Comparing The Gastric Bypass to The Gastric Sleeve
Most patients who research bariatric surgery realize that the two most performed bariatric surgeries in the United States are the gastric sleeve or sleeve gastrectomy, and the Roux-en-Y gastric bypass. There’s a good reason for these procedures being so prevalent. Both are proven with plenty of data behind them, and both allow patients to lose a significant amount of weight and improve or eliminate many of the diseases associated with excess weight and obesity. With such similarities, you might ask what the difference is and why you would choose one over the other. There are subtle differences between the two procedures, and we will discuss those in the article below. While your research may point you in one direction, it’s important to remember that a consultation with a qualified bariatric surgeon is the only way to know which procedure is best for your situation.
Who Chooses the Gastric Sleeve?
The ideal patient for the gastric sleeve is typically on the lower end of the obesity scale according to their BMI. This is because, on average, the gastric sleeve allows for slightly less weight loss than the gastric bypass. That said, long-term data shows that this gap is not huge and narrows over the long term. Bypass patients tend to lose more weight faster in the early days and typically enjoy a slightly greater overall weight loss.
The gastric sleeve is also excellent for patients concerned about rerouting the intestine. While there are many benefits to doing so, the gastric sleeve is ultimately a simpler procedure with fewer overall risks as a result.
Patients who choose the gastric sleeve will also have fewer postoperative dietary modifications than those with a gastric bypass; this can be a double-edged sword, but with appropriate attention to their post-operative lifestyles, sleeve, and bypass patients will do just fine.
A gastric sleeve may also be considered the first stage of a duodenal switch for patients with extremely high BMIs. We often use the gastric sleeve to allow patients to lose weight and make the second part of the procedure safer. The gastric sleeve is all they need to lose weight in some patients.
Who Chooses the Gastric Bypass?
The gastric bypass has traditionally been the gold standard in bariatric surgery, and patients are very successful when they take advantage of the combination of restriction and malabsorption that the bypass offers. No part of the stomach is removed during the gastric bypass, but the stomach is divided, and the small intestine is rerouted. This typically leads to faster and more significant long-term weight loss due to this dual mechanism of action.
Patients with uncontrolled or poorly controlled type 2 diabetes may benefit the most from a gastric bypass. The rerouting of the small intestine plays a part in resetting the gut microbiome and helps with insulin sensitivity. Many patients who undergo gastric bypass will see diabetes go into remission within days or weeks of surgery, even before they lose a significant amount of weight.
Anyone suffering from moderate-to-severe reflux may benefit from the gastric bypass because of how it is performed; patients often resolve their reflux quickly and permanently. The gastric bypass can even be considered a surgery to treat reflux. This contrasts the gastric sleeve, which can cause or worsen gastric reflux in many patients.
The gastric bypass also has a postoperative ace in the hole. While it is most definitely uncomfortable, dumping syndrome, something akin to the feelings of low blood sugar, occurs when patients overeat fatty or sugary food. It is a self-limiting condition that helps patients stay on track with their eating habits. The syndrome is often considered a problem by patients, but we see it as an opportunity for patients to get feedback on their eating.
What About Derivative Procedures Like Duodenal Switches and Mini Gastric Bypasses?
The gastric sleeve and bypass are often discussed in the same breath as the duodenal switch and the mini gastric bypass. However, it’s essential to understand that the DS and the mini gastric bypass are Separate procedures with their qualification criteria. We certainly encourage any of our patients to discuss these other procedures with us, and we will discuss these with you to understand the best option for you. However, be sure to come to your consultation with an open mind– with our experience, we can offer you guidance based on dozens or even hundreds of other patients in your position.
Making the Choice
Having decided that you want to have bariatric surgery is already a step in the right direction. You’ve understood that you can’t do it on your own, and bariatric surgery still represents the most reliable, long-term solution for patients suffering from obesity. From here, there are questions and concerns that you will have, and we encourage you to prepare for your consultation with your bariatric surgeon to ensure all your questions are answered and feel confident about your decision.
We look forward to helping you and encourage you to find a bariatric surgeon with our online tool.