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04-16-13 | Posted by

Move over Lap-Band.

Step aside gastric bypass.

Make a little room for the gastric sleeve.

New guidelines from the American Society for Metabolic and Bariatric Surgery, the American Association of Clinical Endocrinologists, and The Obesity Society propel the sleeve from an experimental procedure to a go-to primary weight loss surgery. For a time, gastric sleeve surgery was considered experimental and often used as the first surgery in a staged approach to weight loss.

To perform a gastric sleeve, your surgeon removes about 85 percent of your stomach through small incisions. It is not reversible like gastric banding with the Lap-Band. No foreign objects are left in the body during the procedure so there is no risk of infection or rejection. There is also no bypass of the small intestines with the sleeve, which means that there is less risk for nutritional shortfalls. Most people lose 50 to 80 percent of their excess body weight within six months to one year after sleeve surgery.

Still, the guidelines don’t recommend one surgery over another. “We educate and teach the patients about the risks and benefits of each,” explains guideline author Daniel B. Jones, MD, a professor of surgery at Harvard Medical School in Boston. Personal preferences also play a role, he says. For example, if someone likes to drink alcohol, doctors may not recommend gastric bypass as it can increase the chances of  addiction, and they won’t lose as much weight with the band if they consume alcohol.

The new guidelines validate the sleeve, but there is not enough evidence to support the use of other weight loss surgeries such as gastric plication, electrical neuromodulation, and/or endoscopic sleeves yet. “As cool and fun and neat as these operations are and as less invasive as they appear, there is not enough data to say they are mainstay procedures, “ Jones says. “They are still collecting data and maybe by the next report, there will be a thumbs up or thumbs down.”

“The sleeve is rising in popularity because it has finally been recognized as an accepted operation, which means a great increase in insurance coverage, where in the past when it was investigational, the sleeve was not covered,” says Christine Ren-Fielding, MD, a New York City-based bariatric surgeon and the founder of the NYU Langone Weight Management Program in New York City. “Sleeve, like the band, is also in its honeymoon period, which may change as a greater number of surgeons perform, and greater number of patients undergo, this operation,” she says.

As time goes by, differences in complications may arise between the sleeve and the Band. For now, it is always beneficial to have an additional treatment option for severe obesity in the armamentarium.


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