The Most Popular Weight Loss Surgery

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A number of surgical options are now available for the treatment of obesity. These include gastric bypass, gastric banding, and gastric sleeve (sleeve gastrectomy) procedures, among others. However, some procedures have become more popular among bariatric surgeons than others. 

Which Weight-Loss Surgery Is Most Popular Now?

Over the past year or so, the popularity of the gastric sleeve procedure (also known as sleeve gastrectomy) has skyrocketed, due to its effectiveness and safety as compared with other procedures.

In fact, according to Bariatric Surgery Source, the gastric sleeve procedure now appears to be overtaking gastric bypass as the new “gold standard” procedure.

What Is Sleeve Gastrectomy?

Sleeve gastrectomy, or gastric sleeve, is a surgical procedure that reduces food intake and induces weight loss. In this procedure, approximately 60% of the stomach is removed (usually laparoscopically), such that the remaining portion of the stomach takes on the shape of a tube or sleeve.

Because the stomach is smaller after the operation, the gastric sleeve patient will feel fuller faster and with less food. For these reasons, the gastric sleeve procedure is known as a “restrictive” type of bariatric surgery.

Who Is a Candidate for Sleeve Gastrectomy?

According to the latest obesity guidelines released by the American Heart Association (AHA), the American College of Cardiology (ACC), and The Obesity Society (TOS), bariatric surgery may be an option for adult patients who meet certain criteria.

These criteria include a body mass index (BMI) of 40 or greater, or a BMI of 35 or greater in a patient who has other medical conditions (known as “comorbid conditions”) caused by obesity. The obesity guideline writing committee did not find sufficient evidence to recommend bariatric surgery for patients who have BMIs that fall below these cutpoints.

The guideline further advises primary care doctors and others caring for patients with obesity with high BMI to try “behavioral treatment with or without pharmacotherapy” first, and then if this has not worked along with other diet and lifestyle measures to achieve sufficient weight loss, bariatric surgery may be considered.

Sleeve gastrectomy may be the first procedure performed in patients who are extremely obese, with extremely high BMI, with the intention of performing a second procedure, such as gastric bypass or duodenal switch, at a later time.

Also important to consider is that sleeve gastrectomy may not be the best choice for patients with significant gastroesophageal reflux disease.

How Effective Is the Gastric Sleeve Procedure?

Research has found sleeve gastrectomy to result in an average 65% excess weight loss. Initial evidence points to gastric bypass and gastric sleeve procedures being more effective than gastric banding in terms of magnitude of weight loss. For this and other reasons, gastric banding is beginning to fall out of favor among surgeons.

However, longer-term follow-up studies are needed, as no studies of bariatric surgery appear to report outcomes beyond five years.

What Are Possible Complications or Side Effects?

Certain risks are common to all surgical operations that require anesthesia, such as the possibility for heart or lung problems and even death (which is rare). For bariatric surgery in particular, there are complications that can develop over the longer term, such as bowel obstruction, gallstones, hernias, stomach perforation, ulcers, malnutrition, vomiting and dumping syndrome (in which food empties into the small intestine too quickly, resulting in diarrhea, nausea and vomiting).

As with most bariatric surgery procedures, patients will need to be followed closely for the rest of their lives to monitor for vitamin and mineral deficiencies. Most patients will require vitamin supplementation and laboratory (blood test) monitoring on a regular basis, as many if not all of the bariatric surgery procedures cause changes in how the body absorbs certain vitamins and nutrients.

Patients who have had bariatric surgery must still be strict about their diet and lifestyle habits, as it is not uncommon to gain weight once more even after the surgery if the recommended lifestyle changes, which include both diet and exercise, are not followed vigilantly.

Sources:

Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society [published online November 27, 2013]. J Am Coll Cardiol.

Puzziferri N, Roshek TB, Mayo HG, et al. Long-term follow-up after bariatric surgery: a systematic review. JAMA 2014;312:934-942.

Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004;292:1724-1737.

Arteburn DE, Fisher DP. The current state of the evidence for bariatric surgery. Editorial. JAMA 2014;312:898-899.

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