25 year young man with a BMI of 41 consulted for Bariatric surgery.But for the snoring and fatty liver,He has no comorbidities.He tried diet and exercise but was not successful .He travels widely because of business commitments.Father and mother are diabetics.Bl sugar,HbA1c,Thyroid functions,cortisol,andSerum insulin are normal.
This is dependent of his eating habits. If sweet eater I would prefer a gastric bypass. If volume-eater a sleeve gastrectomy is a possible procedure.
If he is willing to change his eating habits then sleeve gastrectomy....
I would go for a RYGB which is still regarded as "Gold - standard" for patients whose BMI is in the early 40s. I think it is because of its
1) excellent initial weight loss - 60 to 70% at 18 months
2) durability even at 5 years (He is only 25 and certainly a procedure that lasts longer would be better)
His frequent travel commitments may come slightly in way of his dietary adjustments post-RYGB, but I suppose with adequate pre-op education and carefull counselling, that can be overcome.
As a gastroenterologist following up on may bariatric patients - the quality of life after RYGB (especially the first year) is much inferior to LSG. It is mainly attributed to the "anatomic alterations" of th GIT and it being a non pylorus-preserving procedure.
Sleeve gastrectomy preserves the pylorus and is much more easily adaptable.
Thankyou all,,but my concern is that he is only 25 yrs and actively tours because of business commitments, I am not sure whether LSG is a durable procedure in the long run,even though I explained the pt about LSG only!
Sleeve or Bypass are good options, However, as he travels widely, small bowel obstruction and gastric outlet obstruction which are impredictable, may become a major problem especially when he is away of medical resources. For that, the best option seems to be SLEEVE.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2749388/?report=reader
Beeing a young patient a sleeve gastrectomy seems to be more appropriate.
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