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.
Illustration by Joules Garcia for Verywell Health
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:
- 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.
- The small intestine is also separated from the stomach and segmented into two pieces.
- 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.
Gastric Sleeve vs. Gastric Bypass: A Comprehensive Overview
Weight loss surgeries have emerged as effective solutions for managing obesity and associated metabolic disorders, including diabetes. The two most common types are gastric sleeve and gastric bypass, each with unique mechanisms and benefits.
Understanding the Procedures
What is Gastric Bypass?
Gastric bypass surgery, specifically the Roux-en-Y technique, has a long history of application and has evolved significantly over the years. This minimally invasive procedure is performed laparoscopically, requiring several small incisions rather than a large one.
- The surgeon divides the stomach into a smaller upper section and a larger lower section.
- The small intestine is then segmented, and a part is bypassed, connecting the longer segment of the intestine to the new smaller stomach.
This adjustment reduces the stomach’s capacity and limits caloric absorption, allowing patients to feel full sooner while consuming fewer calories.
What is Gastric Sleeve?
Also known as laparoscopic sleeve gastrectomy, gastric sleeve surgery is the most frequently performed bariatric procedure today. It entails removing 50% to 80% of the stomach, resulting in a smaller organ approximately the size of a banana.
Post-surgery, individuals experience a significantly reduced appetite, allowing them to feel satisfied after consuming smaller meals.
Weight Loss Expectations
Both gastric sleeve and gastric bypass surgeries aim to promote effective weight loss. According to the American Society for Metabolic and Bariatric Surgery, around 90% of patients achieve a 50% reduction in excess body weight following these procedures.
- Patients undergoing gastric sleeve can expect about a 60% reduction in excess weight.
- Gastric bypass typically results in a 65% to 70% loss of excess weight.
Overall, both methods yield comparable weight loss results over a five-year period, though gastric bypass may demonstrate a slight advantage in long-term outcomes, particularly for individuals with diabetes.
Health Benefits
Beyond weight loss, these surgeries address various health issues linked to obesity:
- Reduced Cancer Risk: Bariatric surgery may lower the risk of certain obesity-related cancers.
- Diabetes Management: Both procedures are effective in controlling blood sugar levels, although gastric bypass often shows superior results in observational studies.
- Blood Pressure Improvement: Many patients experience a decrease in hypertension, often eliminating the need for medication.
- Sleep Apnea Relief: Both surgeries can alleviate symptoms of sleep apnea, although some individuals may still require ongoing management.
- Joint Pain Reduction: Patients with osteoarthritis frequently report improvements in knee pain after surgery.
- Urinary Incontinence Benefits: Post-surgery, there is a noted decrease in urinary incontinence symptoms among patients.
Risks and Complications
Like any surgical procedure, both gastric sleeve and gastric bypass carry potential risks:
Risks Associated with Gastric Bypass
- Anastomotic leak
- Bowel obstruction
- Gallstones
- Dumping syndrome
- Internal hernia
- Nutritional deficiencies
- Wound infections
Risks Associated with Gastric Sleeve
- Gastroesophageal reflux disease (GERD)
- Stomach narrowing (stricture)
- Nutritional deficiencies
- Staple line leak
While complications are uncommon, they may require further intervention or long-term management.
Recovery Process and Long-Term Impact
Post-operative recovery typically spans one to three days in the hospital, involving prescription pain control initially, transitioning to over-the-counter options thereafter. Patients are encouraged to begin light movements and follow specific dietary guidelines as they heal.
Long-term success relies heavily on lifestyle modifications, including nutritional changes and consistent exercise. Support from the bariatric team plays a crucial role in maintaining weight loss and achieving health goals.
Making the Right Choice
Choosing between gastric sleeve and gastric bypass is a critical decision influenced by individual health factors and desired outcomes. Gastric bypass may lead to more significant weight loss and have greater efficacy in managing diabetes due to its wider impact on digestive processes.
Conversely, gastric sleeve poses a lower risk for complications and is often recommended for those with previous abdominal surgeries. Each individual’s circumstances will vary, making it essential to consult with a bariatric surgical team to identify the most suitable procedure.
Conclusion
Both gastric bypass and gastric sleeve surgeries serve as viable options for weight reduction and managing metabolic disorders. While they share similarities, they also present distinct differences in terms of risks and nutritional impacts. A thorough evaluation guided by healthcare professionals can help determine the best approach for successful outcomes.
