There are several types of weight loss surgery. Today, the gastric sleeve (laparoscopic sleeve gastrectomy) has become the most common form of bariatric surgery. Gastric sleeve surgery has far outpaced lap band surgery in recent years. This reflects the results of data gathered by hundreds of physicians who perform bariatric surgery or practice in a bariatric clinic setting.
The rise of gastric sleeve surgery has been dramatic. It was only 10 years ago, that the American Society for Metabolic and Bariatric Surgery (ASMBS) issued its first statement on gastric sleeve gastrectomy. That statement identified the gastric sleeve as a “possible option” for selected obese patients, but it also cited the lack of evidence for sustained weight loss using the procedure.
At the time, use of gastric sleeve gastrectomy as primary bariatric surgery, was uncommon. The preferred procedures were gastric bypass surgery and lap band surgery. Gastric sleeve surgery got a big boost in 2009 when the Michigan Bariatric Surgery Collaborative, a very large database, published data showing that gastric sleeve gastrectomy produced significant weight loss with few complications.
That same year, United Healthcare (UHC), one of America’s largest health carriers, included coverage for gastric sleeve surgery. In 2010, Aetna Health changed its rules to cover both open incision and laparoscopic sleeve gastrectomy among its covered weight loss surgery procedures. In 2012, the Centers for Medicare & Medicaid Services joined in (at least partially) and began covering laparoscopic sleeve gastrectomy on a case-by-case basis for Medicare patients.
Acceptance by insurance carriers is an important marker of success. This is especially true for weight loss surgery because bariatric surgery cost is relatively high compared to measures like diet and behavior modification. An insurance company is not willing to pay for procedures such as weight loss surgery, unless the benefits can be demonstrated. Impressive results collected from bariatric clinic settings convinced these companies that the gastric sleeve was a safe and highly effective form of bariatric surgery.
In 2011, the ASMBS issued another statement on gastric sleeve gastrectomy, saying that there was substantial data from dependable studies showing that the gastric sleeve produced “…durable weight loss, improved medical comorbidities, long-term patient satisfaction, and improved quality of life.” The data demonstrated that the gastric sleeve is safe and works in the long term.
Following these developments, use of the gastric sleeve procedure grew rapidly. By 2015, almost 54% of all bariatric surgery procedures were gastric sleeve operations. For most patients, the gastric sleeve had become the best of available weight loss surgery options. During the same time period, the lap band procedure declined from more than 35% of all bariatric surgery to less than 6%.
Sleeve gastrectomy or the gastric sleeve is a procedure that reduces stomach size to approximately the size of a banana, limiting food intake. Normal digestion and absorption of nutrients is unchanged, but the patient feels full after consuming a far smaller amount of food. Lap band surgery had been the first choice as late as 2011, but declined dramatically by 2015. This reflects the eagerness of physicians who practice in bariatric clinics and surgeons who perform weight loss surgery to put medical evidence ahead of old habits.
The lap band procedure had seemed like a very attractive weight loss surgery option, but as time passed, its shortcomings became more apparent. Those problems included inadequate weight loss, slipping of the band and other complications that might require lap band removal. For these reasons, the lap band procedure has declined substantially.
There is a second weight loss surgery procedure that should be discussed: the gastric bypass or Roux-en-Y gastric bypass. In 2015, this bariatric surgery accounted for 23% of the weight loss surgery procedures in the United States. This was actually down from the 37% share it had in 2011, but the gastric bypass and the gastric sleeve together accounted for three quarters of all weight loss surgeries.
The gastric bypass produces the largest reduction in stomach size of all weight loss surgery procedures. Importantly, normal digestion and absorption of nutrients is changed by the gastric bypass, and this makes patients more likely to experience side effects. These side effects can include dumping syndrome, and also malnutrition due to the poor absorption. The gastric bypass is also a more complicated and longer form of weight loss surgery. Nevertheless, the gastric bypass produces the most dramatic initial weight loss associated with any bariatric surgery. For this reason, it may be the best weight loss surgery option for some patients.
But what is the best weight loss surgery option? Only a qualified medical examination can determine this. Both of these procedures can be effective in treating severely overweight patients. Deciding which bariatric surgery is right for a given patient requires the expert knowledge and experience of doctors and surgeons in a hospital or bariatric clinic. Each patient and every clinical situation is unique; factors such as age, the presence of medical conditions like diabetes, the patient’s BMI (body mass index) and surgical risk factors should all be evaluated.
Our practice is well qualified to evaluate all of these factors. If our clinic can be of assistance in any way, please contact us at (386) 231-3530. Our offices, located in Daytona, New Smyrna and Palm coast are all part of the Florida Hospital network.
