Sleeve Gastrectomy And Roux-en-Y Gastric Bypass: What you Need to Know

1. Introduction

As a bariatric surgeon, I spend a lot of time explaining the various treatments available for obesity, especially the surgical options. I’m often surprised by how much confusion there is about these procedures, even among those who might benefit most from them. This inspired me to write this article, “Sleeve Gastrectomy and Roux-en-Y Gastric Bypass: What You Need to Know.” My goal is to demystify these two common bariatric surgeries, breaking down their differences in simple, easy-to-understand terms. By the end of this article, you’ll have a clearer understanding of what each procedure entails, who they’re best suited for, their benefits, and potential risks. This information will help you make an informed decision about your weight loss journey.

Bariatric surgery is a powerful tool to help people struggling with severe obesity achieve significant weight loss and improve their overall health. Among the most common types of bariatric surgery are the sleeve gastrectomy and the Roux-en-Y gastric bypass. Understanding the differences between these procedures can help patients make informed decisions about their weight loss journey.

2. Definition of Sleeve Gastrectomy and Roux-en-Y Gastric Bypass

Sleeve Gastrectomy: The sleeve gastrectomy, often referred to as the gastric sleeve, involves removing about 80% of the stomach. This leaves a tube-like or sleeve-shaped stomach. The smaller stomach holds less food and produces fewer hunger hormones, which helps reduce appetite and calorie intake.

Roux-en-Y Gastric Bypass: The Roux-en-Y gastric bypass (RYGB) involves creating a small pouch from the stomach and connecting it directly to the small intestine, bypassing most of the stomach and a portion of the small intestine. This reduces the amount of food you can eat and changes how your body absorbs nutrients, aiding in weight loss.

3. Patient Selection Criteria

Eligibility for Sleeve Gastrectomy

• BMI (Body Mass Index): Typically, patients with a BMI of 40 or higher, or 35-39.9 with obesity-related health conditions such as diabetes or hypertension.
• Age: Generally, adults aged 18-65. However, exceptions can be made for younger or older patients based on individual health status. Our program, at the Longstreet Clinic Center for Weight Management, is an ASMBS accredited adolescent program which means we can see patients from 15 years of age and older.
• Previous Weight Loss Attempts: Should have attempted other weight loss methods like diet, exercise, and medication without long-term success.

Eligibility for Roux-en-Y Gastric Bypass

• BMI: Suitable for patients with a BMI of 40 or higher, or 35-39.9 with severe obesity-related conditions.
• Age: Typically for adults aged 18-65, with consideration for other age groups based on medical evaluation.
• Health Status: Must be healthy enough for surgery, with a comprehensive medical evaluation to assess any risks.

4. Indications for Each Procedure

Sleeve Gastrectomy:

• Preferable for patients with a higher BMI or those needing a less complex surgery.
• Suitable for those with significant obesity-related health conditions.
• Often recommended for patients with previous abdominal surgeries where bypass might be more complex.

Roux-en-Y Gastric Bypass:

• Effective for patients with severe GERD (gastroesophageal reflux disease) as it can alleviate symptoms.
• Preferred for those with type 2 diabetes, as it often leads to significant improvement or remission.
• Suitable for patients who may not benefit enough from a sleeve gastrectomy alone.

5. Secondary Effects

Sleeve Gastrectomy

• Positive Effects: Significant weight loss, reduced hunger, and improvement in obesity-related conditions.
• Potential Issues: Nutrient deficiencies (less common than with bypass), acid reflux, and potential for weight regain.

Roux-en-Y Gastric Bypass

• Positive Effects: Rapid weight loss, improvement in type 2 diabetes, and alleviation of GERD symptoms.
• Potential Issues: Nutrient deficiencies (more common due to malabsorption), dumping syndrome (rapid gastric emptying), and risk of bowel obstruction.

6. Possible Complications

Sleeve Gastrectomy

• Short-term Risks: Bleeding, infection, leaks, and blood clots.
• Long-term Risks: Stomach leakage, narrowing of the stomach (stricture), and potential for chronic acid reflux.

Roux-en-Y Gastric Bypass

• Short-term Risks: Bleeding, infection, blood clots, and leaks at the surgical connections.
• Long-term Risks: Bowel obstruction, hernias, ulcers, and severe nutrient deficiencies.

7. Outcomes and Benefits

Weight Loss

• Sleeve Gastrectomy: Patients typically lose 60-70% of their excess weight within 1-2 years.
• Roux-en-Y Gastric Bypass: Patients generally lose 70-80% of their excess weight within the first 1-2 years.

Health Improvements

• Both Procedures: Significant improvements in conditions like type 2 diabetes, hypertension, sleep apnea, and joint pain.
• Roux-en-Y Gastric Bypass: Often more effective for rapid improvement in type 2 diabetes and GERD.

8. Conclusion

Choosing between sleeve gastrectomy and Roux-en-Y gastric bypass depends on various factors, including individual health conditions, weight loss goals, and personal preferences. Both surgeries offer substantial benefits and potential risks. Consulting with a qualified bariatric surgeon can help you make the best decision for your health and lifestyle.

If you have any questions or would like to schedule a consultation, please feel free to reach out. Your journey to better health is important, and we are here to support you every step of the way.

Dive deeper into the world of obesity and its treatment strategies by exploring the insights shared in my latest book, “Losing Weight Gaining Life: A Complete Guide to Overcoming Obesity.” This comprehensive resource offers invaluable information to empower you on your journey towards a healthier life.