The Sleeve Gastrectomy has only been performed as a primary weight loss procedure for the last ten years. The Sleeve started to become popular around the same time that we were beginning to recognize the shortcomings of adjustable gastric banding. It’s become increasingly popular over the last five years and in 2015 was the most commonly performed weight loss procedure in the United States.
The Sleeve is a more straightforward procedure that transforms the stomach into a narrow tube, shaped very much like a shirt sleeve by removing around 80% of the stomach. While most people look at the Sleeve as a surgery that works primarily by reducing your ability to eat large portions, the Sleeve exerts its primary weight loss effect through hormonal changes, just like the gastric bypass. The portion of the stomach that is removed plays a critical role in your metabolic thermostat’s inner workings and removing it causes an immediate lowering of your set point.
Because the stomach is removed completely, this surgery is completely irreversible, in contrast to a gastric bypass that can be reversed, but at high risk. Many patients have downplayed the Sleeve as a minor surgery, but the removal of 80% of your stomach should not be taken lightly. I often pose the following question to Sleeve Gastrectomy patients that I think are taking their decision too lightly: “If you were checking in to the hospital tomorrow to have 80% of your stomach removed, would you consider it a minor surgery?” Even though a Sleeve Gastrectomy can be performed extremely safely with only a 1-2% serious complication rate, it is not a minor surgery.
Many centers have embraced the novelty of the sleeve and have moved toward this surgery exclusively, no longer performing adjustable banding or gastric bypass. This trend has started to reverse and the sleeve zealots who have abandoned all other procedures are decreasing in number and there is a trend toward a more balanced split between the sleeve and the gastric bypass.
The Sleeve Gastrectomy sits immediately between adjustable gastric banding and the gastric bypass in both its risk profile and weight loss effect. Compared to adjustable gastic banding, it is a better surgery that offers more weight loss, however, the complication rate of the Sleeve is higher within the first 30 days of surgery. Also, it carries the risk of a leak which is a very rare, but devastating complication. Compared to the gastric bypass, the Sleeve is a safer operation that requires a shorter recovery time, but the sleeve offers less weight loss than the gastric bypass. Not only do patients lose fewer pounds after a sleeve gastrectomy, but the weight loss is less durable with a higher rate of weight regain after a few years. Because the Sleeve only involves the stomach, the neurohormonal changes that lower your metabolic thermostat’s set point are less powerful than the gastric bypass that offers both stomach and intestinal effects. The result is less weight loss and a less durable effect.