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.
Procedures Explained: Pros and Cons
Gastric Sleeve Surgery
Vertical Sleeve Gastrectomy (VSG) is a permanent weight loss surgery that downsizes the stomach by as much as 85%. This restriction helps in two ways: first, the smaller stomach capacity contributes to making patients feel fuller faster – therefore reducing caloric intake. Secondly, the hunger hormones (Ghrelin) are reduced, allowing patients to be free of hunger desires.
Gastric Bypass Surgery
Gastric Bypass Surgery is a very powerful weight loss surgery that uses two surgical methods to achieve big weight loss for patients. Gastric Bypass uses restriction and malabsorption to reduce caloric intake severely. Gastric bypass is intended for patients who are suffering from co-morbidities, along with a very debilitating obesity.
Notable Differences
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.
Which Procedure is Best For You?
Gastric Sleeve Surgery (VSG)
Less Invasive Surgery
Low Complication Rate
Less Number of Potential Side Effect
Lowest Cost of Procedure
Most Popular Surgery
Gastric Bypass Surgery (RNY)
Highest Amount of Excess Weight Loss (%EWL)
Highest Reduction in Comorbidities and Health-Related Problems
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
| New Stomach is Created: Stoma
|
| 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 |
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| Disadvantages |
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| Realistic Expectations |
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| Post Surgery Dietary Info |
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| Resolution of Co-morbidities |
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| 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 Costs
Gastric Bypass Costs
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
Gastric Sleeve Surgery
New stomach is like a hot dog or a “sleeve” and has the same shape as the duodenal switch pouch but smaller. With vertical sleeve gastrectomy surgery, there is no anatomical changes, no changes to pyloric valve, and no intestinal bypass. The gastric sleeve surgery significantly restricts the volume of food that can be eaten. The mixing of food with bile and pancreatic enzymes occurs as before surgery with no changes. Therefore, there is a no malabsorption of nutrients, dumping, or bowel movements.
Gastric Bypass Surgery
New stomach is a small pouch and is connected to the small intestine where food and digestive juices are separated for the first 3 to 5 feet. The RNY significantly restricts the volume of food that can be eaten. The delay in mixing of food with bile and pancreatic enzymes induces a moderate fat and protein malabsorption as well as calcium, iron, and B-complex vitamins absorption reduction. The alterations in intestine also change the bowel movements: different smells, more gas, and occasional cramping.
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 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.
Candidacy Requirements
Gastric Sleeve
BMI 30+
Existing abdominal scarring
Previous Ulcer
Sleeve is easily revisable
Gastric Bypass
BMI 35 to 55
Severe Acid Reflux or GERD
Slower Metabolism
“Sweet Tooth”
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
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.
Comparison of Similar Procedures
References
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* Prices are subject to change. Not valid on blackout dates. Prices depend on the surgeon, surgery, additional fees, and schedule. Prices may rise because of BMI level and previous abdominal surgeries.
** All of the testimonials are covered in our disclaimers. Individuals results will vary; there is no guarantee stated nor implied.
Last Updated: September 6, 2018 by Ron Elli, Ph.D.
Reviewed by Dr. Kimberly Langdon, M.D. August 2018