Does the sleeve always work?

sleeve gastrectomy because of its excellent success rate and low complication rate. In fact, many studies show an equivalent weight loss success and equivalent diabetes remission success rate as gastric bypass surgery but with fewer complications of blockages, reoperations, and vitamin deficiencies.  In my own hands, after a decade of experience with other bariatric surgeries, and other complex gastrointestinal surgical procedures, I have completed approximately 2000 sleeve gastrectomy procedures with 0.0% mortality and approximately 1000 consecutive procedures with 0.0% leak rate. One published paper describes many of the technical elements leading to illumination of leaks as a complication. Other experienced surgeons and centers have produced similar results. But does the sleeve always work? The answer is that no surgery always works, and instead what we see is a bell-shaped curve of weight-loss results after the sleeve, similar to that after gastric bypass surgery. This means there are amazing successes in which the person loses every single extra pound, but it also means there are people who are very unsuccessful and who lose very little weight. Why would it not be successful? There are numerous answers, and it’s common to lay some of the blame on a lack of proper diet and discipline, lack of exercising, and failure to follow through with recommended behavior changes. But I think it’s also clearly true that each individual has different genetics and some different biochemistry involved, so some of us are more likely to succeed than others. Regardless of the causes, not everyone will achieve success with the sleeve procedure, so what are the next options? Our philosophy has been to get back to basics and first emphasize proper dieting that emphasizes vegetables and protein, and minimizes carbohydrates, then emphasize the dedication to daily physical activity, with regular walking of an hour a day, for example. Then we give some consideration to weight-loss medications and see if that may help jumpstart the process, and also utilize protein shakes and a very low-calorie diet. But one of the great virtues of the sleeve is that it is compatible with a wide variety of relational minimally invasive procedures that may yield excellent weight-loss results. The options boil down to procedures to tighten the gastric sleeve itself, to convert to a gastric bypass, or to change to a duodenal switch procedure. With careful discussion one can choose the best option. Although more long-term data is needed, we have found some success with “re-sleeve” in selected patients whose sleeve appears to have a generous volume. Gastric bypass is technically very easy to perform but yields mixed results. Laparoscopic duodenal switch might yield the best results over time and is nicely compatible with the sleeve procedure. This can only be performed with a laparoscopic technique and recent technical advances and data have favored a loop or single anastomosis duodenal switch. It appears to induce hormonal mechanisms that lead to greater weight loss success, while mitigating vitamin deficiencies. If you or a loved one have regained weight after a sleeve procedure done years ago, or simply failed to lose adequate weight after the sleeve, talk over the options with your bariatric surgeon by scheduling an informational consultation. Dr. Sasse is a certified expert in bariatric surgery, and he is currently accepting new weight loss patients in Reno, NV. There are multiple options and a high likelihood of success with further dedication and further intervention. Kent C. Sasse, M.D., MPH, FACS, FASCRS, FASMBS Adjunct Assistant Professor, University of Nevada School of Medicine]]>