Gastric Sleeve vs Gastric Bypass Overview

Choosing between gastric sleeve vs gastric bypass is a huge decision to make, as the implications will affect the future of your life. It’s important to know exactly what you are signing up for when determining which bariatric procedure is best for you. Here we will show the pros and cons, similarities and differences, and long-term results you can expect for both gastric sleeve surgery and gastric bypass surgery.

Most bariatric surgery statistics are showing that patients are steering away from gastric banding surgery, and opting to choose gastric sleeve surgery and gastric bypass surgery. Every year since 2005 statistics shows that gastric sleeve and gastric bypass are being out-chosen for bariatric surgery.

Gastric bypass surgery used to account for 80% of all the bariatric surgeries in the United States. However, as of 2016, about 70% of bariatric surgeries performed are gastric sleeve surgery or vertical sleeve gastrectomy.

Gastric sleeve surgery accounts for over 90% of all bariatric surgery procedures performed today. Now let’s delve deeper into detail about gastric sleeve vs gastric bypass.

The notable difference between these two operations is that gastric bypass provides slightly more expected excess weight loss (%EWL) than the gastric sleeve – although comes with more potential risks and complications.

Also after gastric bypass, there is fat malabsorption which does not occur in sleeve surgery (VSG). As a result of bypass malabsorption, essential nutrients and minerals are not absorbed by the body. Therefore, it is important to take vitamins and dietary supplements lifelong. A Rand Corporation study found that patients lose on average 20 pounds more with Roux-en-Y gastric bypass than with vertical sleeve gastrectomy.

Having insurance for weight loss surgery is a difficult process in the United States. You should first make sure your doctor agrees with your decision to get bariatric surgery. Then, speak with your insurance provider to see if you have coverage for gastric sleeve surgery or gastric bypass surgery. If you have insurance coverage, it generally takes about one year to be approved – after a long pre-op diet, check-ups, classes, psychologist, and nutritionist meeting. If you stay on top of everything, you have a better chance of being approved for surgery.

Gastric sleeve surgery is less invasive than gastric bypass and there is no rerouting of the intestine. There is no malabsorption in gastric sleeve patients as it is with gastric bypass. There is a chance to stretch the new stomach (stoma) in gastric bypass and not so much in gastric sleeve as the pyloric valve stays intact.

In this section, you will learn what are the criteria to choose between gastric sleeve and gastric bypass. Gastric sleeve is good for patients with extensive scars from a previous surgery in the middle of the abdomen. There is less of a chance of dumping syndrome in gastric sleeve. Gastric sleeve is better for patients with ulcer history, taking aspirin, or smoke.

In general, RNY gastric bypass is better for patients with severe acid reflux and GERD. Patients with slow metabolism are better off with gastric bypass. Also, if patients have previously had gastric fundoplication surgery, meaning the stomach is wrapped around the esophagus valve to control acid reflux, then gastric bypass is the best option for them.

Obesity is a major cause of GERD and the problems associated with it. Weight loss, in general, through lifestyle modification & exercise, pharmacotherapy or surgical treatment has been shown to significantly relieve GERD symptoms. Studies show that Laparoscopic Sleeve Gastrectomy (LSG) has been linked to an increased occurrence of GERD.

The restriction in the stomach contributes to a reduction in the emptying of the stomach and increase in intragastric pressure. However, the reflux does not always worsen with gastric sleeve. For some people, the extra fat in the abdomen is creating the pressure that is causing the reflux or they have an undiagnosed or untreated hiatal hernia. In those people, reflux symptoms can improve with weight loss with sleeve gastrectomy and/or repair of a Hiatal hernia.

In Laparoscopic Roux-n-Y Gastric Bypass (LRYGB), the pyloric valve stays in the separated stomach and has no role in regulating food. That is why LRYGB is the most practical bariatric procedure to cure GERD with an equal effect to that of Nissen fundoplication.

Rapid weight loss after bariatric surgery increases the risk of developing symptomatic gallstone disease. Studies show that approximately 25 to 30% of patients undergoing weight loss procedure may develop symptomatic gallstones within the first year postoperatively. A regression analysis shows that gastric sleeve surgery has a higher chance of developing gallstones in some patients [2]. Gastric bypass may result in a chance of gallstone formation due to a slightly higher weight loss within the first 12 months.

Some surgeons routinely remove the gallbladder for every patient going through the weight loss surgery to prevent the gallstone complications. Mexico Bariatric Center surgeons do not recommend the removal of gallbladder at the time of the surgery unless the patient already has cholelithiasis. MBC surgeons recommend administering ursodiol as prophylaxis therapy for 6 months after surgery.

As bariatric surgeries alter structure and function of the GI tract in various ways, it is crucial to evaluate patients’ comorbidities, other health issues, lifestyle and level of commitment when considering which surgery fits best for them. We hope that this overview of gastric sleeve vs gastric bypass proves helpful to you.

For additional questions please don’t hesitate to contact us using the below contact form, and we will get back to you as soon as possible.