Even though the Roux-en-Y gastric bypass (RYGB) has always been seen as the “flagship” or gold standard of weight-loss surgeries, recent studies have shown that there is a new king in town – sleeve gastrectomy (SG).
When still back in 2011, gastric bypass was performed almost two times more often than the sleeve gastrectomy, then already in 2016, the tables were turned. The numbers of sleeve gastrectomy cases were three times higher than RYGB.
In addition to “two giants” in the bariatric surgery field, a third standard procedure in the big game is worth naming – gastric band procedure. Its share of the pie of the gastric procedures has reduced during the last decade, but it has remained one of the pioneers of weight-loss surgeries.
To give you a better overview of what each of these three most popular weight-loss surgeries serves, we compared them and brought out some of their best qualities and potential risk factors every patient should be aware of.
Sleeve Gastrectomy
Also known as gastric sleeve, sleeve gastrectomy has become the most common bariatric surgery in recent years. There are a few solid reasons for that, i.e., sleeve gastrectomy involves only partial removal of the stomach, leaving the gastrointestinal tract intact. Compared to more complex gastric procedures (like RYGB), it’s less technically demanding with few postoperative complications and long-term nutritional problems.
The term “sleeve” comes from the new shape patient’s stomach will take, which is far more narrow, almost looking like a tube.
Advantages
- Reduces the amount of food you can or want to eat
- Doesn’t require foreign objects (GB), and bypass or re-routing of the digestive tract (like in RYGB)
- Doesn’t cause digestive problems
- Doesn’t cause mineral or vitamin deficiencies
- Rarely leads to dumping syndrome
- Requires a relatively short hospital stay (approx. 2 days)
- Causes beneficial changes in gut hormones that suppress hunger, reduce appetite, better satiety, and controls blood sugar
- A more straightforward procedure with fewer risks and complications
- Expected weight-loss within 2 years – 60-70%
- Low initial mortality rate – 0.08%
Disadvantages
- It’s a non-reversible procedure
- Has a higher early complication rate than the gastric band procedure
- May not lead to as significant and fast weight loss as with the gastric bypass
- The use of staples can lead to later injuries
- Increased chance of acid reflux
Gastric Bypass
The former most popular weight-loss operation occupied the first place for years because of its ability to bring the most rapid weight loss (10-17% more over four years than with other surgeries). It’s primarily meant for patients with morbid obesity or obesity paired with comorbid conditions.
Gastric-Bypass is rapid and most extensive weight loss compared to other weight-loss surgeries
Gastric Bypass can be done both in a traditional way, open surgery, as well as laparoscopically. During the procedure, a small stomach pouch, with a capacity of about 30 ml, is formed by dividing the top of the stomach from the rest. A small intestine, which regularly comes after the stomach itself, is attached to the new, formed stomach pouch. As a result, the digestive enzymes and stomach acids from the bypassed stomach and first portion of the small intestine will eventually mix with the food.
Advantages
- Rapid and most extensive weight loss compared to other weight-loss surgeries
- Restricts the amount of food that can be consumed
- May lead to increased energy expenditure, which means faster weight loss
- Can alleviate several comorbid diseases, such as high blood pressure and cholesterol, type II diabetes, arthritis, sleep apnoea, chronic headaches, and muscle pain
- Also produces favorable changes in gut hormones that enhance satiety and reduce appetite
- Expected excess weight loss within 2 years – 70-80%
- It’s a reversible procedure
- Low initial mortality rate – 0.14%
Disadvantages
- It’s technically a more complex procedure than the gastric band and sleeve gastrectomy, which could potentially result in more significant complication rates
- Dumping syndrome – certain types and amounts of food may trigger discomfort, weakness, diarrhea, nausea, and dizziness
- Nutrient and vitamin deficiencies – patients must supplement their diet with minerals and vitamins (particularly, B12, iron, calcium, and folate)
- Generally, more extended hospital stay and recovery time compared to sleeve gastrectomy and gastric band
- Post-operative bleeding and ulcers may occur
Gastric Band
Also known as an adjustable gastric band, it’s one of the safest bariatric procedures out there because it enables you to control your food intake more effectively by placing a band around the stomach’s upper part.
This operation involves minimal incisions because the band is inserted into your stomach laparoscopically. Depending on your weight-loss journey, the band can be adjusted to reduce your potential discomfort and better the results. It’s generally done by filling the band with sterile saline, injected through a port placed right under the skin.
Advantages
- Reduces the amount of food you can or want to eat
- It’s a reversible and adjustable procedure
- Has the lowest risk for vitamin or mineral deficiencies
- The shortest recovery time and hospital stay compared to gastric sleeve and gastric bypass
- Has the lowest rate of early postoperative complications among other bariatric procedures
- Doesn’t interfere with the digestive system
- Expected excess weight loss within 2 years – 40-50%
- Low initial mortality rate – 0.03%
Disadvantages
- Slower and less extensive weight loss compared to other procedures
- Requires a foreign object to stay in the body
- Requires regular follow-up visits and band adjustments
- A small percentage of patients experience: 1) dilation of the esophagus if the patient overeats, 2) mechanical problems with the band, tube, or port, 3) band slippage or band erosion into the stomach
Conclusion
the landscape of weight-loss surgeries has been rapidly changing, with the sleeve gastrectomy rising to prominence as the most common bariatric procedure today. However, each surgery, be it the sleeve gastrectomy, gastric bypass, or gastric band, presents its unique advantages and potential drawbacks.
While the sleeve gastrectomy is praised for its simplicity and low risk of postoperative complications, the gastric bypass still holds its place due to its rapid and extensive weight loss results. The gastric band procedure, on the other hand, stands out for its adjustability, safety, and the least interference with the digestive system.
Nevertheless, one size doesn’t fit all when it comes to choosing the best weight-loss surgery. Each individual has unique health conditions, needs, and goals. Therefore, a thorough discussion with a healthcare professional is crucial before deciding on the procedure that will serve you best.
Remember, the goal is not just weight loss, but a healthier, happier life. So, let’s start the conversation, understand your current situation, and work together to design the best action plan and weight-loss surgery for you.
