Bariatric surgery is nowadays dominated by two major procedures- gastric sleeve and gastric bypass. Both these procedures are highly effective for long term weight loss in morbidly obese individuals. The choice of procedure is determined by several patient related factors and may also be influenced by surgeon’s preference.
Whereas gastric sleeve is purely a restricted procedure which decreases the stomach capacity and restricts caloric intake, gastric bypass is a combined operation which leads to both restriction and malabsorption. Gastric sleeve is preferred for younger patients with big appetites to decrease their intake. It doesn’t require stringent vitamin supplementation like it’s counterpart and not plagued with long term deficiencies of essential nutrients.
On the other hand, gastric bypass is preferred for older adults with established metabolic syndrome for more effective weight loss. The overall weight loss may be greater as compared to gastric sleeve with lesser chances of weight regain. It also avoids acid reflux which may be nagging problem for some patients who have undergone gastric sleeve. However, there is a requirement for long term protein and vitamin supplementation to avoid the side effects of vitamin deficiency in the future.
Gastric sleeve is technically easier to perform and may be the choice for the novice surgeons in the early phase of their career. Gastric bypass is often preferred by surgeons with greater experience who have long tackled the problems of acid reflux and weight regain seen in gastric sleeve patients.
Thus, both procedures are effective given that they are chosen for the right kind of patients. The most important determinant of long term success of the procedure being the lifestyle modification and regular follow up being adopted by patients after their bariatric surgery.