Sleeve Gastrectomy

The sleeve gastrectomy is the most common bariatric procedure, involving the removal of 80% of the stomach to create a narrow gastric tube that restricts food intake and reduces hunger hormones (ghrelin). This typically results in a 25-35% total body weight loss (50-70% excess weight loss) and excellent resolution of comorbidities.

Advantages of sleeve gastrectomy over gastric bypass include its simplicity and safety, with fewer long-term complications such as dumping syndrome, ulcers, bowel obstructions, and vitamin deficiencies. However, there is a rare (1%) risk of leakage, which can lead to prolonged hospitalization and multiple interventions. Long-term, 11-33% of patients may experience reflux, necessitating medication or possibly revisional surgery.

Image of Sleeve Gastrectomy

Roux-en-Y Gastric Bypass (RYGB)

Single Anastomosis/Mini Gastric Bypass (MGB)

The Single Anastomosis/Mini Gastric Bypass (MGB) is a simplified version of the RYGB, involving the creation of a long, narrow stomach pouch and a single connection to a loop of the small intestine, reducing food intake and calorie absorption. This procedure leads to similar weight loss and improvement in health conditions as a RYGB, but MGB is generally considered less complex than the traditional RYGB with a decreased risks of bowel obstructions and internal hernias in comparison.  Otherwise dumping and ulcer risks remain similar with the potential of bile reflux, which may require medication or revisional surgery.

Laparoscopic Single Anastomosis Duodenal-Ileal bypass with Sleeve (SADI-S)

SADI-S is probably the most powerful weight loss procedure suitable for both primary and revisionary cases following sleeve gastrectomy. It consists of two steps: initially performing a sleeve gastrectomy, followed by a small bowel bypass,  (a connection is made between the Duodenum to the middle part of the small bowel ‘the ileum’ )  to decrease nutrient absorption and alter hormones that promote weight gain. This procedure leads to the highest weight loss and which is often sustained over time.  However, it is more complex, with a higher frequency of surgical complications compared to other bariatric procedures. Long-term risks include vitamin and mineral malabsorption, protein malnutrition, and chronic diarrhoea.

Intestinal Bipartition ( Single Anastomosis Sleeve Ileal Bypass ‘SASI’)

Intestinal Bipartition (IB) is a relatively new type of bariatric surgery that involves dividing the small intestine into two separate pathways One pathway is much shorter than the other. Food is routed through both pathways, but the shorter pathway allows for less absorption of nutrients and calories. This procedure is still being studied, but it shows promise for people with type 2 diabetes who are obese or overweight.

How does IB work?

The exact mechanism of how IB helps with weight loss and diabetes is not fully understood, but it is thought to work in a few ways:

• Reduced calorie absorption: By dividing the small intestine, IB changes the way food is digested and absorbed. This can lead to a reduction in the number of calories your body absorbs, which can help with weight loss.
• Improved insulin sensitivity: Studies have shown that IB can improve insulin sensitivity, which means that your body uses insulin more effectively. This can help to lower blood sugar levels.
• Hormonal changes: IB may also affect the production of hormones that regulate appetite and metabolism. This could help to reduce hunger and increase feelings of fullness.

Dr. George is among a small number of surgeons globally performing this promising revisional bariatric procedure. If you are interested in exploring this option, please contact us for more information.