Gastric Sleeve vs. Lap band Surgery – Bariatric Surgeon, Las Vegas

“I am a Bariatric and general surgeon. I completed a fellowship at USC in advanced laparoscopic surgery. We address a lot of complicated general surgeries such as complicated hernias and also complicated gall bladder disease. Although most of my practice is in bariatric I still do these procedures.

Well, gastric sleeve is a newer weight loss operation. It’s been around for about eight years now. Although it’s a part of other operations that we have been doing since 1988, has been there for a while, and in gastric sleeve, what we are doing is that we are shrinking the stomach down to a sleeve or a long narrow tube.

We do that by freeing up the majority of the stomach, taking a stapler and going up and cutting by 85 % of the stomach. We use something called a booze or scissor to make the two appropriate sizes. We don’t want too narrow, we don’t want too big, we want just right.

And we use that booze as a scissor, we come along inside that and staple up on the stomach and tapper it down to a long narrow sleeve that empties down at the bottom, and it’s a nice operation. I really like the gastric sleeve because it seems to give us all the benefits of the band because now u have lots of restrictions like a lap band would do or a realized band.

You have lots of restrictions, but it also gives us the benefits of the bypass. Hormonal changes that we see in the bypass that are so powerful, we see in the sleeve. So, for example, hunger, when you are hungry when you diet and you eventually fail. That hunger hormones are called ghrelin, and that’s produced in the stomach and that’s taken out with the sleeve.

So with the sleeve, it’s the tapering of the stomach making it smaller and narrower, and was getting two things out of it. Getting good restrictions and getting hormonal changes as well. Choosing a surgery is very difficult. We don’t have a professional guidebook, I wish I did. I wish I could look it up and say well, you drive a Honda, and you vote Democratic, so you get a band. We don’t have it. We have to go with the patient's comfort and what they are comfortable with.

So what I try to do with patients is simply tell them about the operations, tell them the pros and cons because they all have them, for the band and the sleeve, and see what clicks somebody, what’s comfortable. The band is a nice operation.

The reasons I choose the band are that it’s the safest surgery I can do for my patients, and there is the surgeon, which is always my priority. It’s the safest surgery I can do, it's reversible and it’s adjustable and these are all options that are very strong and safe for my patients and allow me a good night’s rest as well.

The sleeve is a little more aggressive than the surgery, but the benefits are definitely there sleeve we are cutting things away for the first time, but we are getting not only restrictions but some hormonal changes as well. So the weight loss is a little bit stronger with the sleeve. The weight loss may be as good as the bypass of the sleeve.

So it’s hard to choose between, again it’s on the patient, what’s comfortable, what clicks. Some people, for example, want to have the safest surgery, which is understandable; it’s going to be a band.

Now, the person feels like they have to have the strongest surgery available but still want to be safe. That’s going to be a sleeve. Now the person might not want the foreign body inside them, the lap band is the foreign body.

It’s meant to stay there for the life of the patient so that again is the sleeve. There are various reasons for choosing. It’s important that the patients are comfortable. It’s important that they know that the reasons they have are good reasons. There are no bad reasons to choose these operations after you talk to your surgeon.”

The surgeon considers the comfort of the patient as the most important factor in the selection of the right surgery for him. The gastric sleeve involves cutting down a part of the stomach and taking it out along with the hunger hormone, whereas, in the lap band, a foreign body (swizz band) is installed in the upper portion of the stomach.

The band is adjustable and it is the safest surgery of all. So the choice of selecting the safest or the most effective surgery lies with the patient.