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Other Bariatric Procedures

Sleeve Gastrectomy
Gastric Bypass
Pancreaticobiliary Bypass

Sleeve Gastrectomy

The sleeve gastrectomy removes greater than 90% of the stomach.  It leaves a very thin tube along the greater curve of the stomach. This is an irreversible procedure which needs to be carefully explained to the patient.We do not routinely do this as a primary bariatric procedure for the following reasons.

  • It is unproven in terms of weight loss in both 2 year and 5 year studies
  • There are significant risks with sleeve gastrectomy vs gastric banding.  These risks are related to the staple line and the staple line leaking, and the staple line bleeding. In one hospital in Australia this surgery has been suspended due to the high numbers of complications and litigation
  • World literature does not yet support this as an operation which should be offered other than part of a two step procedure.  This is where patients are super-obese and it is considered too difficult or dangerous to offer another bariatric procedure.
  • This operation is not reversible.  Patients are committed to having a reduced stomach for all their life, which may produce nutritional and trace element deficiencies.
  • There is growing concern that removal of 90% of the stomach also removes the cells which produce ghrelin, which mediates growth hormone and in turn may have a significant effect in terms of depression—as yet there is insufficient data to identify that there is an increased risk of suicide due to the reduced stomach size but it is being investigated and/or whether this is related to non reversibility.  
  • There is no ten-year data which suggests that this procedure is as good as the lapband or gastric bypass.

Gastric Bypass

The gastric bypass involves a 20ml pouch being created at the top of the stomach.  The bowel then is joined to this pouch to bypass the stomach.  We offer this operation rarely now, because the ten-year data on lap gastric banding indicates that it is as good as the gastric bypass but with less potential for complications, and offers equivalent weight loss.

  • The gastric bypass can produce Vitamin B12 deficiency, iron deficiency, folate deficiency.
  • The gastric bypass may also produce intermittent diarrhoea and dumping.
  • The gastric bypass may have stretching of its pouch and bowel limb, which allows weight gain at between 5 and 8 years.

Pancreaticobiliary Bypass

This particular operation is reserved for the severely obese and we at the Ashford Surgical Obesity Clinic feel it should only be done in a tertiary care/university hospital where ongoing care and follow-up can be guaranteed.  The risk of death and complications from this drastic bariatric surgical procedure prevents us offering it as a reliable, safe alternative.