4 incidences are less compared to different types of gastric bypass surgery. In the Asian Pacific population or in countries that have a high incidence of gastric cancer, it is deemed to be acceptable surgery compared to gastric bypass surgery, as the excluded stomach from bypass cannot be routinely checked. The disadvantage of a LSG is that the procedure does carry a chance of leakage in both the short term and long term. With the better understanding of LSG over the past 10-15 years and the advances in technology, the leak rate has gone down from 1-2% to 0.5% or less and even 0.1% in institutes that perform a high volume of LSG. LSG leakage is complex and difficult to manage and requires experienced surgeons to deal with the complications. Sleeve leakages are multifactorial relating to a patient’s tissues and surgical technique, and also the fact that LSG has simply higherpressure systems compared to gastric bypass surgery, which results in the highest pressure point on the top of the stomach. Another drawback of the SG is the long-term data on reflux. The current incidence varies from 5% to 20%, but most of it is managed by medical therapy and may not require surgical repair of a hiatus hernia or conversion to bypass surgery. Laparoscopic Roux-en-Y Gastric Bypass Laparoscopic Gastric Roux-en-Y Bypass (RYGB) as a bariatric, weight loss operation has been studied for over 50 years and is often referred to as the “gold standard”. However, it is important to understand that this does not mean it is the best operation for everyone. Every bariatric surgical procedure has its own characteristics; your treating physicians or surgeons should only make the choice of operation after a thorough evaluation of your particular health issues and potential health risks. The operation is done by laparoscopic technique unless the patient has had previous abdominal surgery. The procedure takes around one to two hours and the hospital stay is around two to three days. The RYGB procedure consists of making a small gastric pouch and diverting food past the majority of the stomach and a segment of the small intestine. The stomach pouch is connected to the middle of the intestine. The procedure is reversible, if necessary, as the stomach and intestine are not removed. It can also be achieved by transecting previous sleeve gastrectomy as a revisional procedure. The intention of the small gastric pouch is to give patients a sensation of fullness, but it does allow passage of the food via the anastomosis (joint of the stomach to the small intestine). The food passes more quickly through the intestine and activates specialised cells, L-cells, further along the gut that are important in the regulation of blood glucose and satiety. The hormones produced by theses cells act directly on the pancreas, the liver and the brain. Therefore, the RYGB besides mechanically restricting food intake will also work on complex neuro-hormonal pathways to improve patient’s metabolic disease. The degree of malabsorption is not long lasting since small intestine absorption will adjust with time. There are variations in versions of RYGB in terms of the length of the intestine that is bypassed. The typical recommendation is approximately one metre of biliary pancreas limb and one metre of alimentary limb. These reconstructions are best to be discussed with the surgeon in terms of the decisions of the length of the intestine bypass, based on the patient's small intestine total length and also the roux limb. There are some surgeons who are also advocating the use of a band around the pouch to prevent the pouch from getting stretched. However this is a foreign body and it does have consequences in terms of symptoms like vomiting and erosion of the band (band migrated inside stomach) can be a huge issue. The variation is better to be discussed with your surgeon and it will be on a case-by-case basis.
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