diabetes.

According to the American Society Metabolic and Bariatric Surgery and the National Institutes of Health, gastric bypass surgery has been historically the most popular bariatric surgery in the United States.

After the surgery, weight loss tends to be swift and dramatic. About 50% of it happens in the first six months and may continue for up to 2 years after the operation. Because of the rapid weight loss, obesity conditions such as diabetes, high blood pressure, high cholesterol, arthritis, sleep apnea, and heartburn, often get better quickly.

Revision Surgery

Although rarely required, the most common reason patients consider a revision surgery is because the patient did not lose enough weight or too much was gained back. Also, complications that may occur after gastric bypass surgery, such as ulcers, chronic vomiting, hernia, staple line failure, can often be improved through revisional surgery. Usually, it is a revision from Gastric Sleeve to Gastric Bypass; very rarely, a modification from Gastric Bypass is needed.

Patients who need a Revision Weight Loss surgery will have their health history and treatment revised and reevaluated to ensure a successful loss of weight and its maintenance in the future.

The results obtained from a revision can vary widely depending on the original procedure and the reason for the modification; these surgeries are usually successful in resolving the associated problems and promoting further weight loss. Weight loss following a revision is usually not as dramatic as the initial bariatric procedure, but it can be substantial over time. As revision surgery can be more complex and involve more risks than general weight loss surgery, it is important to choose a bariatric surgeon experienced and skilled in performing revision surgery.