Patterns of Repetition

Revisiting Gastric Sleeve and Bypass Surgeries

One and done is a lovely turn of phrase. It’s also one of those sweet little lies about dealing with obesity. “You can lose the weight and keep it off for good.” That’s the seductive promise of a currently trendy weight loss app. It’s also implicit in the false positioning of bariatric surgery as a “last resort.” But a new study in JAMA Network Open reminds us of the truth about gastric sleeve and bypass surgeries.

There’s a good chance that you’ll need a follow up procedure some time within four years after the initial operation.

Revisiting Less Often with Sleeves

Kristina Lewis and colleagues examined insurance records for 13,027 patients in a nationwide database. They found that 26.5 percent of gastric bypass patients had another endoscopic procedure within four year of their bypass. The number for sleeve patients was lower – 18.5 percent. Lewis explains the importance of understanding your choices:

If you’re having bariatric surgery and trying to decide between a sleeve and a bypass, this may be really important to know.

Although bypass surgery is more effective for weight loss and diabetes remission, patients should be aware that it may be associated with a slightly higher risk of undergoing additional procedures later.


Living with a chronic disease is all about making tradeoffs. So it’s no surprise that choosing between gastric sleeve and bypass surgeries involves tradeoffs. Study co-author David Arterburn sums it up:

This study adds to a complex and emerging picture of choosing a procedure for bariatric surgery. Bypass appears to be slightly more effective than sleeve for weight loss and diabetes remission. But it is also associated with a higher risk of subsequent operative and endoscopic interventions.

The choices we make set the patterns for our lives. On we go.

Click here for the study, here and here for more perspective.

Patterns of Repetition, photograph © Rich Renomeron / flickr

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December 20, 2019