The Sleeve Gastrectomy Research Paper

Gastric Bypass versus Sleeve Gastrectomy

Gastric Bypass versus Sleeve Gastrectomy
Even with the most ideal weight loss program that includes diet, exercise, tablets, and behavior modification, the best results that a person can expect is to lose is 22 pounds. Furthermore, they will only be able to maintain that loss as long as they continue the program permanently (Abdelkader Hawasli, M.D., FACS, FICS, n.d.). The National Institutes of Health (NIH) has recommended bariatric surgery as the only proven way for morbidly obese patients to successfully lose weight (“Weight Control,” 2010). There are several procedures that are available, two of which are the Roux-en-Y gastric bypass and the vertical sleeve gastrectomy. The
procedure for each is different and help the patient lose weight in a different way. They also have varying complications. While gastric bypass has long been considered the gold standard for bariatric procedures, sleeve gastrectomy offers just as many benefits with fewer negative side effects.
The procedures for the gastric bypass and the sleeve gastrectomy are fairly different.
The gastric bypass consists of two steps. The first step is to staple the stomach to make it into a smaller pouch, while the rest of the stomach remains separated and unused. The second step involves rerouting the intestine so that it attaches from the pouch to a lower part of the small intestine. This is a completely reversible procedure, though reversal is not easily done. With the sleeve gastrectomy, the stomach is stapled to create a long skinny sleeve, about the size of a hot dog. The remainder of the stomach is then removed, thus making the procedure irreversible. Since the top part of the stomach and the bottom part of the stomach where it meets the intestine are left in place, no rerouting of the intestine is
necessary.
Both procedures are effective in helping patients lose weight. Because the patients are left with a smaller stomach pouch, they can eat less food and still feel satisfied. In the gastric bypass, since part of the intestine is not used, less of the fat and nutrients from the food eaten is absorbed into the patient’s bloodstream. Both of these work together to help the patient lose weight. With the sleeve gastrectomy, the patient loses weight because of the smaller stomach, but also because the part of the stomach that produces the hormone ghrelin (this hormone is believed to be what makes people feel hungry) is removed.
With both the gastric bypass and the sleeve gastrectomy, patients will be required to alter the way they eat. Since their new stomach pouch is so little, they can only eat small amounts of food, usually one to two ounces to start with. Patients are advised not to drink 30 minutes prior to eating or 30 minutes after eating. Also, when eating, they are advised to eat protein first, then vegetables, then, finally, any carbohydrates, if they still have room. Eating carbohydrates such as rice, pasta, and bread are usually not recommended because these will expand in the stomach and may induce vomiting. All bariatric surgery patients are required to take supplements daily, including a multivitamin, B-12, calcium, and sometimes iron.
Though they have a major commonality in how they help patients lose weight, both procedures have differing complications. With the gastric bypass, patients often encounter problems with malnutrition. Since part of the intestine is bypassed and fewer nutrients are absorbed, sometimes a patient will not get enough of the essential vitamins and minerals the body needs despite taking supplements. For this reason, patients are monitored and checked frequently for nutrient levels in their blood.
Another issue with gastric bypass is called “dumping syndrome.” Dumping syndrome occurs when the bypass patient eats too much, has high fatty foods, or consumes sweets. In this scenario, the results are that the body is not able to tolerate what has been eaten and then rejects it by causing the patient to vomit or have severe abdominal cramping with diarrhea. The bypass patient is advised to avoid this at all costs since it is incredibly uncomfortable and can result in dehydration, a serious condition that can cause confusion, weakness, coma, organ failure, and even death if not treated properly.
Conversely, the most severe possible problem that a sleeve gastrectomy patient will have is also very rare.
It is a post-operative complication where the staple line of the stomach may leak; therefore, releasing stomach acid into the abdomen (not an issue in the gastric bypass since the staples only separate one section of the stomach from the other). This issue is usually caught very quickly and resolved; however, if not found quickly, it can result in death. Also, because the sleeve gastrectomy is a much newer procedure than the gastric bypass, true statistics are not available on how patients fair with their weight loss in the
long-term.
While all surgery carries a certain amount of risk, because the gastric bypass is more likely to have negative consequences after the procedure, having a sleeve gastrectomy is preferable to many patients. It is possible for both of these procedures to fail to help patients lose weight or maintain a significant weight loss but this only when patients do not comply with the dietary restrictions necessary for success. The stomach, like the rest of the body, is capable of stretching and expanding so if patients continue to overeat, they will stretch out their pouch and not have successful weight loss. However, study after study has been done on various bariatric surgery options and all have shown that, when properly used, weight loss surgery is an excellent tool to help the morbidly obese lose weight and live healthier lives.

References
Abdelkader Hawasli, M.D., FACS, FICS. (n.d.). Sleeve Gastrectomy “The Promising Future for Morbid Obesity” [PowerPoint slides]. Retrieved from http://http://www.naama.com/pdf/laparoscopic-sleeve-gastrectomy-morbid-obesity-abdelkader-hawasli-md.pdf
Furtado, L. (2010). Procedure and outcomes of Roux-en-Y gastric bypass. British Journal Of Nursing (BJN), 19(5), 307-313.
Lubrano, C., Mariani, S., Badiali, M., Cuzzolaro, M., Barbaro, G., Migliaccio, S., & ... Spera, G. (2010). Metabolic or bariatric surgery? Long-term effects of malabsorptive vs restrictive bariatric techniques on body composition and cardiometabolic risk factors. International Journal Of Obesity, 34(9), 1404-1414. doi:10.1038/ijo.2010.54
Weight Control. (2010, February). Consumer Health & Wellness 2010, (), 148-151. Business Source Complete.
Weight-control information network. (2011). Retrieved from http://www.win.niddk.nih.gov/publications/gastric.htm