Gastric Sleeve vs. Gastric Bypass: A Comparison of the Benefits, Risks, and Effectiveness of Gastric Sleeve and Gastric Bypass Surgery
Vertical sleeve gastrectomy, also called gastric sleeve, is an option for patients who are too ill or are not qualified to undergo more radical bariatric procedures. It can be a standalone surgery or the first part of a two-step procedure that involves a subsequent surgery – generally a full gastric bypass – to lose an individual’s remaining excess weight. On the other hand, gastric bypass is a much more invasive procedure that aims to reduce stomach size by surgically creating a small pocket in the stomach. This guide will compare gastric sleeve vs gastric bypass surgery to help you learn about their differences and reach a sound decision.
How They Work
Vertical sleeve gastrectomy works by surgically removing the side part of the stomach while leaving a smaller tub for storing food. However, it doesn’t bypass the intestines. It also removes ghrelin, which is the hormone responsible for stimulating hunger. After the operation, patients feel full after consuming only one to three ounces of food. Many patients also observe up to a 70 percent reduction of excess weight two years following the surgery. In gastric bypass surgery, the stomach is also made smaller, and part of the small intestine is closed off so that food bypasses it. A new stomach pouch is created by making a small or large incision in the abdomen. Like vertical sleeve gastrectomy, it causes you to feel full for a long period after eating only a small portion of food. The main difference is that gastric bypass bypasses part of the digestive track whereas sleeve gastrectomy doesn’t.
Good Candidates For Each Procedure
Sleeve gastrectomy is often used as a first step to lower the weight of a patient with a BMI above 50. Qualified patients can later decide to undergo more complex procedures such as gastric bypass or a duodenal switch. Patients with specific medical conditions that hamper them from choosing complicated operations are good candidates for gastric sleeve surgery as a standalone procedure. Gastric bypass is suitable for patients with a BMI above 40. It’s generally a suggested option for obese people who find it extremely difficult to lose weight with exercise, diet, and medication. It’s also an option when a patient has a life-threatening problem related to obesity, such as type 2 diabetes. The most common type of bariatric surgery is Roux-en-Y laparoscopic bypass surgery, which yields long-term positive results but has slightly higher risks, according to research.
Benefits of Each Surgery
Vertical gastrectomy offers more benefits than gastric bypass, including the following:
- It is a safer and less complex operation
- It limits ingestion of food and hunger by getting rid of ghrelin, the hunger hormone
- It leads to natural digestion that doesn’t cause nutritional deficiencies typically associated with gastric bypass
- It keeps the small intestine and pyloric valve intact
- It is an option for high-risk patients with high BMI and/or medical issues such as Crohn’s disease, prior surgery, anemia, or anti-inflammatory medication
Gastric bypass, however, offers long-term results substantiated by years of research as compared to vertical gastrectomy, which is a relatively new procedure. It offers the following benefits:
- It controls amount of food you can consume
- Malabsorption promotes more weight loss
- It prevents and limits intake of sweets
- It sustains long-term weight loss results
Risks, Disadvantages, and Complications
When comparing the two procedures, it’s important to note that fewer long-term studies have been conducted on the results of gastric sleeve surgeries compared to gastric bypass, which is widely regarded as the standard weight loss option due to several decades of comprehensive studies and experience.
Based on available studies, gastric sleeve has the following risks and disadvantages associated with it:
- Bleeding, infection, and blood clots
- Stomach leakage along the stapled edge
- Nonreversible
- Not covered by certain insurance companies because it is considered to be investigational or experimental
Risks and disadvantages associated with gastric bypass:
- Bleeding, infection, and blood clots
- Stomach leakage along the stapled line
- Complex, invasive surgical procedure
- Dumping syndrome
- Potential nutritional deficiency
- Ulcer, gallstones, bowel obstruction, and reflux
Overall, vertical sleeve gastrectomy is less risky than gastric bypass, but you’ll have to check with your insurance provider first to ensure that it is covered.
Related Article: 5 Common Gastric Bypass Surgery Side Effects
Safety and Effectiveness
According to the results of studies conducted at the Naval Medical Center and Cleveland Clinic Florida, sleeve gastrectomy is quickly becoming a popular option that is as safe as or even safer than gastric bypass surgery. The research revealed that gastric sleeve has proven itself to be a relatively safe and effective procedure for patients suffering from morbid obesity. Still, longer studies found that gastric bypass delivers consistently positive results among patients with successful operations.
Weight Loss Results
Based on average weight loss results of recent studies, vertical gastrectomy leads to a faster weight loss rate, particularly in low BMI patients. Long-term results are not yet available, but recent studies show more than 60 percent loss of excess weight. Usually, rapid weight loss occurs in the first six months after surgery, and a patient can maintain a loss of 53 to 69 percent of excess weight in the next five years. Gastric bypass leads to a slow yet steady weight loss rate. Based on long-term studies, patients generally lose more than 60 percent of excess weight after surgery, although many experience side effects such as high blood pressure, sleep apnea, and back pain. The procedure leads to an average weight loss of 77 percent in the year following the surgery. A clinical assessment of bariatric surgery data confirmed that patients experienced significant improvements of obesity-related medical problems.
Comparing Dietary Guidelines
Patients who choose to undergo vertical sleeve gastrectomy can consume around 600 to 800 calories daily during the weight loss period, while those who select gastric bypass can consume 800 calories daily. The former procedure requires a diet that consists of five small, healthy meals per day without snacking, while the latter requires three small meals chewed into a pureed consistency. Some foods are less problematic for gastric sleeve patients than others, and high-calorie foods should be avoided. Gastric bypass patients should avoid high-fat and high-calories foods as well as fibrous, sticky, and dry foods that may cause stomach blockage. These include bread, tough meat, nuts, raw vegetables, and pasta. Carbonated drinks should also be avoided, as these can cause bloating.
Related Article: 8 Foods to Avoid: Post-Bariatric Surgery Surgery Diet, 6 Tips for a Pre-Bariatric Surgery Diet
Which Is Better?
We choose Gastric Sleeve. Vertical gastrectomy has many advantages and Gastric bypass is considered effective based on long-term result statistics, but this surgery is associated with higher risks. As a candidate for surgery, it’s also important to take your condition into account. If you take anti-inflammatory medication, which may cause ulcers if gastric bypass is chosen, then it’s best to opt for sleeve gastrectomy. If you’re looking for a less invasive surgery, gastric sleeve is also recommended by doctors. However, if you want proven, consistent results that may last for a long period based on decades of research, then you may want to consider undergoing gastric bypass. On the whole, many doctors today recommend gastric sleeve as a faster, less expensive, and more effective weight loss procedure with lower complication rates, and so do we.
Related Article: How much does gastric bypass surgery cost?
I am 1 year post op from having the gastric sleeve and down 156lbs, never happier, my starting weight was 317lbs currently weighing at 161lbs
That’s fantastic. I’m 2 months out of sleeve surgery down 40lbs to 187. Sleeve is a great surgery. Would recommend to anyone.
Did you have any bad side effects, and why did you choose the gastric sleeve instead of the bypass?
I had the Ruen-Y gastric bypass in 2003, fifteen years ago. It was life changing and life saving. Being permanent, I had to make permanent changes to my diet and lifestyle. I lost 200lbs, and have kept it off. I went from a size 26 to a size 4. It saved my life, HOWEVER, now it has also put my life at risk. The part of my intestine that is bypassed is responsible for absorption of some nutrients. I was diagnosed after my bypass surgery with a genetic lung disease, and am in need of a lung transplant. (This underlying disease, Alpha-1, may have been the indirect cause of my obesity and shortness of breath to begin with, but it was misdiagnosed as COPD and sleep apnea). I finally got to the top of the transplant waiting list only to be denied because the anti-rejection medications that I would have to take cannot be absorbed naturally in my bypassed intestines. What saved my life 15yrs ago is now a double edged sword. People, do ALL your research before you have this procedure done. I don’t regret having it, it indeed extended my life by a few more years, but I wish I had known the true cause of my obesity before I had it done.
I thank you very much for your candid post. My daughter and I suffer from Alpha 1 Antitrypsin deficiency as well. We too, have struggled with weight loss issues, obesity and a COPD diagnosis. In what manner do you think Alpha 1 causes obesity? We eat organic, don’t smoke or drink, lots of water and good nutrients, yet I am still fat (possibly from all the steroids I take?). No lung transplant for me as I also have Systemic Lupus, Diabetes and Hashimotos. What would you suggest that I can do to lose weight Phyllis? By the way, I’ve just been praying for you and hoping that you are doing well.
hi had a gastric band in 2015 witch has stopped working for me and the fat is creeping back and all so had an twisted bowel and a strangulated hernia last year i now want this band taken out and a bypass doing but been told that i can not have this done been offed the sleeve but i want the bypass help what should i do thank andrew from the uk
I would definitely get a 2nd opinion. When I had my band, I was told I could not get the gastric bypass and was told to get the sleeve. Due to the stomach with the sleeve being larger than it was with the band, I did not lose weight and kept gaining. 2 years later, I went to a different surgeon who was able to do the RNY Gastric Bypass. Its been almost 5 years since revision to bypass and I have maintained goal weight! Don’t waste your time with a procedure you know you don’t want!
I had RNY gastric bypass 10 years ago…it was the best decision I made. Even with the new sleeve procedure available, I would choose RNY again. I originally wanted the lap-band but my doctor talked me out of it after asking me some questions that basically told him that I can be a bit non-compliant and he wanted me to have success and the lap band requires maintenance. Now I wasn’t the biggest at 209 lbs but I had comorbidities that made my weight gain dangerous. I stand 5’1″ with a small frame. In less than a year I reached 110lbs and now, 10 years later, I am maintaining a healthy weight of 128lbs. People tend to romanticize the idea about the lap-band, sleeve, and rny as I did when I went for my consultation. You need to be honest about your situation and your eating habits…if you like sweets and that’s your downfall, get the rny because it will discourage you from eating a lot of sweets and you will find alternative and healthier options to satisfy your sweet tooth. Ultimately with time, you will be able to eat most of the same things you did prior to your surgery and portion control will easier. The success of the surgery is not in the method but in how willing you are to change your lifestyle and what you are willing to do to maintain it.
I talk to the surgeon on Tuesday about which procedure is best for me.I am diabetic type 2 and have GERD. He said in the seminar that he recommends the rny procedure. I want the sleeve only. I wowon’t do the rny. Has anyone had GERD before the sleeve and do you have problems with it post surgery?
I personally did not have gerd but i had severe reflux. There are some in my bariatric support group that had gerd. It has fixed theyre issues. I also had a hiatal hernia repair during the sleeve. I have never felt better. I did a ton of research and chose the sleeve also. I would not change a thing. I am just 9 months post and have lost 135 lbs. Started at 356. Best choice ever. Why would u ever wanna bypass any of ur digestive system and have to rely on suppliments the rest of your life. Good luck to you. Be happy tp help with any questions if needed.
I had/have GERD/ Reflux. 19 months post sleeve still on omeprazole in an attempt to resolve (it has been 19months on the meds) hiatial hernia fixed when sleeved. In maintenance below goal wt.
I am 160lbs over weight I have chronic back pain from car accident also the cartlidge inmy hip is GONE need hip replacement also need both knees to be replaced have high blood pressure I am so afraid of surgeries I know I need one but don’t which one t o get want my family to be with me but some say NO some its up to you feels like they saying they don’t care but in the end I kniw its all up to me ,, just trying to get feedback from someone who maybe going thru this also !!! Please help someone !!!thank to all
I know its been a month but i had surgey back in dec of 13. I had the sleeve. I was 200 lbs overweight with severe osteoarthritis in my left leg and need a knee replacement in the worst way but with my osteoarthritis and the de ay in my leg i will never be able to get one. The sleeve was my only option. I have since lost 135 lbs and feel absolutely wonderful. Still have pain here and there but what a life changing decision. The surgey was so easy and recovery so quick. Best choice you will ever make if u havent already!! After much research i chose the sleeve and it was the best choice i made! No bypassing my digestive system and still have digestive juices and no worries of malabsorption. Happily answer any questions if i can. Good luck to you!
I am a type 2 diabetic but my surgeon said I could have sleeve or bypass. It was a lifestyle choice. I want the sleeve but am afraid it won’t work long term. I don’t want to have a bypass 3 years from now.
Hi! I have some medical problems as well. I have a torn meniscus in my knee and bad bursitis in my hip. Both in the same leg. I also have sleep apnea and high blood pressure. But what made me decide to even consider this surgery is the fact that I need a breast reduction. The surgeon wouldn’t even consider it because my BMI was over 40. After 6 months of researching and going to support groups, I have decided to get the Gastric Sleeve.
I have the lap-band and it hasn’t worked to well for me. My doctor told me to do some research on the sleeve and gastric and I am leaning towards the sleeve. I am so scared of the Gastric surgery.
I had gastric bypass surgery in 2004. I was diagnosed with gastroporesis about 6 months ago. Constant vomiting and hospitalizations for malnutrition and dehydration, will be getting a feeding tube into my intestine. Looking into having the bypass reversed, was told that it cannot be reversed.
I notice these posts are old. Wondering if you girls with sleeve a few years ago have regained. I had sleeve 3 years ago and have regained half of what I lost while still eating healthy 90% of the time. Getting ready to have revision to bypass
Don’t do it , I bitterly regret having a gastric bypass , my constant need for iron infusions , B12 injections , many supplements to be taken throughout the day for the rest of my life , I would have it reversed if I could but it can’t be , please stick with what you have and make it work for you , best wishes .
Sleeve 3 years so with 100% excess weight lost. 185 lbs gone. It took 15-16 months to lose. Been maintaining since loss. I personally would not do bypass.
HOW DID YOUR SURGERY GO? WHATS THE RECOVERY TIME?
I am scheduled for gastric sleeve on 4/30/19 and now I am doubting my choice and contemplating the bypass. Would LOVE to hear how it went for you and if you still believe the sleeve was your best choice.
I am 11 years post gastric ynr bypass went from 130kg down to 62kg have settled on 75kg. Only regret is that I didnt do it 30 years ago. I sm from Cspe Town South Africa. Lynette Hubbard