According to a University of Michigan Health System study, gastric sleeve surgery (SG or gastric sleeve) has become more popular than Roux-en-Y gastric bypass (RYGB) in recent years. This study indicates that patients and surgeons prefer sleeve gastrectomy (SG) to other weight-loss procedures in correcting obesity and maintaining weight. A vertical sleeve gastrectomy (VSG) reduces the amount of food the patient ingests and controls their hunger, resulting in weight loss. According to a JAMA study published September 3, 2014, VSGs have become the most popular surgical procedure for type 2 diabetes patients. The reasons behind the shift are not yet completely understood or verified.
Changes in Preferred Bariatric Surgery
Bariatric surgery is the necessary procedure or therapy to assist patients with morbid obesity. Through the years, there have been significant changes to procedures to ensure that they are safe and effective for patients, thus making the procedures more available to patients. With reduced recovery time and a better idea of how the surgery is effective, surgeons and primary care physicians are more likely to recommend surgical procedures to develop real solutions.
While the long-term results of sleeve gastrectomy are not yet apparent, the preference change may be due to the higher level of safety with the procedure as well as the success rate for patients when it comes to weight loss. A significant weight loss for patients in the second and third year after sleeve gastrectomy is accompanied by a significant reduction of pre-existing comorbidity. This means patients are safer with the procedure, and they are getting excellent results overall.
Related: Gastric Sleeve Weight Loss Timeline
Knowing these trends in the bariatric practice and why they occur can dramatically assist primary care physicians in informing their patients and the direction they recommend. Additionally, it is beneficial to the surgeon when providing pre-operative counseling to their patients.
The study that developed this information was conducted by Bradley N. Reams, M.D., M.S., a surgical resident at the Department of General Surgery, and Justin Dimick, M.D., M.P.H., an assistant professor of surgery as well as chief of the Division of Minimally Invasive Surgery at the University of Michigan Health System. The study analyzed the data of 43,732 adult patients who had undergone bariatric surgery. This data was a compilation of information from 39 hospitals.
It was discovered that sleeve gastrectomy was selected 6.0 percent of the time in 2008 and 67.3 percent in 2013. That translates into an increase in the choice of sleeve gastrectomy of 61 percent. Additionally, it was shown that Roux-en-Y gastric bypass was picked 58.0 percent in 2008 and 27.4 percent in 2013. Laparoscopic adjustable gastric banding went from being chosen 34.5 percent of the time in 2008 to 4.9 percent in 2013.
Patients over 65 years with type 2 diabetes and those with gastroesophageal reflux disease seemed to have stayed with surgeries other than sleeve gastrectomy.
A major difference between the sleeve and bypass is the mechanism of action to reduce weight. Sleeve surgery is restrictive, whereas gastric bypass surgery is restrictive as well as malabsorptive. Gastric bypass is a more aggressive operation as it changes the anatomy.
Both procedures produce substantial weight loss as well as a reduction in comorbidities. Gastric bypass has a better weight loss and resolution of obesity-related medical conditions. Gastric sleeve patients need to work a little harder to maintain their weight loss after the first two years, called the honeymoon period.
It is clear from these findings that there is a shift in the bariatric surgical preference for patients to sleeve gastrectomy. The gastric sleeve in Mexico constitutes 90% of all the procedures performed. Whether or not this trend will continue or not is unclear and will require continued study and research.
Many bariatric surgeons find sleeve gastrectomy to be less invasive than other procedures and very efficient in reducing the weight of the patient. The long-term results of these patients are still unknown, and with time there will need to be more studies conducted to see how they do in the long run.
UPDATED September 2022 – Ron Elli, Ph.D.