Gastric Sleeve vs Gastric Bypass

Overview of Gastric Sleeve Surgery and Gastric Bypass Surgery Comparison

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. Now let’s delve deeper into detail about gastric sleeve vs gastric bypass.

Procedures Explained: Pros and Cons

Notable Difference Between Gastric Bypass and Gastric Sleeve

The notable difference between these two operations is that gastric bypass provides slightly more expected excess weight loss (%EWL) than the gastric sleeve.

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.

Which Procedure is Best For You? (Gastric Bypass/Sleeve)

• Highest Amount of Excess Weight Loss (%EWL) – Gastric Bypass Surgery (RNY)
• Less Invasive Surgery – Gastric Sleeve Surgery (VSG)
• Low Complication Rate – Gastric Sleeve Surgery
• Less Number of Potential Side Effect – Gastric Sleeve Surgery
• Lowest Cost of Procedure –  Gastric Sleeve Surgery in Tijuana, Mexico
• Highest Reduction in Comorbidities and Health-Related Problems – Gastric Bypass Surgery
• Most Popular Surgery: Gastric Sleeve Surgery as of now

Find Out if You Pre-Qualify For Gastric Sleeve or Gastric Bypass Surgery HERE

Gastric Sleeve vs Gastric Bypass: Table Comparison

Type of Surgery	Gastric Sleeve	Gastric Bypass
Method of Weight Loss	Restrictive: Reduce Stomach Size and the Hunger Hormone, Ghrelin	Restrictive & Malabsorptive: New Stomach Created & Alters Digestion
Stomach Alterations	Stomach Size Reduced 70-85% of the stomach is removed. Long narrow vertical pouch (~ 2-3 oz / 60-100cc).	New Stomach is Created: Stoma The stomach is bypassed, with a new smaller stomach (stoma) Small pouch (about 1/20-30cc)
Changes to Intestine	No Change	Cut and Bypassed: The stoma is connected and rerouted to bypass a large portion of intestines to reduce absorption of nutrients and calories.
Operating Time	1.5 hours	2 hours
Average Hospital Stay	1 to 2 days	2 to 3 days
Time off Work	2 weeks	2 to 3 weeks
Recovery Time	3 weeks	4 to 6 weeks
Advantages	No intestinal changes: Fewer complications and side effects including dumping syndrome Hunger depressed because of reduction in Ghrelin production Lifetime Approach to Obesity Simple procedure	High Expected Weight Loss, Comparable to Duodenal Switch. Gastric Bypass has been performed hundreds of thousands of times. Thus, side effects and complications are known.
Disadvantages	Surgery risks or complications comparable to gallbladder removal. Stomach Could Enlarge (not to the original size). Requires Less Nutritional Supplements and Vitamins – Not as much as gastric bypass. Newer surgery with limited long-term data.	Major and complicated surgery with associated risks. Leakage, Bleeding, Vomiting all occur. Daily Supplements and Vitamins are Required. Dumping Syndrome is Common.
Realistic Expectations	Patients can expect to lose 60%-70% of excess weight in about 2 years. Long-term results were not available at this time. Easily converted to Duodenal Switch or Gastric Bypass if needed.	Provides mild malabsorption of nutrients meaning less caloric intake. Patients can expect to lose 70% of excess weight. Less qualified (patients who lose Duodenal Switch.)
Post Surgery Dietary Info	Patient must eat three meals a day containing 600-800 calories per day (recommended for the first 24 months) and about 1000-1200 after that. There is no dumping or diarrhea. Patients must take vitamin and protein supplements (specially during the 1st year post-operatively)	Patients must eat three small meals a day. Patients must avoid sugar and fats to prevent Dumping Syndrome. Patients must take vitamin and protein supplements to avoid deficiency (Multivitamin, Calcium, Vitamin B12, and Iron for menstruating women)
Resolution of Co-morbidities	T2DM 75% HTN 56% GERD 56% OSA (CPAP use) 62%	T2DM 93% HTN 45% GERD 56% OSA (CPAP use) 77%
Candidate Efficacy	VSG is useful for high risk or very high BMI patients (BMI > 60kg/m2) patients as a “first-stage” procedure. Much lower complication rate than the RNY Gastric Bypass or Duodenal Switch due to there being no intestinal bypass performed.	Gastric Bypass is useful for patients with a BMI of 35-55 and those with a “sweet tooth.” It uses a two-pronged approach, making it very effective for candidates with a higher BMI ranges as opposed to patients with a lower BMI.

Gastric Sleeve Surgery Costs

Gastric Sleeve Surgery costs are completely dependent on the location of the procedure. The cost of gastric sleeve surgery varies from $4,195 to $8,500 in Mexico. In Canada, the cost of VSG is on average $19,000 while in the United States is up to $25,000 without insurance. At Mexico Bariatric Surgery, we offer high-quality sleeve surgery in Tijuana for only $4,195*.

Gastric Bypass Surgery Costs

Gastric bypass surgery costs are similar to the gastric sleeve procedure. In the United States, the price of gastric bypass goes upward of $20,000-$30,000 without insurance. Alternatively, Mexico Bariatric Center offers RNY gastric bypass in Tijuana for as low as $5,995 – less than one-third the amount in the United States.

Insurance Coverage

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 Complications

Gastric sleeve surgery has the lowest potential complications compared to other weight loss surgery procedure. Mainly, because it only removes a portion of the stomach, there are no anatomy changes. Also, the procedure is less-invasive compared to gastric bypass surgery. There is slightly less excess weight loss than gastric bypass, although the gastric sleeve has fewer risks and complications. The complications include; sleeve leakage, hemorrhaging or bleeding, and stroke or heart problems.

Gastric Bypass Surgery Complications

Gastric bypass is one of the oldest bariatric procedures that is currently still one of the most popular surgeries today. Although most surgeons have extensive experience with bypass surgery, there are still more complications than gastric sleeve surgery. The complications include gallstones, stomal stenosis, pouch stretching, leakage, nutrition deficiencies, dumping syndrome, vomiting, ulcers, and protein deficiency.

Sleeve vs Bypass Digestive Tract

Which Surgery is Right for Me?

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.

How to Choose Between Gastric Sleeve and Gastric Bypass?

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.

Key Components for Patients to Consider:

Bariatrics and Gastro-Esophageal Reflux Disease (GERD)

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.

Bariatrics and Ulcers

If the patient has issues with ulcers or taking Aspirin or Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) on a regular basis, the gastric sleeve surgery is recommended over gastric bypass. Gastric bypass increases the risk for ulcers; both marginal ulcers and stomal ulcers. The new pouch (stoma) in bypass surgery is small and not possible for ulcers to be endoscopically identified.

Bariatrics and Cholelithiasis

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.

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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.

If you have any further questions, you are welcome to contact us at any time.

Mexico Bariatric Center

855-768-7247

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Reference:

1. The effect of bariatric surgery on gastroesophageal reflux disease
2. Gallstones and Bariatric Surgery: To Treat or Not to Treat?