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Gastric Bypass vs. Sleeve Gastrectomy continued...

“In some previous studies, sleeve gastrectomy was found to have equal efficacy in weight reduction to gastric bypass for morbidly obese patients,” says study researcher Wei-Jei Lee, MD, PhD, a surgeon at Min-Sheng General Hospital.

Lee says that in her study, rerouting food around the duodenum (a portion of small intestine) appeared to make the difference.

“In type 2 diabetes, the duodenum may play a role in insulin resistance. Therefore, duodenum exclusion by surgery might help in reducing insulin resistance,” Lee says.

Choosing Weight Loss Surgery

In light of these results, doctors say it’s important for patients to go into any weight loss surgery clear-eyed and armed with information.

“What I try to explain to everybody is that a band is a diet with a seatbelt, there’s no metabolic weight loss component to it at all,” says Mitchell Roslin, MD, chief of bariatric surgery at Northern Westchester Hospital in Mount Kisco, N.Y. “You put a seatbelt around the stomach.”

Often significant weight loss, by itself, will improve diabetes.

To the extent that people lose weight with Lap-Band, Roslin says, they may see their diabetes improve. But weight loss with Lap-Band tends to be slower than it is with a bypass and in the long term may not be as substantial.

If control of diabetes is a primary concern, having an operation that bypasses the upper intestine is probably the best bet, says John G. Kral, MD, director of surgical services at SUNY Downstate Medical Center in New York.

“Adding type 2 diabetes to the equation, the evidence is fairly clear that diversionary operations are more effective. That is a powerful factor for a patient who would come requesting a bariatric operation and who has type 2 diabetes,” Kral says.

However, he adds that the gastric bypass is a complicated procedure that’s best performed by an experienced surgeon at a hospital where they are frequently performed.

Kral says surgeons need to have performed about 125 gastric bypass procedures before they can reliably and safely repeat them in patients.

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