Gastric sleeve surgery, also known as the sleeve gastrectomy, has become a popular choice for patients seeking excellent weight loss in a straightforward procedure that doesn’t require the maintenance and long-term complication rates of a Lap Band.
It’s very difficult to get insurance companies to approve new procedures. So why would they approve gastric sleeve surgery?
Gastric sleeve procedure details
Super Obese individuals (people with a Body Mass Index over 45) have an increased risk during any surgery. And the longer the time under anesthesia, the greater the risk. Gastric bypass surgery can last over 2 hours. Duodenal switch surgery often takes over 4 hours. That’s a long time to be under anesthesia.
So surgeons started breaking the procedure up into two stages. The first stage was to reduce the size of the stomach. The second stage would be done a year later after the patient lost some weight. The second stage of the procedure would include bypassing some of the intestines to reduce calorie absorption.
So surgeons started coding the first part of the procedure as the first half of a duodenal switch. Insurance was paying.
When patients came back a year later, they had lost so much weight that a second procedure wasn’t necessary.
Studies like this one started to emerge (Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2). Complication rates were low and weight loss was as good, if not better, than gastric bypass. And because the surgery took less time and was less complicated to perform, surgeons liked it.
Patients also liked the procedure. After surgery and often for months after the procedure patients noticed they weren’t hungry. Some patients had to remind themselves to eat.
Later, research showed that the hunger producing hormone ghrelin was significantly lowered in gastric sleeve patients. It’s believed that the area of the stomach removed during gastric sleeve surgery produces much of the hormone ghrelin. While gastric bypass patients experienced less hunger, it seemed to be more pronounced in gastric sleeve patients.
POTENTIAL BENEFITS TO PATIENTS
Gastric sleeve surgery has the benefits below:
- May reduce hunger.
- The hunger inducing hormone ghrelin is reduced by removing a portion of the stomach largely responsible for its production.
- Reduction of hunger occurs in most patients but not all.
- Shorter operating time compared to gastric bypass.
- Does not re-route intestines.
- No dumping syndrome.
While dumping syndrome can be a tool to reinforce good eating habits, it’s very unpleasant.
The pylorus remains intact and sugars have time to digest since the intestines remain untouched.
No adjustments are needed. The Lap Band requires regular adjustments (doctor visits).
No foreign objects are left in the body. The Lap Band leaves a silicone band around the upper portion of your stomach.
Weight loss occurs over 18 months.
Gastric bypass weight loss is very quick. The majority of weight loss occurs in the first year.
Lap Band is gradual and requires major lifestyle changes for success. The majority of weight loss occurs over 3 years.
WHY YOUR SURGEON PREFERS SLEEVE GASTRECTOMY OVER LAP BANDS
Surgeon getting ready to perform gastric sleeve.
Guess what? Your surgeon may prefer gastric sleeve or bypass over Lap Bands. Surgeons want you to be successful. Most surgeons care about getting you healthy. But, they also know that you’re a future referral source. You are a future success story.
If your surgeon has been performing bariatric surgery for long enough he or she has seen patients that lose little or no weight with a Lap Band.
This doesn’t mean the band isn’t working. It just means that certain patients cannot implement the lifestyle changes (3 small meals a day, high protein, exercise, low carbs, etc.) that are needed to be a success with the Lap Band.
The failure to lose weight is significantly less with gastric bypass or gastric sleeve surgery. Granted, after the weight comes off, it’s up to the patient to keep it off.
For a surgeon that is trying to help, it’s difficult to identify patients that are truly dedicated to implementing exercise and healthy, nutrient dense foods into their diet.
It’s a much better bet and ‘safer’ to recommend bypass or sleeve.