Gastric Sleeve vs Gastric Bypass Surgery

Gastric Sleeve Surgery vs. Gastric Bypass Surgery

Choosing between gastric sleeve or gastric bypass is a huge decision to make, as the implications will affect the future of your life. Sleeve gastrectomy and RNY gastric bypass result in similar excess weight loss during the first 12 to 24 months. They also resolve a lot of comorbidities, such as diabetes type 2. Both procedures limit the amount of food you can eat. Sleeve operation makes you less hungry as bypass decreases the vitamins and minerals absorbed.

Gastric sleeve operation is less complex and invasive than gastric bypass. It has less chance of difficulties during and after surgery with fewer side effects. However, there are specific criteria for opting with the sleeve procedure rather than bypass. This guide will help you determine which surgery choice is most suitable for your circumstances.

Consult with MBC’s top-rated weight loss surgeons in finding out the best option for you!

gastric bypass vs gastric sleeve - Mexico Bariatric Center

Bypass Versus Sleeve Cheat Sheet

In deciding which is better bypass or sleeve, consider eight general factors,

  1. Sleeve with BMI < 45  and bypass with BMI > 45
  2. If you smoke, the sleeve is a better alternative
  3. If you take aspirin regularly, the sleeve is the way to go
  4. If you drink, bypass can increase the likelihood of alcoholism – go with the sleeve
  5. GERD/reflux can worsen with sleeve, so you need to go with bypass
  6. Bypass is more effective in curing diabetes type 2 – high insulin users need bypass
  7. If you have a previous fundoplication, bypass is the right one
  8. Sleeve if you have excessive scar tissues from previous abdominal surgery

We will show the pros and cons, similarities and differences, and long-term results you can expect for both Vertical Sleeve Gastrectomy (VSG) and Roux-en-Y Gastric Bypass (RYGB).

How Gastric Sleeve Surgery Works

Gastric sleeve surgery is a permanent weight loss surgery that downsizes the stomach by as much as 80%.

Gastric Sleeve Surgery Schematic
  • Less Invasive Surgery

  • Low Complication Rate

  • Low Risks and Side Effects

  • Low Surgery Costs

  • Most Popular Surgery

The restriction acts in two ways: first, the smaller stomach capacity contributes to patients feeling full faster – reducing caloric intake. Secondly, the hunger hormones (Ghrelin) are reduced, allowing gastric sleeve patients to be free of hunger desires.

How Gastric Bypass Surgery Works

Gastric bypass surgery is a powerful bariatric procedure that uses two surgical methods to achieve significant weight loss.

Gastric Sleeve Surgery Schematic
  • Highest Amount of Excess Weight Loss (%EWL)

  • Better Remission of Type 2 Diabetes Mellitus

  • Highest Reduction in Comorbidities & Health-Related Problems

RNY gastric bypass uses restriction and malabsorption to reduce caloric intake considerably. This procedure is intended for patients who are suffering from co-morbidities, along with very debilitating obesity.

Which Procedure is Best for Me?

Gastric sleeve is good for patients with extensive adhesions from a previous surgery in the abdominal area. Sleeve gastrectomy is also suitable for patients with ulcer history, taking aspirin, or smoking. Learn More

Gastric bypass is better for patients with severe acid reflux/GERD and slow metabolism. If patients have previously had Nissen fundoplication anti-reflux surgery, meaning the stomach is wrapped around the esophagus valve, then gastric bypass is the most appropriate. People requiring high amounts of insulin are better off with RNY bypass.

Candidacy Requirements

Do I Qualify for Gastric Sleeve?

  • BMI 30+

  • Existing Abdominal Scarring

  • Previous Ulcer

  • Sleeve is Easily Revised

  • Smoker

Do I Qualify for Gastric Bypass?

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What is the Biggest Difference?

The notable difference between these two operations is that gastric bypass provides slightly more expected excess weight loss (%EWL) than the gastric sleeve and is better suited for the resolution of obesity-related health problems. On the other side, the RNY gastric bypass has higher rates of risks and more complications than the sleeve gastrectomy.

Gastric sleeve is less invasive than gastric bypass because there is no rerouting, or bypassing, and portion of the intestines. As a result of the malabsorption, essential nutrients and minerals are not absorbed by the body. Therefore, it is important to take vitamins and dietary supplements lifelong after 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. The possibility of a future revision surgery has many effective options for sleeve patients, although not so many for RNY patients.

Table Comparison of Sleeve versus Bypass

Statistics show that since 2005, sleeve gastrectomy and Roux-en-Y gastric bypass have been the most widely requested and effective treatments of morbid obesity and type 2 diabetes.

Gastric Bypass Surgery, once known as the “gold standard”, accounted for 80% of all bariatric procedures performed in the United States. Today, Gastric Sleeve Surgery accounts for over 90% of all weight loss surgeries performed across the country.

Gastric SleeveGastric Bypass
MethodRestrictiveRestrictive & Malabsorptive
StomachRemove 80-85%
(2-3 oz.)
New Pouch Created
(1 oz.)
AnatomyNo ChangeReroutes Intestines
Duration1.5 hours2.5 hours
Hospital1 to 2 days2 to 3 days
Time Off1 to 2 weeks2 to 3 weeks
Recovery3 weeks4 to 6 weeks
Low Risk
Higher %EWL
More Effective on Comorbidities
Less %EWL
Vitamins Required
Dumping Syndrome (Common)
Hard to Revise
Weight Loss60-75% (%EWL)64-80% (%EWL)
Post-Op3 to 5 Meals/Day
800-1200 Cal
3 to 5 Meals/Day
Avoid Sugar and Fats
Vitamin and Protein Supplements
HealthT2DM: 75%
HTN: 56%
GERD: 56%
OSA (CPAP): 62%
T2DM: 93%
HTN: 45%
GERD: 56%
OSA (CPAP): 77%
CandidacyBMI of 30+
“1st” Procedure
BMI of 35+
“Sweet Tooth”
Severe Acid Reflux
  • (%EWL) = % Excess Weight Loss

  • T2DM = Type 2 Diabetes Mellitus
  • HTN = Hypertension

  • OSA = Obstructive Sleep Apnea

Comparing Costs and Insurance Coverage

Having insurance to cover for weight loss surgery in the United States is a difficult task and lengthy process. You should first make sure your doctor agrees with your decision to get bariatric surgery. Then, speak with your insurer 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.

Depending on location, gastric sleeve costs range from about $4,595 up to $24,000+. On the other hand, gastric bypass costs start at $5,995 and can go up to $27,000. Mexico Bariatric Center can help you decide which surgery is best for you quick and hassle-free. Just take a few minutes to do the health application.

Sleeve vs Bypass Cost Comparison

Complications and Side Effects

Complications After Gastric Sleeve

Gastric sleeve surgery has the lowest potential complications compared to other weight loss procedures. Mainly, because it only removes a portion of the stomach.

Complications After Gastric Bypass

The Roux-en-Y Gastric Bypass is an established bariatric procedure. Even with extensive surgical experience, there are more complications with bypass versus sleeve.

Digestive Tract and Anatomy