Which Is Right for You?

Gastric sleeve and gastric bypass are two types of weight loss surgery. They are effective for weight loss and for managing metabolic disorders such as diabetes. Metabolic disorders disrupt the process of obtaining energy from food.

Gastric sleeve affects only the stomach, while gastric bypass affects the stomach and the small intestine. People may choose one surgery over another based on risks, desired outcomes, and long-term management.

How They Work

In general, weight loss surgery (bariatric surgery) involves changing the stomach and/or the small intestine. These surgeries are now usually done laparoscopically.

In laparoscopic surgery, several small incisions are made through which a surgeon can access the abdominal organs. Cameras and surgical tools are inserted through the incisions. A large incision, such as in open surgery, is not needed.

Gastric Bypass

Gastric bypass has been used for decades. It has undergone updates over the years and is now usually done laparoscopically. Roux-en-Y is one type of gastric bypass whose steps include:

1. The surgeon separates the stomach into two sections. The top section is the smaller part and is the one used to digest food after the surgery.
2. The small intestine is also separated from the stomach and segmented into two pieces.
3. The surgeon bypasses the top section, which is 3 or 4 feet long. The second, longer part of the small intestine is connected to the smaller top part of the stomach.

The bypass includes a large part of the stomach and 3 to 4 feet of the small intestine. They remain in the body, but food does not move through them. This results in feeling full from eating smaller meals and having fewer calories absorbed.

Gastric Sleeve

Gastric sleeve surgery alters the stomach. It is also called a laparoscopic sleeve gastrectomy or sleeve gastrectomy. It is the most common type of bariatric surgery.

Gastric sleeve surgery removes 50% to 80% of the stomach. The part of the stomach that’s left is about the size of a banana.

After gastric sleeve surgery, people have a smaller stomach and feel fuller after eating less. They also have less hunger.

How Much Weight Loss to Expect

One of the main objectives of bariatric surgery is weight loss, and this type of surgery is largely successful.

According to the American Society for Metabolic and Bariatric Surgery, about 90% of people who have bariatric surgery lose 50% of their excess body weight. It is also notable that this weight loss is sustained in the long term.

People lose about 60% of their excess weight after gastric sleeve surgery. Gastric bypass surgery generally results in a 65% to 70% loss of excess weight.

It’s debatable which type of bariatric surgery yields more significant weight loss results. Studies on these procedures use different metrics for measuring weight loss, making comparisons difficult. Generally, weight loss is the same between gastric sleeve and gastric bypass surgery after five years.

Gastric bypass may have a slight advantage in long-term weight loss. One study shows that after 10 years, people with a gastric bypass kept more weight off.

Other Benefits

Gastric sleeve and gastric bypass surgery help people lose weight. They can also help with conditions associated with obesity, such as:

• Cancer: People with obesity have an increased risk of some types of cancer. After bariatric surgery, the risk of cancer associated with obesity reduces significantly.
• Diabetes treatment: Some randomized studies show that gastric sleeve and gastric bypass surgery are equally effective in managing diabetes. Some observational studies show gastric bypass surgery better controls blood glucose levels.
• Hypertension (high blood pressure): Bariatric surgery is effective for high blood pressure management. Most bariatric surgery patients don’t need medication or lifestyle changes for hypertension in the years following surgery. After 10 years, however, about 40% tend to resume blood pressure medication.
• Sleep apnea: Bariatric surgery helps treat sleep apnea. This is a condition in which breathing pauses and restarts multiple times during sleep. It doesn’t always stop the symptoms completely. People might still experience sleep apnea symptoms and need ongoing management.
• Osteoarthritis: Osteoarthritis is a wear-and-tear degenerative joint disease that progresses with age. Knee pain improves after bariatric surgery for people with obesity. Information is lacking on which weight loss surgery is more effective for osteoarthritis.
• Urinary incontinence: Urinary incontinence is a loss of bladder control, which is common in people with obesity. A 2020 review of studies found that one year after bariatric surgery, the percentage of people with symptoms of urinary incontinence lowered significantly.

Risks and Complications

Bariatric surgery comes with certain risks and complications. Some risks are typical of any surgery, and others are specific to gastric sleeve and gastric bypass surgery.

The potential complications with gastric bypass surgery include:

• Anastomotic leak: A leak of intestinal contents at the surgical site
• Anastomotic stricture: A narrowing of the intestine at the surgical site
• Bowel obstruction: A blockage in the intestines
• Cholelithiasis: The formation of gallstones
• Dumping syndrome: A problem with food moving out of the stomach too quickly
• Gastrogastric fistula: An abnormal tunnel between the digestive tract and the skin or another organ
• Gastrointestinal or intra-abdominal bleeding: Bleeding in the digestive system or the abdomen
• Incisional hernia: A weak spot in the abdominal wall near the incision
• Internal hernia: A weak spot in the abdominal wall
• Malabsorption: The body doesn’t absorb enough nutrients from food
• Marginal ulceration: Ulcers in the small intestine or stomach
• Nutritional and vitamin deficiencies
• Venous thromboembolism: A blood clot in a vein
• Wound infection: Viruses or bacteria infect the surgical site

The potential complications with gastric sleeve surgery include:

• Cholelithiasis
• Gastroesophageal reflux disease (GERD)
• Gastrointestinal or intra-abdominal bleeding
• Incisional hernia
• Nutritional and vitamin deficiencies
• Sleeve stricture: A narrowing in the stomach
• Staple line leak: An opening where the stomach is stapled
• Venous thromboembolism
• Wound infection

Most complications are uncommon and treatable, either with medications or revision surgery. Nutritional deficiencies, strictures, hernia, and fistula are problems that might need long-term treatment and may not be completely reversible.

People who have gastric sleeve surgery and do not have successful weight loss or who have complications such as gastroesophageal reflux disease (chronic acid reflux) may sometimes have an additional surgery to be converted to Roux-en-Y gastric bypass.

Recovery and Long-Term Impact

People usually spend one to three days in the hospital after a bariatric surgery. Prescription pain control methods are needed, especially in the first few days. After that, people will move to over-the-counter pain relief at home.

Patients are encouraged to stand up in the first hours after surgery and add walking, leg, and breathing exercises starting the day after surgery. Breathing exercises and moving around help avoid complications like pneumonia (lung infection). Lifting anything heavier than 15 to 20 pounds for about six weeks after surgery should be avoided.

Follow-up appointments with the surgeon or other healthcare professionals occur the week or two after surgery. Nutrition is essential to recovery, so people are given instructions about their diet, as well as supplements to take home. Changes to diet and exercise plans continue indefinitely to support weight loss.

People will start on clear liquids after surgery and then move to full liquids and solid foods as tolerated. They feel full sooner when eating after bariatric surgery. Working with a nutrition healthcare professional is part of recovery. Support includes learning to maintain weight loss through diet and exercise.

These lifestyle changes are long term and essential for success. The support of the bariatric surgery team helps people achieve their goals.

How to Choose

Both types of bariatric surgery cause significant weight loss, have similar recovery times, and manage metabolic disorders. However, there are a few differences.

Gastric bypass affects more of the digestive system and might cause more weight loss than gastric sleeve after 10 years. It is more effective for diabetes because the change in the digestive system also affects hormone production. It also has a slightly higher risk of complications.

A gastric sleeve has a lower risk of complications. It is recommended for people with previous abdominal surgeries or who have other surgical risk factors.

Gastric sleeve impacts less of the digestive tract, making it a better option for people taking medications that are absorbed in the small intestine. It also means more nutrients are absorbed from food, resulting in fewer nutritional problems.

The bariatric surgical team and other healthcare providers assist individuals in selecting the most suitable procedure. Many factors beyond weight loss influence the decision.

Summary

Gastric bypass and gastric sleeve are appropriate treatments for weight loss. They both help manage metabolic disorders and other health conditions. However, there are differences in risk factors and potential vitamin deficiencies.

The decision between gastric sleeve and gastric bypass takes into account both the individual’s health history and desired outcomes. The bariatric surgical team and other healthcare providers can explain and discuss more factors with the person.