Gastric Sleeve vs Gastric Bypass

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Gastric sleeves and gastric bypasses are two popular weight loss surgeries that can help patients achieve their goals. These procedures can be life-changing for those who have struggled with weight loss for years.

But how do they compare, and what can you expect from each procedure? In this blog post, we will take a closer look at gastric sleeves and gastric bypasses, compare them both, and provide insights into what you can expect from each procedure.

Gastric sleeve vs Gastric bypass

Both the gastric sleeve, aka vertical sleeve gastrectomy (VSG), and the gastric bypass, aka Roux-en-Y gastric bypass (RNY), can lead to significant weight loss and improvements in related health conditions, such as type 2 diabetes and high blood pressure.

However, they are different in terms of their approach and how they affect the digestive system.

Typically anywhere from 60-95% of your stomach will be removed depending on the procedure.

However, just because the procedure removes about 60-95% the volume of your stomach, doesn’t mean it will reduce your appetite or calorie intake by 60-95%.

Here are some of the key similarities and differences between gastric sleeve and gastric bypass:

Similarities:

• Both procedures are typically done under general anesthesia and involve making small incisions in the abdomen.
• Both procedures are intended to help patients lose weight by reducing the amount of food they can consume and altering how the body absorbs nutrients.
• Both procedures are usually recommended for patients who have a BMI of 40 or higher, or a BMI of 35-40 with significant obesity-related health problems.

Differences:

• Gastric sleeve involves removing a large portion of the stomach to create a smaller, banana-shaped stomach. This reduces the amount of food the patient can eat, but does not alter the digestive system in the same way as gastric bypass.
• Gastric bypass involves creating a small stomach pouch the size of a golf ball, and rerouting the small intestine to bypass the rest of the stomach and a portion of the small intestine. This reduces the amount of food the patient can eat and changes how the body absorbs nutrients.
• Gastric sleeve is a simpler surgery with a lower risk of complications, while gastric bypass is a more complex surgery with a higher risk of complications.
• Gastric sleeve typically leads to slower weight loss than gastric bypass, but also has a lower risk of nutritional deficiencies.
• Gastric sleeve surgery typically takes 1-2 hours, while gastric bypass surgery typically takes 2-4 hours.

Biliopancreatic diversion with duodenal switch

Biliopancreatic diversion with duodenal switch (BPD/DS) is a weight loss surgery that is a modification of the traditional duodenal switch procedure. It involves two separate surgeries, one to reduce the size of the stomach and another to reroute the small intestine, which limits the amount of food that can be eaten and absorbed.

Benefits:

• BPD/DS typically results in greater weight loss than gastric sleeve or gastric bypass surgery.
• Patients can consume larger amounts of food than gastric bypass or gastric sleeve patients.
• BPD/DS can also help improve certain obesity-related conditions such as type 2 diabetes, high blood pressure, and high cholesterol.

Risks:

• BPD/DS is a more complex surgery with a higher risk of complications compared to gastric sleeve or gastric bypass.
• There is a higher risk of malabsorption and nutritional deficiencies, which can require more frequent lifelong monitoring and supplementation.

Recovery

The RNY procedure is more complicated, so the surgery and recovery times are usually longer.

After gastric bypass or gastric sleeve surgery, the first few weeks of aftercare are critical for the success of the surgery and the patient’s overall health. Here is a general explanation of the typical aftercare for the first few weeks after surgery:

1. Hospital Stay: After surgery, patients will typically spend 1-3 nights in the hospital. During this time, they will receive pain medication, antibiotics, and fluids through an IV. The healthcare team will monitor the patient’s vital signs and provide education on diet, exercise, and self-care.
2. Clear Liquid Diet: For the first few days after surgery, patients will be on a clear liquid diet, which includes water, broth, sugar-free gelatin, and clear juices. Patients must take small sips of liquids frequently and avoid gulping or using straws to prevent nausea, vomiting, or dehydration.
3. Gradual Progression to Pureed and Soft Foods: After the clear liquid diet, patients will progress to pureed and soft foods. This includes pureed vegetables, soft fruits, and protein-rich foods such as cottage cheese, pureed chicken, and mashed beans. Patients must take small bites, chew slowly, and avoid high-fat, high-sugar, or high-carbohydrate foods.
4. Nutritional Supplements: Patients will need to take nutritional supplements, such as multivitamins, calcium, and iron supplements, to prevent nutrient deficiencies. The healthcare team will provide instructions on how to take these supplements.
5. Pain Management: Patients may experience pain or discomfort after surgery, which can be managed with pain medication. The healthcare team will prescribe medication and provide instructions on how to take it safely.
6. Physical Activity: Patients will need to start with light physical activity, such as walking, and gradually increase their level of activity over time. The healthcare team will provide instructions on how to exercise safely and avoid strenuous activities.
7. Follow-Up Visits: Patients will need to schedule regular follow-up visits with their healthcare provider to monitor their progress and ensure that they are meeting their weight loss goals. These visits may include blood tests, nutritional counseling, and other assessments.

Patients can typically return to light activities, such as walking, within a few days of surgery. However, it may take several weeks to months before patients can resume more strenuous activities, such as lifting heavy objects or intense exercise.

In general, it can take several months to a year for patients to fully recover from surgery and achieve their desired weight loss goals. Regular follow-up appointments with a healthcare provider are essential during this time to monitor progress, manage any complications, and adjust the post-operative diet and exercise plan as necessary.

Side effects and complications

Because bypass surgery is more complicated than sleeve surgery, there is more potential for things to go wrong during a bypass.

Here is an overview of some of the more common and rare side effects associated with these weight loss surgeries:

Common Side Effects:

• Pain, swelling, and bruising at the incision sites.
• Nausea, vomiting, and diarrhea for the first few days after surgery.
• Difficulty swallowing or feeling full quickly.
• Acid reflux, heartburn, or bloating.
• Constipation or diarrhea.
• Hair loss or thinning.
• Changes in mood or energy levels.

Most of these common side effects are temporary and can be managed with medications and/or changes in diet and lifestyle.

Rare Side Effects:

• Infection or bleeding at the incision sites.
• Blood clots or other circulation problems.
• Bowel obstruction or hernia.
• Nutritional deficiencies, such as anemia, vitamin D deficiency, or protein malnutrition.
• Dumping syndrome, a condition in which food moves too quickly through the digestive system, leading to nausea, vomiting, and diarrhea.
• Wound dehiscence, which is when the incision site splits open.
• Ulcers or strictures in the digestive tract.

These rare side effects are more serious and may require additional medical treatment or surgery. The risk of these complications can be reduced with proper pre-operative evaluation and post-operative follow-up care.

Long-term side-effects

Pain from surgery should pass with time, although you may need to be on a painkiller as you recover.

Initial weight loss can be quick, and in some cases, this rapid weight loss can cause problems, such as increasing the risk of developing gallstones. You may be prescribed a medication like ursodiol to help reduce gallstone formation.

Heartburn and reflux may also be a consistent issue, although it tends to be more common in sleeves.

If you eat too quickly you could also end up with nausea and vomiting. You’ll need to eat slowly and carefully, chew thoroughly, and take small bites and portion sizes to minimize these issues.

Gastric dumping syndrome

Gastric dumping is another side effect from these surgeries, although it is more common in bypasses.

This is when food moves too quickly from the stomach into the intestines, resulting in blood having to rush to your intestines to digest and absorb the food.

This causes lightheadedness and dizziness, bloating, abdominal discomfort, and diarrhea. It can on occasion cause some patients to faint.

This mechanism also causes alcohol to affect you more strongly, and what normally took 6 drinks to get you tipsy, may now only take 2.

You’ll need to slow down your eating and drinking, and avoid consuming too many calorie dense and sugary foods or drinks, to reduce the risk of this happening too often.

Nutritional deficiencies

Nutritional deficiencies will frequently be an issue, and although gastric sleeves may present less of a risk, you’ll likely still need to take a lifelong vitamin and mineral supplement after you undergo either surgery, or even consider Vitamin Injection Therapy, if your deficiency is too severe.

As a result, fatigue, low energy, and poor exercise tolerance is also common.

Make sure you’re getting all the necessary macronutrients, like protein and fat in your diet, and micronutrients, like vitamins and minerals by supplementing or injecting them.

How effective are they?

For the suitable patient, these surgeries can be very effective. They are typically significantly more effective than lap bands, or gastric balloons. Weight loss is typically fastest at the beginning, and slows down to a more steady pace later on.

Gastric sleeves and bypasses typically have patients losing around 20-30% of their current body weight over a few years. So a 400 pound individual would be expected to lose around 120 pounds in a few years, if things go well.

Gastric bypasses are typically more effective than gastric sleeves. This is because although both surgeries drastically reduce the size of your stomach, the bypass not only reduces the size more, but also bypasses the stomach, so less nutrients and calories are absorbed overall.

The beneficial effects of weight loss caused by these surgeries can in some cases be life changing, particularly for those with other issues like diabetes or high blood pressure.

Some patients are able to completely come off their diabetes or blood pressure medication. Chronic muscle or joint pains can resolve completely.

Of course these effects are not only limited to those who lost weight from these surgeries, but also to anyone who has lost large amounts of weight themselves, or with the help of other tools like medications or diets.

When does it not work?

In some cases, even gastric bypass surgery fails to help a patient lose weight in the long-term. Here are some reasons why gastric bypass surgery may fail:

• Non-compliance: Patients who do not follow the recommended diet and lifestyle changes after surgery may not achieve the desired weight loss. Non-compliance can include consuming high-calorie, high-fat, or high-sugar foods, failing to exercise regularly, or not attending follow-up appointments with healthcare providers.
• Medical Conditions: Certain medical conditions, such as hypothyroidism, Cushing’s syndrome, and polycystic ovary syndrome (PCOS), can make it difficult for patients to lose weight even after surgery. These conditions may require additional treatment to manage and may need to be addressed before or after surgery.
• Psychological Factors: Mental health conditions such as depression, anxiety, or eating disorders can contribute to weight gain and may affect a patient’s ability to lose weight after surgery. Addressing these psychological factors through therapy or medication may be necessary to support successful weight loss.
• Surgical Complications: In some cases, surgical complications may arise, such as leakage, bleeding, or infection, which can affect a patient’s ability to lose weight after surgery. These complications may require additional surgery or treatment to manage.

How much do these cost?

Gastric bypasses are typically more expensive that gastric sleeves. Without insurance coverage, the cost of gastric bypass surgery in the United States can range from $20,000 to $35,000 or more, while the cost of gastric sleeve surgery can range from $12,000 to $25,000 or more.

However, it is worth noting that many insurance plans do cover gastric bypass surgery for eligible patients who meet certain criteria, such as having a BMI of 40 or higher or a BMI of 35 or higher with obesity-related health conditions. In these cases, the cost of surgery may be significantly reduced, and some insurance plans may cover all or a portion of the cost of surgery.

Should you try it?

Overall, the gastric sleeve and bypass are some of our strongest interventions for weight loss available.

But keep in mind that even then, it should always be regarded as a support tool, not a complete replacement for an effective weight loss diet and lifestyle.

If you do decide to undergo one of these surgeries, keep in mind that you should not be getting the surgery hoping to eat whatever you want and still lose weight.

It will help give individuals the boost and support needed to start implementing a good weight loss diet, but in the long-term, it will still not be able to replace it. You’ll still have to build good eating and living habits years after your surgery.

Remember there are people who fail on gastric sleeves or bypasses, and regain the weight after a year or two because they didn’t control what they were eating.

Learn more about

• 6 Things To Know Before Getting Weight Loss Surgery
• Other weight loss procedures

See also

• 
  Comparing Different Gastric Balloons
  Many types of gastric balloons exist, from swallowable to adjustable, although the standard Orbera balloon remains the most commonly used.
• 
  Gastric Balloon Diet Plan
  Once you have a gastric balloon, properly transitioning from liquids on day 1 to 3, to solids by day 14, is key to success on your balloon.
• 
  The Allurion gastric balloon
  The Allurion is a swallowable gastric balloon that naturally passes into the stools itself. However, it is smaller than the Orbera balloon.
• 
  Medical Devices for Weight Loss
  Medical devices like lap-bands, gastric balloons, or AspireAssist often face issues that make them less ideal for weight loss than they seem.
• 
  Gastric Sleeve vs Gastric Bypass
  Gastric bypasses more drastically alter your stomach, and are more effective than the sleeve. Both are serious weight loss surgeries.