Comparing Gastric Sleeve vs. Bypass Surgery

If you're considering weight loss surgery, you’ve likely come across two popular options: gastric sleeve and gastric bypass. Both are effective bariatric procedures that can lead to significant weight loss and improvements in health. But how do they work, and which one is right for you? In this article, we’ll break down what each surgery involves, their benefits and risks, and what life after surgery looks like, so you can make an informed decision about your weight loss journey.

What Is Gastric Sleeve Surgery?  

A gastric sleeve surgery is the most commonly performed bariatric surgery in the US. It involves surgically stapling a large part of the stomach, leaving behind a tubelike sleeve that is about the shape of a banana. This procedure removes a large portion of the stomach, including the part that releases the hunger hormone (ghrelin). This results in increased fullness, decreased caloric intake, and loss of excess weight and body fat.

A laparoscopic sleeve gastrectomy or gastric sleeve procedure is performed by using surgical staplers to remove about 80% of the stomach. The remaining stomach pouch resembles a banana and holds less food. Removing a large part of the stomach also reduces hunger and increases fullness, which helps you lose weight. In addition, there are beneficial effects on metabolism, such as better blood sugar control. 

What Is Gastric Bypass Surgery?

The Roux-en-Y gastric bypass involves creating a small stomach pouch and connecting it to the small intestine. The newly created stomach pouch is smaller and holds less food. As a result, you ingest fewer calories, resulting in significant weight loss.

A gastric bypass is performed by dividing the stomach into a smaller upper portion and a larger lower section. This smaller egg-sized pouch bypasses most of the stomach. The surgeon then divides and connects the small intestine to the new stomach pouch. The larger bypassed part of the stomach is also connected to the small intestine about 3-4 feet further down. The new bowel connections resemble the letter Y, hence the name Roux-en-Y gastric bypass. 

How Does A Gastric Bypass Work? 

Bariatric procedures work in several ways. Some procedures create a smaller stomach pouch that holds less food. The portion of the stomach that releases the hunger hormone is removed, so you feel full more quickly and consume fewer calories. In addition, a gastric bypass prevents food from entering the first part of the small intestine, leading to decreased absorption of calories. 

In addition to the impact on hunger, fullness, and caloric intake, bariatric procedures also impact hormones and metabolic health. They can result in better blood sugar control and remission of obesity-related health problems, such as high blood pressure and diabetes.

What Happens To The Rest of Your Stomach After Gastric Bypass? 

A gastric bypass procedure divides your stomach into two parts: a smaller upper portion and a larger lower portion. The smaller stomach pouch receives and digests the food you eat. The remaining larger part of your stomach does not receive any food but continues to produce stomach acid and digestive enzymes. Both stomach pouches are connected to the small intestine in a Y-shaped connection. Food passes from the smaller pouch to the small intestine through a surgically created connection. Stomach acid and digestive enzymes pass from the larger bypassed stomach pouch and mix with ingested food in the intestine. 

Other Bariatric Surgical Techniques

Adjustable Gastric Band: The adjustable gastric band is a silicone device that is placed around the upper part of the stomach. It limits the amount of food you can eat. However, because of poorer outcomes and greater complication rates compared with other procedures, this procedure is not commonly performed anymore.

Biliopancreatic Diversion with Duodenal Switch (BPD-DS): BPD-DS is similar to a gastric bypass in that a banana-shaped pouch in the stomach is created and connected to the small intestine. However, a larger part of the small intestine is bypassed, resulting in significantly decreased absorption of calories and nutrients. 

Single Anastomosis Duodenal-Ileal Bypass with Sleeve (SADI-S): SADI-S is a laparoscopic (minimally invasive) procedure that is a simplified version of the biliopancreatic diversion with duodenal switch (BPD-DS). 

What Are The Requirements for Weight Loss Surgery? 

The requirements for weight loss surgery are:

• Severe obesity with a body mass index (BMI) of 40 or higher.

• Obesity with a BMI between 35 and 39.9 and one or more weight-related health problems, such as high blood pressure, type 2 diabetes, or sleep apnea.

• Individuals with a BMI of 30–34.9 may be eligible if they have severe metabolic disorders or obesity-related complications that significantly impact health.

Note: Bariatric surgery is not for everyone. It is for people who have been unable to achieve a healthy weight with diet, exercise, and medications or those who keep regaining lost weight.

Pros And Cons of Gastric Sleeve 

Advantages 

• A gastric sleeve is a technically simpler procedure with a shorter surgical time.

• It is the most commonly performed bariatric surgery in the U.S.

• There are usually fewer complications because a gastric sleeve does not involve surgery on the small intestine. 

• Patients with certain high-risk medical conditions may be candidates for a gastric sleeve.

• A sleeve gastrectomy may be a first-step procedure before other bariatric surgery procedures, such as a gastric bypass or SADI-S. 

• Rapid and sustainable weight loss.
• Remission of obesity-related health problems.

Disadvantages 

• A gastric sleeve is not reversible.

• The impact on metabolism is less compared to other types of metabolic and bariatric surgery. 

• The surgery can cause or worsen acid reflux and heartburn. If you suffer from one of these, you may not be a candidate for a gastric sleeve. 

What Happens 10 Years After Gastric Sleeve?

The long-term outcomes from gastric sleeve are good. Studies published in JAMA Surgery have found that most people are able to lose about half of their excess weight and maintain the weight loss 10 years after the surgery. 

Pros And Cons of Gastric Bypass 

Advantages

• This weight loss procedure is performed with a standardized technique that has been refined over the years.

• Gastric bypass can result in reliable and rapid weight loss.

• It can lead to remission of obesity-related health conditions such as diabetes, high blood pressure, high cholesterol, heart disease, stroke, sleep apnea, nonalcoholic fatty liver disease, osteoarthritis, and certain cancers.

Disadvantages

• A gastric bypass is technically more complex than a sleeve gastrectomy or adjustable gastric band.

• Bariatric surgery patients who undergo Roux-en-Y gastric bypass have a greater risk of vitamin and mineral deficiencies compared to other types of bariatric procedures. 
• The risk of surgical complications is higher due to the involvement of the small intestine. 
• Patients who undergo gastric bypass are at risk of peptic ulcers, especially with tobacco use or taking NSAIDs (painkillers such as ibuprofen).
• There is a risk of bowel obstruction after laparoscopic Roux-en-Y gastric bypass.
• This obesity treatment can cause dumping syndrome (feeling sick after eating or drinking).

Long-Term Health Outcomes

Studies reveal that gastric bypass results in substantial and sustained weight loss, with an average 60% excess weight loss maintained for 10 years or longer.

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Choosing Between Gastric Sleeve and Gastric Bypass  

Which Weight Loss Surgery Is Safest?

While both surgeries carry risks, a sleeve gastrectomy is often considered safer than a gastric bypass because it is technically less complex.

What Is The Best Surgery To Lose Weight?

Of the three most common procedures (gastric bypass, sleeve gastrectomy, and adjustable gastric band), gastric bypass produces the greatest weight loss on average, but it is also associated with more complications after surgery.

To determine the best surgical solution for you, your doctor will consider the following:

• Health Conditions: If you have severe obesity and serious health problems, your doctor may recommend gastric bypass over other surgical procedures because it has the maximum metabolic impact. If you have acid reflux (GERD), you may not be a candidate for a gastric sleeve, as this procedure can worsen reflux.

• Lifestyle Changes: Both surgeries require lifelong lifestyle changes. However, gastric bypass generally requires more intensive changes and more risks than gastric sleeve. You will need more vitamin and mineral supplementation after gastric bypass surgery.

• Safety: A gastric sleeve is technically simpler and takes less time to perform. Bariatric surgeons usually recommend gastric bypass for people with extreme obesity (BMI 45 or higher).

• Efficacy: On average, gastric bypass patients lose 50 to 80% of their excess body weight, and gastric sleeve patients lose 60 to 70% of their excess body weight in the 12 to 18 months following the procedure.

Recovery After Bariatric Surgery  

Most people are discharged from the hospital 1 to 3 days after weight loss surgery. The recovery time for both gastric sleeve and gastric bypass is 2-4 weeks. You can expect to return to most normal activities 4 to 6 weeks after your procedure.

Is Gastric Bypass a Serious Surgery?

Yes, gastric bypass is a serious surgery. Like all major surgeries, it carries risks, including risks associated with anesthesia, bleeding, infections, blood clots, and heart or lung problems.

Medications and Dietary Supplements

Your healthcare team will prescribe medications after bariatric surgery. You’ll need to take some medications for the short-term (about 6 months) and others long-term or even indefinitely. Some of these medications include:

• Proton pump inhibitors such as omeprazole to lower the risk of stomach ulcers. 

• Ursodiol to lower the risk of gallstones due to rapid weight loss. 

• Special bariatric multivitamins containing high doses of vitamins and minerals to prevent deficiencies.

• Calcium and vitamin D supplements.

• If you have had a gastric bypass, you will require regular injections of vitamin B12. 

Your surgeon will ask you to crush tablets for the first three months to prevent them from getting stuck in your digestive system. You can, however, swallow capsules, chewables, and liquid medications immediately after your weight loss procedure. 

You will need to work with your healthcare providers to adjust the doses of medications for chronic health conditions such as high blood pressure and diabetes. You may develop low blood pressure and low blood sugar after rapid weight loss and need to take lower doses or fewer medicines.

Your doctor will ask you to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve) because they increase the risk of stomach ulcers. People who undergo gastric bypass can never take NSAIDs. Gastric sleeve patients may be able to resume NSAID use after about 3 months.

Lifestyle and Dietary Changes Post-Surgery

Birth control

Women of childbearing age should use an effective method of birth control, such as an intrauterine device (IUD), for 12 to 18 months after a bariatric procedure. Pregnancy is not recommended during this time due to the massive weight loss and impact on the body’s nutritional status, which can put a developing baby at risk. 

Return to work

Most bariatric surgery patients return to work 2-4 weeks after surgery. Your surgeon may ask you not to do any heavy lifting for 2-4 weeks after your surgery. 

Diet and food intake

You may need to eat soft foods for a few days after your weight loss surgery. Over time, you can increase the variety of foods you eat. Your healthcare professional will recommend eating healthy foods. Bariatric surgery patients should eat a high-protein diet with 60 to 80 grams of protein a day and limited amounts of carbohydrates and sugars. The recommended daily caloric intake is 500-700 calories daily (and no more than 1,000 calories per day) for 12 months after bariatric surgery. 

Learn about healthy portion sizes for weight loss and maintenance.

Exercise

To get the best results from your bariatric procedure and reach a healthy weight, aim to exercise for 30-45 minutes every day, including cardio (aerobic activity) 3-5 times a week and weight training 2-3 times a week. 

Alcohol

Talk to your bariatric surgeon about the safety of consuming alcoholic beverages. Alcohol has a stronger effect in people who have undergone weight loss procedures. 

What is Life Like After Bariatric Surgery?

The decision to undergo metabolic and bariatric surgery is a big one. Your results from the surgery depend on your commitment to a healthy lifestyle. The surgery itself decreases the body’s ability to absorb calories, but you must establish healthy habits soon after surgery to achieve and maintain your weight loss goals. This includes eating healthy, counting calories, and getting regular exercise, which should become lifelong habits.

Many people find that joining support groups for people who have undergone bariatric surgery helps to reinforce a new attitude towards healthy living and staying committed to lifestyle changes. These groups encourage you to engage in activities and behaviors that support health goals and a new lifestyle.

Frequently Asked Questions

What Can You Never Do Again After Bariatric Surgery?

If you have gastric bypass surgery, you may never be able to take nonsteroidal anti-inflammatory drugs like aspirin, ibuprofen, and naproxen again. There may be other restrictions for the first few weeks and up to 12-18 months. You will also have to take dietary supplements lifelong to prevent mineral and vitamin deficiencies.

In terms of diet, there are no firm rules about what you can or cannot eat after bariatric surgery. Dietary choices vary from person to person. Some people avoid sugar and simple carbohydrates. Others find sodas and caffeine give them trouble. Yet others develop sensitivity to dairy. 

Another advantage of weight loss surgery is that the sensation of fullness is enhanced after eating a smaller amount of food. For example, you may find one cookie satisfies you instead of a whole bag.

Can You Ever Eat Normally After a Gastric Bypass?

Yes, you can eat normally about 6 to 8 weeks after a gastric bypass. However, your healthcare provider will encourage you to eat high-protein foods and limit sugars and simple carbohydrates. You will also have to eat slowly to avoid dumping syndrome. Additionally, you’ll have to make lifestyle changes such as chewing thoroughly, staying well hydrated, and limiting caffeine and alcohol.

How Much Weight Loss After Bariatric Surgery?

You can expect to lose anywhere from 50% to 80% of your excess body weight after bariatric surgery. This means if you weigh 300 lbs and your ideal body weight is 150 lbs, you can expect to lose 75 lbs or more in the 12 to 18 months following your procedure. Most people regain some of the initial weight loss, but this is usually a small amount.

Is Bariatric Surgery Painful?

Bariatric surgery is usually done with a minimally invasive approach. Most patients find that their pain after surgery is manageable and not overwhelming.