Gastric Sleeve on the NHS

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Gastric sleeve surgery is now the dominant bariatric surgery procedure in the NHS and across the world. It’s grown very popular over the last few years. It has advantages over the gastric band and gastric bypass that have enabled it to achieve primacy. It bests the band because its more powerful and weight loss is usually greater in the short term, and it defeats bypass because its faster and easier to perform and some of the long-term complications are avoided, e.g. lower vitamin and mineral deficiency risk and no risk of an internal hernia. 

There are also reports that will show it offers the lowest cost to the NHS. Certainly, the NHS commissioning groups get paid less for sleeve than for band and bypass. Certainly, the gastric sleeve is an excellent procedure and we recommend it widely to patients, but there are also downsides and uncertainties that may not be fully accounted for. Our view is that for most patients there is a choice to be made between band or sleeve, or sleeve or bypass.

For patients who are generally healthy, the band and sleeve are good options. The sleeve is more powerful but more invasive, and generally more expensive. People who worry they won’t be able to work with the band or who don’t want the maintenance of a band would opt for a sleeve.

The band is lower risk, lower cost and less powerful. For patients who are struggling with weight-related health issues and/or who have higher BMI, the choice is generally between sleeve and bypass. For patients dealing with diabetes, acid reflux and high blood pressure, the gastric bypass is generally the better option. For younger patients who want a simpler procedure and who want to keep open the option of revision to bypass in the future, the sleeve can be a good option.

So, there is a lot to consider when making your choice. For this reason, it’s important to choose a provider who offers all 3 options and who will explain the pros and cons of all 3 to you.

When considering the sleeve, make sure you are fully aware of the long-term uncertainty about acid reflux as a side effect and also that you understand the risk and implications of a staple line leakage should you experience one. These are all good procedures and warrant your consideration.

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Rishi Singhal

Rishi is an expert bariatric surgeon based in the West Midlands and also Medical Director at Healthier Weight

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