Are You a Candidate for Metabolic Bariatric Surgery? Sleeve gastrectomy or gastric bypass surgery: which one should I choose?

Obesity is an increasingly common condition in modern civilized society. Some people think that it is merely an ugly appearance, but they ignore the fact that this long-neglected condition may hide greater dangers. Clinical studies have shown that obesity can cause metabolic dysfunction and chronic inflammation in the body. In addition to increasing the risk of high blood pressure, diabetes, cardiovascular disease, stroke, sleep apnea or other metabolic diseases, long-term inflammatory responses may even cause malignant lesions such as colorectal cancer, bladder cancer, breast cancer, endometrial cancer, etc., not to mention the impact on quality of life and life expectancy.

Fortunately, modern medicine has begun to pay attention to obesity, including lifestyle adjustments, diet control, exercise, and then drug treatment. Each of them plays its own important role and has a certain weight loss effect. However, after trying various conservative treatments, some patients still fail to achieve the desired weight loss effect. At this time, metabolic weight loss surgery can be considered.

Metabolic Bariatric Surgery

By reducing stomach capacity or shortening the length of the small intestine's absorptive function, the purpose of reducing calorie intake can be achieved, thereby reducing weight. The current mainstream surgeries include sleeve gastrectomy (Figure 1) and gastric bypass surgery (Figure 2). Sleeve gastrectomy is a procedure that removes the greater curvature of the stomach. The remaining stomach is formed into a sleeve-like tube with a volume of about 15-20% of the original stomach volume. The purpose of suppressing appetite is achieved by reducing the stomach volume. At the same time, sleeve gastrectomy can also reduce the secretion of gastric hunger hormone (ghrelin) and reduce hunger. Statistically, about 60-70% of excess weight can be reduced two years after the operation (ideal weight is defined as BMI22, excess weight = actual weight - ideal weight).

Sleeve gastrectomy is a relatively simple surgery that takes less time and has lower complications and mortality rates. It is currently the mainstream surgical procedure used in Asia.

Gastric bypass surgery

The stomach is cut into a small stomach with a volume of about 30-50ml at the front and a large stomach at the back. The small stomach is connected to the small intestine after a detour of about 150-200 cm and then connected to the small intestine from the large stomach. In this way, the small intestine at the front has no absorption function and has the effect of reducing volume and absorption. About 70-80% of excess weight can be reduced two years after the operation. It also has better effects in treating diabetes caused by obesity. However, gastric bypass surgery is more complicated, and its complications and mortality rates are slightly higher than those of sleeve gastrectomy. It is also more prone to trace element deficiencies, and long-term supplementation of iron and folic acid may be required. In addition, after gastric bypass surgery, gastroscopy cannot examine the large stomach at the back end, so those with a family history of gastric cancer or a higher risk of gastric cancer may need to consider it with caution.

Regardless of the surgical procedure chosen, current research has shown excellent weight loss results, and it can also control or improve metabolic diseases caused by obesity. However, those with severe gastroesophageal reflux disease, gastric ulcers, a family history of gastric cancer, or those who have undergone gastric surgery still need to discuss and communicate carefully with their doctors to weigh the benefits and risks of the surgery before choosing the most suitable treatment method for themselves. If you need consultation and assistance with metabolic weight loss surgery, please contact our general surgery metabolic weight loss team, where professionals will evaluate and explain the surgery to you.