Roux-en Y (RY) gastric bypass or gastric bypass is an established surgical treatment for morbid obesity. This is usually performed with laparoscopy or “key-hole” surgery. It involves partitioning the stomach into a small pouch and re-arranging part of small bowel. The small stomach pouch, about the size of one's thumb, is fashioned with surgical stapler and separated from he remainder of stomach. The upper half of small bowel is sectioned and re-arranged into 2 limbs - Roux or the 'food' limb and biliopancreatic or “ digestive enzyme” limb. The “food” limb is then connected to the small stomach pouch to restore the continuity of gut and the “digestive enzyme” limb connected to the “food” limb downstream to allow digestion of food and absorption of nutrients in the “common” limb. With gastric bypass, patients feel full and satisfied with small portion of food. In addition, the re-arrangement of small bowel triggers hormonal changes that suppress hunger and improve diabetes.
Sleeve gastrectomy provides reliable weight loss. It requires fewer dietary modifications and less intensive review compared to gastric banding as there is no need for adjustments. The risk of nutrient deficiency is minimal compared with gastric bypass and although a portion of the stomach is removed, access to the biliary tree (ERCP) is preserved (compared with gastric bypass).
Sleeve gastrectomy is not reversible. It is a more invasive procedure compared to gastric banding as it involves removing 80% of the stomach. Notable risks include staple line leakage, staple line bleeding and stricture (narrowing of the stomach sleeve) - see below for more information on risks. Sleeve gastrectomy is a relatively new procedure. Although deemed safe and effective, the is little data beyond 10 years as to how effective it will be with time. There is the possibility that the 'sleeve' may dilate with time and result in weight regain.
All types of weight loss surgery carry risks. Most patients will not experience any complications but it is important that you are aware of the risks so you can make an informed decision regarding your surgery. Risks can generally be divided into general surgical risks and specific risks. General risks include but are not limited to:
On average sleeve gastrectomy patients can expect to lose up to 25-30% of body weight over the first 12-18 months following surgery. This of course depends on following an appropriate diet and maintaining an adequate regime of exercise.
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