Which of the obesity surgeries should be preferred?
Gastric Sleeve or Bypass?
Frequency of obesity; It has doubled all over the world in the last 30 years. This situation is expected to continue to increase. Diet, sports, acupuncture, herbal products and medications cannot show the expected success in treatment. The most effective and definitive results in this regard are achieved through surgery. So which surgery is superior or should be preferred?
There are basically two types of surgeries performed due to obesity. These are Sleeve Gastrectomy (tube Stomach = Stomach Reduction surgery), which reduces the stomach volume, and by pass (note: popularly known spellings: bypass, bypass) surgeries, which reduce the stomach volume but reduce food absorption. Both surgical methods have similar results in terms of short-term (1-2 years) weight loss. Bypass surgeries seem to be slightly more effective in terms of long-term results. However, Bypass surgeries have disadvantages such as creating a shortcut through the small intestines, lifelong use of vitamin B12, internal herniation (risk of intra-abdominal hernia), and occasional Bile Reflux (bile coming to the mouth). In addition, Gastric Sleeve Surgeries have the possibility of continuing this condition in those who complain of Reflux (bitter water coming into the mouth) due to paraesophageal hernia (popularly known as Stomach Hernia) and the risk of leakage is slightly higher than other surgeries. It has disadvantages.
According to a study published in the Journal of Obesity Surgery, the world's most respected obesity surgery journal (October 2016), comparing the data of many centers;
Gastric Bypass (Roux-en-Y Gastric by pass) In the study comparing 348 patients who underwent surgery and 347 patients who underwent Sleeve Gastrectomy, it was revealed that major complications were at similar rates in both surgeries. However, while pneumonia was more common after sleeve gastrectomy surgery, fistula (the formation of a channel between the internal organs and the skin or between two internal organs), bridge (adhesions) and incarceration (intestinal compression and malnutrition) were encountered more frequently in bypass surgeries. Complications (problems) such as leakage, infection, and stenosis are at a similar rate. When both surgeries were compared in terms of minor complications, it was revealed that they carried similar risks. The main of these minor risks are; bleeding, infection, reflux, wound infection, dysphagia (painful swallowing), vomiting, and trocar site pain. Unlike sleeve gastrectomy, patients with dehydration (liquid loss) were seen in bypass surgery. Of the 695 patients who underwent sleeve gastrectomy and bypass surgery, one bypass patient died, and all 347 patients who underwent sleeve gastrectomy recovered. When compared in terms of the need for re-hospitalization, it turns out that this rate is higher in those who underwent bypass surgery.
As a result; Gastric Sleeve and Bypass surgeries are surgeries with similar risks. However, dehydration (fluid loss), intestinal obstruction and the need for re-hospitalization are more common in bypass surgery. For these reasons, it seems that the correct approach would be for the patient and the physician to decide together which surgery should be performed. The experience of the physician is also important in this regard. The opinions of a physician who performs both surgical methods and has comparative knowledge and experience should be taken into consideration, rather than a physician who only performs sleeve gastrectomy or bypass surgery.
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