Gastric Sleeve vs Gastric Bypass. Which Is Better for Weight Loss at 200 kg?

If the weight is 200 kg and the BMI is very high, the liver size is very large and the worldwide recommendations say that sleeve gastrectomy should be offered as a choice of procedure for better safety as a first stage procedure. That means a patient undergoes surgery, loses significant amount of weight and then the patient is followed for maintenance of weight loss and now the era has changed.

We have medications to maintain weight loss. In case we see slight weight regain or the medications don’t work or are not available, this patient ideally should undergo second stage bariatric procedure. Even if the patient undergoes gastric bypass at the weight of 200 kg, the truth remains the same.

Patient still needs to be followed, patient may still have weight regain because the very fact that he has gone to 200 kg means his genetics is very different. Certain genetic modifications, certain genes do not respond to any procedure in the first stage but they respond better with medications or after the second stage. So there is no such choice but if you look at the guidelines, sleeve gastrectomy is a procedure for better safety.

One must see that availability of CT scan where a patient of 200 kg can fit. Some places do not have a CT scan where patient can fit into CT scan gantry, then in that case a sleeve gastrectomy is a safer choice because patient cannot be investigated after surgery if needed by a CT scan or MRI. However, both procedures work well but sleeve is known as a first stage procedure and it is more for safety.

The patient will still be much better and lose almost about 80% excess weight loss after any of this procedure. Of course still, the best results are at centers with high volume and centers of excellence where a protocol to treat such patient exists.