The science behind weight loss surgery never stops moving and discussion of Lap Band vs. gastric sleeve – more often called a sleeve gastrectomy – has evolved considerably in recent years. At present, sleeve gastrectomies are the most frequently recommended weight loss surgery here at Dr. Feiz & Associates. Understanding why means understanding something about how bariatric surgery has evolved.
To start with, before there were banding and the sleeve, there was the gastric bypass. Though this procedure is still very effective and often used in certain types of cases, it’s quite radical. It reduces the stomach to a very small pouch and, as the name implies, it literally bypasses some of the digestive tract, reducing the absorption of calories. Over the years, doctors have been working on less radical alternatives and two have emerged as the most popular.
The band literally ties off most of the stomach, leaving only a very small available area. The result is that overeating becomes so uncomfortable that patients have every reason to avoid it, giving them plenty of negative reinforcement to avoid excessive eating. As the gastric bypass became established, this much less invasive alternative was extremely attractive to many patients because it left the stomach entirely intact and could be reversed if necessary. Banding has produced good results for many patients, but the major drawbacks, however, were a lower success rate and a higher rate of complications.
Sleeve gastrectomies permanently reduce the size of the stomach by roughly 75-85%. It is much less radical than a bypass, primarily because it doesn’t change the actual workings of the digestive tract beyond reducing the stomach. Over time, it turned out that this type of procedure was significantly more reliable than banding, largely because of a positive side-benefit of the operation. It is that, along with most of the stomach, the surgery also removes something called the fundus, which produces a hunger-associated hormone called ghrelin.
This is even more important than it might sound. Obese people produce more ghrelin than others but, even worse, production of the hormone tends to increase as they lose weight and the body goes into a kind of starvation mode, sabotaging efforts to defeat obesity. It’s become very clear over the years that the two-fold impact of the sleeve procedure – making overeating unpleasant while also reducing the drives that make us want to overeat in the first place – is a very powerful combination.
If you or someone you love is struggling with severe obesity – defined as a body mass index (BMI) of 40 or greater, or 35 or greater with related health problems – our team at Dr. Feiz & Associates may be able to help. To find out more, please contact us at the phone number above. You can also reach out to us over the Internet through our contact page.