Diabetes and gastric sleeve
March 26, 2017FB Live Video: Bypass or sleeve?
April 5, 2017
Bypass vs sleeve vs band vs mini-bypass. There are now many options when it comes to weight loss surgery. When deciding on what is right for you, it’s essential that you compare these options with the help of your surgeon. Today we’re going to put two of the most common metabolic weight loss surgeries to the test: similarities, differences, pros and cons; so you get a true indication of life with a sleeve vs bypass. Ding ding ding – let’s go!
Round 1: bypass vs sleeve
Aptly named, the bypass (technically call a Roux-n-y gastric bypass) is a rearrangement of the plumbing of the gut. The lower portion of the stomach and beginning of the small intestine is bypassed. The remainder of the stomach is left in place.
We don’t change the plumbing in this one, instead your surgeon will remove the majority of your stomach leaving you with a pouch about 250ml (1 cup) in size.
Round 2: What are the similarities?
- Both are keyhole (laparoscopic) surgeries
- Both require a hospital stay of 3-4 days, take 2-4 weeks to recover and about 6-8 weeks before you are eating normal textures again
- Both carry risks – the biggest risk being a leak, but also include nutrient deficiencies, gallstones and other risks typically associated with surgery.
- Both are good options for improving diabetes and other health issues such as high cholesterol, high blood pressure, sleep apnoea and arthritis.
- Both reduce your portion sizes to about 1 cup.
- Both reduce appetite and help to change your relationship with food.
- Both require you to change your eating habits and to focus on eating quality.
- Both require you to take daily supplements.
Round 3: What are the differences?
- Results in 60-80% excess body weight loss after two years (3).
- More malabsorption and no absorption of B12 so a greater risk of nutritional deficiencies and therefore additional lifelong daily supplements including a B12 injection every three months are recommended.
- Technically reversible
- Better for revisional surgery, especially if reflux is involved.
- Higher risk of dumping syndrome with sugary foods due to the sensitivity of the small intestine and the change in the plumbing… See my post on dumping syndrome here.
- Average surgery time is 2hrs 45mins (2)
- Slightly higher risk of serious complications such as leak due to the increased difficulty of surgery(~.8% if done laparoscopically)(1).
- Results in 50-70% excess body weight loss after two years.
- Less malabsorption as no change to the plumbing, but still requires daily life-long supplements.
- Irreversible but able to be converted to a bypass if revision is required.
- Minimal risk of dumping syndrome, but a higher risk of reflux (can be up to 47%)
- Slghtly lower risk of a serious complications such as a leak (~.7% )(1).
- Average surgery time is 1hr 40mins (2).
Final Round: How do you decide?
The number one place to go to ask this question is to your surgeons rooms. They are the only person that will know your medical history, their experience and their preference and can talk you through the risks and benefits in detail. They’ll be able able to give you the winner for you.
If you’re up for theoreticals or want a nice summary, a really interesting tool to help you walk through the options and what might suit you best based on your medical history is: www.bypass-or-sleeve.com.
1: Shikora SA. The use of staple‐line reinforcement during laparoscopic gastric bypass. Obes Surg 2004; 14(10):1313‐20.
2: Shi, X. et al (2010). A Review of Laparoscopic Sleeve Gastrectomy for Morbid Obesity. Obesity Surgery Aug;20(8):1171-7.
3: ASMBS. Bariatric Surgery Procedures.
