The Sleeve vs The Band

Almost two in three Australian adults are now classed as overweight or obese and with an increasing amount turning to weight loss surgery, more people are opting for sleeve gastrectomy as opposed to gastric banding.

Laparoscopic surgeon Dr Stephen Watson of St John of God Hospital in Murdoch said that since the introduction of the current sleeve gastrectomy procedure, the data for which goes back seven years, the number of people electing gastric bands has been steadily declining.

In gastric banding, a silicone ring or band is placed around the upper section of the stomach, creating a small pouch which restricts how much a person can comfortably eat.

Sleeve gastrectomy involves removing the body and fundus of the stomach, leaving behind a sleeve or tube and reducing stomach capacity from 1.5L to 200mL.

Both surgeries are highly effective for weight loss, with sleeve patients losing up to 80 per cent excess body weight on average and band patients up to 50 per cent.

One of the main reasons lap bands have previously been so popular is because they can be tightened by adding or removing fluid, adjusted and reversed.

Cassie Scriven, 22, of Aubin Grove underwent gastric banding surgery in early February and chose it for these reasons in case complications were to arise.

Ms Scriven said the surgery had hugely improved her lifestyle, particularly with eating habits, as her diet was limited to purees and liquids for the first two weeks while her body was adjusting.

“I found it hard at first because of seeing the food my family would eat and knowing I couldn’t have it,” she said.

Many foods such as bread, steak and chicken breast, should be avoided entirely by people with gastric bands, and eating must be done carefully or it can lead to regurgitation, reflux and vomiting.

“With the band you’ve got to eat really slowly,” Dr Watson said.

“You put a bit of food in your mouth, take the fork out of your hand, chew that food, swallow it, then wait a minute before you pick the fork up again. If you eat too quickly with the band it’ll get stuck, you’ll get regurgitation.”

Ms Scriven did not experience any side effects besides a swollen stomach for the first 4-6 weeks and mild discomfort within the first two weeks, and has presently lost 14kg.

Sleeve gastrectomies are now dominant because of the greater weight loss results and less restrictive diet, with patients eventually able to eat almost any food in very small portions.

“They get faster weight loss, greater weight loss, they don’t have to come back and have adjustments done and they can eat in a more normal manner,” Dr Watson said.

Dr Stephen Watson explains how a sleeve gastrectomy is performed. Photo by Joanne Fernandez

Dr Watson explains how a sleeve gastrectomy is performed. Photo by Joanne Fernandez

Maja Pushnick, 46, of Madeley chose to have a sleeve gastrectomy because of the health risk that her weight posed to her life.

Mrs Pushnick said that at first it was very unusual not feeling hungry, which was due to the removal of the part of the stomach that produces the ‘hunger hormone’ ghrelin, but she lost 35kg since her surgery in October 2015.

“I am so happy now,” she said.

While the surgery has been highly effective for her weight loss, Mrs Pushnick will lose her hair from August until early 2017 due to the drastic changes from the operation.

The main short term risk is a leak along the staple line, which would be discovered straight after the operation and only affects 1-2 per cent of patients worldwide, but where the research for gastric banding goes back to 1988, sleeve gastrectomy is a more recent procedure and the long-term effects are unknown.

“Will people overeat?” Dr Watson said.

“Will they stretch it? And if they stretch it will they get weight regain or will they get heartburn or reflux? And if that’s really bad and medicines don’t control the heartburn or reflux, will they need another operation to fix that sleeve?”

The surgery for gastric banding is the safer option, however sleeve gastrectomies present greater effectiveness regarding health and resolution of comorbidities, such as diabetes, hypertension, fertility problems and sleep apnoea.

Having performed about 6500 bands since beginning bariatric surgery in 1999 and 1300 sleeves within the last 3-4 years, Dr Watson said patients must weigh up the pros and cons for themselves.

“It’s really powerful to see people coming back in a month and they’ve lost 10-12kg,” he said.

“They’re off their blood pressure pills, they’re off their diabetic medication, it’s a really powerful tool.”

Categories: Health

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