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Sleeve gastrectomy

Sleeve gastrectomy has been performed laparoscopically in bariatric centres as a stand alone procedure for around 5-8 years. The reason for the first sleeve gastrectomies was to take some initial weight off very large individuals so that the second stage of their operation (biliopancreatic diversion with duodenal switch) could be safely performed.

It was found, however, that the sleeve surgery itself was associated with significant weight loss and therefore the second stage was often not required. More recently surgeons have switched to making the residual stomach smaller than the original sleeves were.

Gastric bypass

Gastric Bypass has been around for almost 50 years in various forms. The fact that it has endured for so long and is still one of the most commonly performed operations for obesity worldwide is proof of its effectiveness.

The essential goal in bypass surgery is to create a small stomach out of the normal stomach for food to go into. This "pouch" of stomach is separated completely from the rest of the stomach, unlike the classic "stomach stapling" operation where there is just a partition in the stomach rather than complete separation. After the small pouch is made, gastrointestinal continuity is maintained by connecting the small bowel to the pouch. Food and fluid consumed therefore bypasses the main stomach and duodenum which remain in place.

Gastric banding

A gastric band is a silicone balloon placed around the top of the stomach in order to induce weight loss through portion restriction and the induction of satiety in between meals.

In order to adjust the volume of fluid in the band a length of tubing is connected from the balloon to a port which is placed on the muscle under the skin which can be accessed by a medical practitioner to insert or withdraw fluid from the balloon.

SIPS surgery

SIPS is essentially a “super-charged” Sleeve Gastrectomy. The first part of the operation is to create a Sleeve Gastrectomy as per usual procedure. The second part is to bypass some of the small bowel from just beyond the stomach to reduce the body’s uptake of calories from food consumed.

Mr Clough will be offering SIPS surgery through the Epworth Hospital in Melbourne.

If you have regained weight or are unhappy with your outcomes after sleeve gastrectomy surgery it may be worth having a consultation with Mr Clough about the role of SIPS in this setting.

Compare the operations

Generally speaking the more complex procedure will likely give the more reliable and substantial weight loss.

Adjustable gastric banding is a relatively safe procedure which does not involve cutting the stomach or rearranging normal anatomy. It is however less reliable than the more complex operations and is a high maintenance procedure involving frequent clinic attendance.

Gastric bypass and SIPS are more complex interventions with a higher possibility of a surgical complication or nutritional compromise. Both are excellent for diabetes and the bypass specifically has decades of experience and study available indicating substantial, reliable weight loss for most.

The sleeve gastrectomy is a relatively newer operation which has a more moderate risk profile and is low maintenance. Weight loss is fairly reliable but long term outcomes are still under a question mark.

Endoscopic procedures are performed through the mouth with a fibre-optic scope and do not involve surgical cuts. They include the Intra-gastric balloon and Endobarrier implantation. These procedures are temporary in the sense that they must be reversed and generally won’t give the same effectiveness of weight loss as the more conventional operations.