The Gastric Sleeve: Pros and Cons

Although the gastric sleeve is generally acknowledged as the newest bariatric surgery procedure, sleeve gastrectomy is really not new since it is a primary component of the BPD/duodenal switch operation which has been used for nearly 20 years. The effectiveness of the sleeve as a primary independent operation was discovered accidentally when surgeons in New York decided to perform the BPD/DS in two separate stages with the sleeve as the first stage. Weight loss during the sleeve stage was a pleasant surprise with a few patients losing so much weight that they didn't require the second malabsorptive stage of the BPD/DS. This finding led these surgeons and others to promote sleeve gastrectomy as an independent procedure.

During the past five years there have been a number of published studies that compare the sleeve with both the LAP-BAND® and RY gastric bypass. The results of these studies have been fairly consistent, showing that the sleeve produces significantly better weight loss than the LAP-BAND® but not quite as much as the RY gastric bypass. Short term weight maintenance has been considerably better than with the band and comparable to RY gastric bypass. Early risks and complications associated with the sleeve are similar to gastric bypass and greater than with the band. Late risks likely favor the sleeve since there are no inherent nutritional risks, unlike gastric bypass and no device related risks which are inherent with the Band.

It appears that a recently identified hormone, ghrelin, plays a prominent role in sleeve induced weight loss. Since ghrelin, which stimulates hunger, is produced in the stomach, removal of most of the stomach markedly decreases ghrelin production and hunger. This appears to be the primary mechanism involved with weight loss since both the band and RY gastric bypass reduce stomach capacity much more than the sleeve.

The most common complaints of patients who have the sleeve are persistent nausea and heartburn associated with reflux, GERD. The nausea gradually disappears in most patients. GERD is usually controlled with medication.

The early success of the gastric sleeve has resulted in its approval by several major insurance carriers in 2010. Unfortunately, Medicare is not yet on board. Because sleeve gastrectomy is a new procedure, the long term results beyond five years are unknown. However, early results are encouraging. Both Dr. Brolin and Dr. Chau have taken extensive special courses that focus on the sleeve and both have personal experience in performing this new operation.