Raymond Washington, M.D.
PINEHURST – The weight-loss surgery called sleeve gastrectomy (or gastric sleeve) used to be offered as the first stage of a two-stage procedure for extremely obese patients for whom the risks of gastric bypass alone were considered too great.
That all changed when surgeons began to note that their patients were losing a large quantity of their excess weight with just the sleeve procedure. Since that time, gastric sleeve has gained acceptance as a primary weight-loss surgery.
Raymond Washington, M.D., medical director of the Bariatric Center at FirstHealth Moore Regional Hospital, believes there will ultimately come a time when sleeve gastrectomy surpasses gastric bypass as the “gold standard” for weight-loss surgery.
“Over the past five years, gastric bypass and Lap-Band surgeries have gotten most of the attention in the media,” Dr. Washington says. “But, in the last year, data have shown great results comparable or better with sleeve surgery, with less concern about nutritional deficits and long-term complications.”
A three-year case-controlled study that concluded in 2009 found that minimally invasive sleeve gastrectomy compared favorably to minimally invasive Roux-en-Y gastric bypass in terms of surgical results, weight loss and resolution of co-morbidities such as sleep apnea, joint pain, diabetes and high blood pressure. Average operating time was less for the sleeve procedure, and the average hospital stay was shorter.
With sleeve gastrectomy, surgery removes a large portion of the stomach, reducing it to about 20 percent of its original size. The open edges are attached to form a banana-shaped sleeve or tube that limits the amount of food the patient can eat and helps the patient feel full sooner.
Unlike gastric bypass, sleeve gastrectomy does not involve rerouting the small intestine or bypassing the natural stomach outlet. This less-invasive approach reduces many of the nutritional complications associated with gastric bypass, making it a more appropriate procedure for people who would find it difficult to follow the strict post-surgical follow-up of the more traditional surgery.
“Long-term surveillance is important, but it is not as important as with gastric bypass,” Dr. Washington says.
There is also less risk of some of the complications of gastric bypass including internal hernias and ulcers. And, because the surgery involves no “foreign bodies,” as with gastric banding surgery, “there is less risk of infection,” says Dr. Washington.
Patients for whom sleeve surgery would not be appropriate include those with a history of severe reflux and Barrett’s esophagus (a condition thought to result from the long-term acid exposure of reflux).
Of course, says Dr. Washington, the weight-loss surgery choice always begins with a conversation between patient and surgeon and a lengthy study of the patient’s health and surgical history.
“This will help us determine the appropriate procedure,” he says.
Raymond Washington, M.D., and David Grantham, M.D., of the FirstHealth Bariatric Center perform sleeve gastrectomy, Roux-en-Y gastric bypass and gastric banding procedures at FirstHealth Moore Regional Hospital. Free weight-loss surgery sessions are held twice each month in the Renaissance Room at Pinehurst Surgical, 5 FirstVillage Drive, FirstVillage Campus, Pinehurst. For more information, call (800) 213-3284 toll-free or go to www.ncweightlosssurgery.org
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