Why Gastric Sleeve is the Favorite Weight Loss Operation
In my last post I showed that gastric sleeve is the favorite weight loss operation, as of 2013, in the United States.
In 2010 <10% of weight loss operations were sleeve gastrectomy operations. In just three short years, the sleeve went from a distant third place in popularity, significantly behind both the gastric bypass and LAP-BAND®, to first place.
This fast rise in popularity suggests that the sleeve gastrectomy operation has advantages over the alternative operations, the gastric bypass and LAP-BAND®. In my opinion the advantages of sleeve gastrectomy are as follows:
- Great weight loss outcomes, similar to gastric bypass
- Less long-term risk than with gastric bypass or LAP-BAND®
- A more normal postoperative eating experience
I will discuss each of these advantages in more detail, but first let’s review the sleeve gastrectomy – what it is and how it works.
About Sleeve Gastrectomy
The sleeve gastrectomy operation involves laparoscopically reducing the size of the stomach from approximately 30-40 ounces in volume to approximately 3-4 ounces in volume. This is done by dividing across the stomach like shown in the diagram, and removing the large excluded portion of the stomach.
The sleeve volume is made to be overly small initially, because over time the sleeve will expand. Studies show that the stomach will approximately double in volume over time, so a 3-4 ounce sleeve will eventually become approximately 6-8 ounces in volume.
A couple important points to make about the sleeve that will be important to the discussion below about the sleeve’s compelling advantages: 1) the stomach pouch is large (3-4 ounces) compared to the gastric bypass pouch (1 ounce) and LAP-BAND® pouch (1/2 ounce), and 2) stomach emptying occurs through the normal muscular sphincter at the bottom of the stomach rather than through the very small fixed diameter openings at the bottom of the gastric bypass and LAP-BAND® stomach pouches.
Excellent Weight Loss
Average weight loss after sleeve gastrectomy is typically reported to be 60-80% of excess weight. This is similar to the average weight loss after gastric bypass, and significantly better than the average weight loss after the LAP-BAND®. Disclaimer – individual patient results vary.
To visualize what 70% of excess weight loss looks like, see photos below:
This patient lost 90 pounds after sleeve gastrectomy, which was 73% of her excess weight. This outcome is the typical weight loss outcome after sleeve gastrectomy. Disclaimer – individual patient results vary.
The sleeve gastrectomy causes weight loss by doing two things.
First, the small stomach restricts food intake by causing more satiety with less food.
Second, the operation changes how the biology that regulates body weight works. Normally, the body will react to weight loss by increasing hunger and cravings, and decreasing metabolic rate to cause weight regain back up to the set-point weight. The sleeve gastrectomy (like the gastric bypass) changes this biology, resulting in the body accepting a new lower weight as the set-point. This is what gives patients the ability to maintain weight loss long-term.
Read more about how surgery changes the body weight set-point.
Less Long-Term Risk
The sleeve gastrectomy is associated with fewer long-term potential complications than the gastric bypass and the LAP-BAND®.
The reason for this is because GI tract anatomy remains more normal. The stomach is made to be substantially smaller, but food travels through the GI tract normally, and there is not an implanted foreign body.
The main long-term potential complication that has been reported after the sleeve gastrectomy is heartburn/reflux (gerd), which has been reported to occur in approximately 10% of patients. In most sleeve gastrectomy patients with gerd, symptoms can be controlled with antacid medications.
A More Normal Eating Experience
Although individual patient results vary, the sleeve gastrectomy operation typically preserves a more normal eating experience than the gastric bypass or LAP-BAND®. A more normal eating experience, in turn, makes the sleeve gastrectomy an easier operation to live with.
The reason for this is because stomach anatomy and function remain more normal.
Sleeve gastrectomy stomach size, while much smaller than the normal stomach, is substantially larger than the gastric bypass and LAP-BAND® stomach pouches. Because of this the sleeve gastrectomy stomach functions more like a reservoir for food than the bypass or band stomach pouch.
Stomach emptying remains more normal with the sleeve gastrectomy because emptying occurs through the pylorus, the muscle at the bottom of the stomach that controls stomach filling and emptying. Stomach pouch emptying with the bypass and band occurs not through the pylorus but through a very small fixed diameter opening.
These two factors – a larger stomach pouch, and emptying through the normal pylorus – result in a more normal eating experience. How you are able to eat, what you are able to eat, and how you feel when you eat all tend to be less altered with the sleeve than with the bypass or band.
The sleeve gastrectomy has become the favorite weight loss operation in the United States for good reasons. Weight loss outcomes are typically excellent, long-term risk is low, and it is an easy operation to live with.