Bariatric surgery is one of the most effective treatments for morbid obesity and associated comorbidities. There are different kinds of procedures of which sleeve gastrectomy and gastric bypass have emerged as the most popular options in today’s time.
Gastric sleeve is a restrictive surgery in which the original stomach is converted into a long narrow tube by stapling. This involves permanent removal of a large portion of the stomach and is irreversible. It results in reduced capacity to take food and creates a caloric deficit in the body with a consequent increase in level of fat burning hormones leading to weight loss. The reduction in volume of the stomach leads to decrease in the level of hunger hormone with early satiety. The absorption of food is not affected in this procedure and hence there is a lesser requirement for nutritional supplements and the chances of developing malnutrition and deficiency are also less compared to other procedures.
Gastric bypass is a combined operation in which a small gastric pouch is created from the original stomach and directly connected to the small intestine to decrease the effective length of the gut. This is a reversible procedure in which the diverted portion of stomach and intestine are left inside the abdomen where they continue to produce digestive enzymes. This procedure may result in greater and more sustained weight loss but also has the risk of developing nutritional deficiencies and thus requires more aggressive and prolonged use of nutritional supplements.
Gastric sleeve is generally preferred for younger patients with lower BMI and who are in an active lifestyle and have not yet developed the metabolic consequences of morbid obesity. It is recommended for people who are volume eaters, vegetarians and also for people with liver, kidney and intestinal diseases in which other bariatric surgeries may be risky. It also may be preferred in individuals with extreme obesity as a first stage procedure to decrease some weight and prepare the patient for a more definitive operation.
On the other hand, gastric bypass is generally recommended for people with higher BMI and those with high levels of visceral fat and people with diabetes and metabolic syndrome. Gastric bypass is more effective in such individuals because of the combined effects of restriction and malabsorption which results in greater weight loss and comorbidity resolution. It also results in gut hormone secretion which stimulates insulin release from the pancreas resulting in better glycemic control. Thus gastric bypass is the procedure of choice for older individuals with higher BMI, diabetic patients and those who crave sweets and people with slow metabolism. It is also recommended for people with Gastroesophageal reflux as a gastric sleeve is generally contraindicated in such individuals.
Thus, although both gastric sleeve and gastric bypass are both effective procedures, they need to be chosen appropriately for particular patients to get the best results.