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Weight Reduction Surgery

Which operation should I have?

The laparoscopic gastric bypass is the “gold-standard” bariatric operation. There is detailed, long-term information about the efficacy and safety of this procedure. The bypass is a technically demanding procedure that should be performed by only an expert surgeon. In contrast to the bypass, the sleeve gastrectomy is a relatively new procedure and information beyond five years is not currently available. The extent of weight loss with the sleeve gastrectomy appears similar to that with the bypass in the initial few years after surgery, but longer term issues are unclear. In comparison to the bypass, the sleeve is a technically simpler operation and requires use of fewer stapling instruments. In super-super-obese patients (BMI more than 60 kg/m2), the sleeve can be a safer operation than the bypass. Another advantage of the sleeve, for super-super obese, is that if there is inadequate weight loss after the operation, then further surgery can be done (the sleeve can be converted into a bypass or another operation called a “duodenal switch”). Following a bypass, further surgery is not usefully helpful. The gastric band is attractive because it technically simple to insert, has very low risk of complications and is easily reversible. However, banding usually provides less weight loss than the bypass or sleeve, requires intensive follow-up and has high-risk of long-term complications. There is no clear-cut “right or wrong” choice of operation and this issue requires detailed discussion to suit the particular needs of an individual patient.