Gastric Bypass vs Sleeve Gastrectomy: A Comparison

You know you’re ready for bariatric surgery, and to lose the weight and keep it off so you get back to the amazing and incredible life that you deserve. But you’re not sure if bariatric procedures like gastric sleeve or gastric bypass surgery is right for you. Which leads to more weight loss? Which has a higher risk of complications? Which is better if you suffer from type 2 diabetes and want your best chance of a cure?

In this article, we’ll walk through these questions together.

What Are the Key Differences Between Gastric Bypass and Gastric Sleeve?

Gastric Sleeve

The gastric sleeve, or sleeve gastrectomy, involves changing the size and shape of the stomach. During the procedure, about 85% of the patient’s stomach is removed, leaving a long thin tube of stomach about the diameter of your index finger. Because your new stomach is a lot smaller than your old stomach, you won’t be able to eat as much. You’ll get full a lot faster and you’ll stay full longer.

The part of the stomach that is removed also produces a hunger hormone known as ghrelin. Ghrelin stimulates your appetite; so when your stomach is no longer producing this hormone, you get less hungry. 

There is no additional anatomical rearrangement, which makes the gastric sleeve a simpler and less complex procedure than bypass surgery.

Gastric Bypass

Gastric bypass surgery involves more anatomical rearrangement than gastric sleeve surgery. It is a combination procedure, which is both restrictive and malabsorptive.

Restrictive: like the sleeve, this surgery works by changing the size and shape of the patient’s stomach in order to limit how much food they can consume at once. This is accomplished by stapling off a 1-oz pouch of the stomach about the size of a person’s thumb. As a result, when you eat you’ll get full faster and you’ll stay full longer, just like with gastric sleeve surgery.

But this surgery works via a second mechanism as well. During surgery, some of the patient’s stomach and small intestine is bypassed. The small intestines still produce digestive juices that help break down food, but the intestinal bypass means that your body will be absorbing fewer nutrients from the food that you do eat. In combination with a smaller stomach, this offers a powerful 1-2 punch that can lead to substantial weight loss and low risk of weight regain.

What Are the Benefits Associated With Gastric Bypass and Sleeve Gastrectomy Surgery?

Gastric Bypass

Because of how the gastric bypass works to reduce nutrient absorption in your small intestines, this surgery can lead to more weight loss than gastric sleeve surgery. It is also excellent at treating type 2 diabetes. At the BMCC, over 90% of our gastric bypass patients experience remission of their type 2 diabetes.

It is largely for these reasons that bypass surgery was considered the gold standard of weight loss surgery for decades. In recent years, duodenal switch surgery has become the new gold standard, owing to its powerful weight loss and even greater ability to combat type 2 diabetes, but the bypass is still an extremely safe and powerful surgery.

Gastric Sleeve

Gastric bypass surgery isn’t right for everyone. If you suffer from Crohn’s disease, an autoimmune disease, or any other condition that requires anti-inflammatory medication, then this surgery may not be the right fit. The anatomical rearrangement of bypass surgery can also make it difficult for some patients to get the necessary nutrients into their body. For this reason, if you suffer from Crohn’s disease or require anti-inflammatory medication or have severe baseline nutritional deficiencies, then we may recommend gastric sleeve surgery as the safest option.

Gastric sleeve surgery is also a simpler surgery, with less anatomical rearrangement and less time spent on the operating table. Surgery only takes 45 minutes, and most of our patients consider it to be an outpatient procedure: they leave the hospital and go home the same day as they undergo surgery. Some patients prefer a surgery like this that’s shorter and simpler.

What Are the Drawbacks of Gastric Bypass and Sleeve Gastrectomy Surgery?

Gastric Bypass

Gastric bypass surgery is longer and more complex than gastric sleeve surgery. The surgery typically takes 1 hour, and more patients may need to stay overnight in the hospital after surgery compared to gastric sleeve patients.

However, it is important to note that both surgeries are extremely safe. Our complication rate is extremely low, and our double-board-certified bariatric surgeon personally commits to remaining in the operating room until every surgery is performed as well as humanly possible. No matter which bariatric procedure you choose, you are in excellent hands with our team.

Some bypass patients also suffer from dumping syndrome, which means that they may experience diarrhea and other symptoms if they eat sugar or high fat containing foods. This can be very uncomfortable but is preventable. However, after surgery it’s important to remember that your dietary plan will need to change anyway, and you won’t be eating sugary or fatty foods. In a strange way, due to the threat of undesirable symptoms dumping syndrome can actually help to keep patients on a healthy dietary plan.

Gastric Sleeve

One possible downside of gastric sleeve surgery is that some patients lose less weight than they might have lost if they had undergone gastric bypass surgery instead. However, it’s important to note that both surgeries are extremely powerful. Many of our gastric sleeve patients lose 100-150 pounds or more and keep it off. No matter which surgery you choose, you absolutely have the potential to hit your weight loss goals and get your life back.

Another potential drawback of gastric sleeve surgery is that if you do suffer from type 2 diabetes, this surgery is not as likely as bypass surgery to send your diabetes into remission. If you suffer from type 2 diabetes, then we strongly recommend that you consider gastric bypass or duodenal switch surgery.

Finally: if you suffer from severe reflux, heartburn, or GERD, then gastric sleeve surgery can aggravate those conditions in a minority of patients. If this is you, then we will recommend a different bariatric procedure such as gastric bypass surgery.

How Much Weight Can I Expect to Lose With Gastric Bypass or Gastric Sleeve Surgery?

Gastric Bypass

Most of our bypass patients lose 65-90% of their unhealthy body weight over the first year and keep it off.

Gastric Sleeve

Most of our sleeve patients lose 60-80% of their unhealthy body weight over the first year and keep it off.

It’s important to note that your overall weight loss is up to you, and depends a lot on how well you stick to your new dietary and exercise plan after surgery.

Which Surgery Is Right For Me?

If you meet the following criteria, then gastric bypass surgery may be right for you:

– Suffer from type 2 diabetes and are looking for your best chance of remission.

– Deal with heartburn, severe acid reflux, or GERD.

-Have a starting BMI >50

– Want to lose 65-90% of your excess weight and keep it off.

If you meet the following criteria, then gastric sleeve surgery may be right for you:

– Don’t suffer from heartburn, reflux, or GERD.

– Don’t suffer from type 2 diabetes.

-Have a starting BMI <50

– Have current vitamin/mineral deficiencies (including anemia).

– Struggle with medical conditions that prevent an intestinal bypass from being an option, such as: Crohn’s disease, conditions that require prednisone or anti-inflammatory medications, or have a history of previous abdominal operations.

– Want to lose 60-80% of your excess weight and keep it off.

No matter what your goals are and what health problems you may suffer from, we’ll help you find the surgical option for obesity that’s right for you.

Taking the Next Step On Your Weight Loss Journey

No matter which surgery you choose, rest assured that you are in excellent hands at the BMCC. Many of our patients say that the decision to undergo bariatric surgery was one of the best decisions of their lives.

“Today, 2 years later and 105 pounds less I am a new person. No walker, no cane, no Oxygen. I am completely cured of diabetes and off all those meds.”—Colleen White, gastric bypass patient.

“We cannot imagine another Doctor or Practice with whom this process could have been so wonderfully orchestrated…. Dr. Long and his staff are the kindest, most loving, and supportive group of individuals we have ever could have met. Each person has contributed to our success, each and every one.”—Keri and Chris Sexton, gastric sleeve patients.

If you’re ready to take the next step, Contact our Denver office today.