Gastric bypass is still the gold standard WLS. It is however a longer and technically more difficult surgery and therefore less safe for the super duper morbidly obese. It's also a cheaper surgery so favoured by those who are self pay. The VSG is a shorter surgery that involves no digestive system reorganisation. The VSG is preferred for the ultra fats because it is far quicker to perform and they can get pretty good results to a point. When they are smaller and have shown they have made the necessary lifestyle changes, and less of an anesthesia risk, a second stage surgery can be performed to convert the VSG to a DS (Duodenal Switch).
VSG rarely comes with dumping syndrome, and questioning of patients who claim to have it usually confirms that they don't. What VSG does come with is a very high risk of acid reflux. As the VSG has no malabsorption component it is often recommended for younger females planning future pregnancies, but that still doesn’t prevent gastric bypass procedures being approved for those women. Gastric bypass is well known for better weightloss results in diet compliant patients, and those results are backed up by decades of studies.
But here’s why a surgeon may choose gastric sleeve:
gastric bypass surgery poses a 4-7% risk of developing an ulcer, whereas gastric sleeve patients don’t ulcer.
They do still get ulcers along the stapleline, although it is not as common. VSG patients will have far more issues with acid reflux though, and in patients with pre-existing GERD, a gastric bypass (or variant) should be the surgery offered as it is the cure for GERD, whereas VSG will exacerbate that health issue.
Additionally, there is a 4-7% chance of a gastric bypass patient needing a follow-up laparoscopy, where as a bypass will usually cause t2 diabetes remission.
That's a new one to me. I'd appreciate seeing a source study for my own educational purposes. The laparotomy part that is. The bypass diabetes stuff is common knowledge. VSG patients are far more likely to need revisional surgery which is both more complicated and has an up to 20x higher risk of very dangerous staple line leaks.
Also, VSG is NOT reversible as the remnant stomach is removed. Technically a gastric bypass IS reversible as the remnant stomach is still living in the abdominal cavity. Reversals are rarely ever performed though. Also, after bypass, the tissue in the remnant stomach is available to be used should it be required later in life to repair the stomach eg. If cancer needs to be removed.
I’m not saying they are never done anymore, but bypass isn’t as common as it used to be. Also think of staples and the kinds of issues those could cause.
The VSG uses far more staples than a gastric bypass. In the VSG the stapleline runs the entire length of the stomach, whereas in a gastric bypass the staples only run across the much narrower top of the stomach. If you think there are no staples in the VSG, then you've just proven your ignorance of WLS procedures.
If you are instead referring to Endoscopic Sleeve Gastrectomy it is NOT the same thing as a VSG, is NOT a common or recommended procedure, and has very poor results and poor durability as the stitches breakdown over time.