Gastric Sleeve vs. Gastric Bypass Surgery: Who’s the Winner?

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?