Sunday, March 6, 2011
My Favorite WLS in 2011? Sleeve Gastrectomy!
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It is official now. My favorite weight loss surgery (WLS) now is the sleeve gastrectomy. Does it cause the most weight loss among all weight loss surgeries? No. Duodenal switch and gastric bypass would cause more weight loss. Is it the easiest operation? No. Probably the adjustable gastric band (Lap Band for instance) is easier to perform. However, the sleeve gastrectomy operation combines a unique set of advantages that, together, make it extremely appealing.
1. It is a true restrictive operation. It does not place an obstructive foreign body like the adjustable gastric band. All it does is, to make the stomach smaller, much smaller. We remove 60-80% of the stomach. And the part that we remove is the most expansible part.
2. Patients feel much less hungry in between meals. Doing so is of great help to the vast majority of morbidly obese patients. The mechanism could very well be due to removing the fundus of the stomach. That part of the stomach is the major source of Ghrelin, aka the "hunger hormone". In that particular aspect, it is more effective than the adjustable gastric band.
3. The weight loss after sleeve gastrectomy is reported to be 68% of the excess weight, which is comparable to gastric bypass. This is more than the average for the adjustable gastric band. Success is also more consistent after sleeve gastrectomy. But notice that we do not have long-term follow-up data for sleeve gastrectomy beyond 5-6 years. Having said so, the data thus far beat the weight loss data with the adjustable gastric banding.
4. The surgery is laparoscopic (so-called "minimally invasive") and does not involve implanting any prosthesis around the stomach. Furthermore, the small intestine (small bowel) is not touched. No division. No bypassing. Therefore, a whole set of potential complications (even though rare or uncommon) that are connected with gastric bypass become no issue.
5. For cash paying patients, sleeve gastrectomy is far less expensive than gastric bypass and even, in many institutions, Lap Band. As such, it is becoming the most appealing operation for weight loss among cash-paying patients.
6. Since there is no need for adjustments (as compared to the adjustable gastric band), sleeve gastrectomy is a relatively a low-maintenance type of weight loss surgery. 7. The recovery time is faster than gastric bypass.
So, all in all, sleeve gastrectomy is a nice balance between the gastric bypass and the adjustable gastric band. In our practice, it is now the most commonly requested (and performed) weight loss surgery. You may wonder, do we insert anything that looks like a sleeve in the stomach? No. Then why is it called "sleeve" gastrectomy? Well, someone looked at the final look of the stomach by the end of the operation, which is almost like a tube, and with some imagination called it a "sleeve".