It’s one of the most common questions our patients ask: if I’m going to have weight loss surgery, should I go with gastric bypass or gastric sleeve?
While both are highly effective weight loss interventions, these two popular surgeries differ in terms of their side effect profile, lifestyle management factors, medicinal effect, complexity, recovery time, and cost.
Before we weigh the pros and cons, it helps to have a basic understanding of each procedure.
Gastric Bypass vs. Gastric Sleeve: A Brief History
Gastric bypass is the original weight loss surgery, whose history goes all the way to the 1950s. Although it has evolved over time, the basics remain the same: it’s a two-step procedure involving the creation of a small pouch out of the stomach. This pouch “detours” or “bypasses” around the larger portion of the stomach.
In contrast, gastric sleeve is a newer, simpler procedure. It’s a single-step surgery that involves removing a portion of the stomach, and sealing the remainder into a “sleeve”. Although its history goes back to the 1980s, it rose in popularity to become the number one weight loss surgery in the 2010s.
Both surgeries are performed laparoscopically (via highly targeted surgical incisions), involve unique but relatively mild side effects, are considered highly safe, and most importantly, trigger massive, potentially life-saving weight loss.
Now that you have this basic understanding, lets explore which procedure might be best for you.
Determining Your Priorities
In helping patients choose the best procedure for them, we start with their priorities.
Are they trying to attain a specific weight goal? Are they pursuing a medical goal, like diabetes remission? Is it important for them to minimize downtime so they can get back to work? What kind of recovery are they prepared to commit to? What side effect profile sounds better?
Answers to these questions help us determine each patient’s unique circumstance, allowing us to point them in the right direction.
Choosing Your Side Effects
Let’s talk side effects.
Gastric sleeve can cause acid reflux in about 20-25% of patients. Sometimes that requires medicine, and less frequently, a surgical intervention (typically, a conversion into a gastric bypass).
By contrast, gastric bypass doesn’t pose a risk for acid reflux. However, it does pose a risk for dumping syndrome: when patients eat something on “the naughty list” — foods that are high in sugar and fat — they experience discomfort. Some people think that sounds terrible, while others want the motivation of “the stick” to stay on track with their weight loss goals. Bypass also carries a 4-7% chance of ulcer formation and a 4-6% chance of a bowel issue requiring surgery
The Role of Recovery Time
In terms of downtime, gastric sleeve patients recover more quickly. In fact, sleeve patients can sometimes go home the same day as the procedure, and be back at work in a week. By contrast, gastric bypass entails 1-2 nights in the hospital and 2 weeks off work to recover.
For some patients, this is the most important factor; they need to get back to work as soon as possible. For others, a longer recovery time might be a non-issue.
Do You Need To Maximize Weight Loss?
Moving down the road, gastric sleeve typically results in 60-65% of extra weight off, while bypass is 70-75% — an additional 10% in poundage. For someone with a fairly low BMI — for instance, 60 pounds of extra weight — that additional 10% (6 pounds) might not make a big difference. However, if you’re 250 pounds overweight, that additional 25 pounds is going to make a big difference.
What About Diabetes Remission?
Some patients pursue bariatric surgery to accomplish a specific medical goal, like diabetes remission. Diabetes remission rates run about 60% with a gastric sleeve procedure, and 80% with a gastric bypass. If remission is your goal, that 20% bump probably makes it worth opting for gastric bypass, maximizing your chances of getting off insulin and diabetes medication.
Weighing the Risks
Long-term side effects and other risks are an additional factor to consider.
For instance, gastric bypass surgery poses a 4-7% risk of developing an ulcer, whereas gastric sleeve patients don’t ulcer. Additionally, there is a 4-7% chance of a gastric bypass patient needing a follow-up laparoscopy — an additional surgery that removes obstructive scar tissue so that the procedure can remain effective. A follow-up laparoscopy is not a real risk factor with gastric sleeve surgery.
Although these are low percentages, adding them together means that gastric bypass poses a 14% greater chance of requiring additional surgery compared to gastric sleeve. For some patients, the benefits of the gastric bypass (additional weight loss, diabetes remission) make that increased risk worth it; for other patients, it’s better to not take the risk.
Zooming out and considering serious risks, we find that major complications from either procedure are rare. In our practice, major complications represent less than 1% of surgeries, with gastric bypass posing a slightly higher complication risk than gastric sleeve.
Considering the Costs
Here’s the reality: for many patients, the single determinative factor in choosing a procedure will be cost. As of this writing, our self-pay patients can get a gastric sleeve procedure for as low as $9950. By contrast, a gastric bypass costs around $14,000 — a significant difference for most patients. These costs reflect the greater involvement of the surgery, and the additional hospital time.
Depending on your circumstances, there are a handful of other considerations that might come into play in selecting your procedure.
If a patient has previously had abdominal surgery or history of previous bowel obstructions, we sometimes advise them to opt for the simpler gastric sleeve procedure. Likewise, if you have health issues that make anesthesia a concern, the shorter surgical time of a sleeve can make it a better option. Finally, if your circumstances make it important to minimize potential issues around medication absorption (for instance, if you take psychiatric medicine), we may also recommend gastric sleeve.
What Matters Most?
This article has guided you through the main decision tree we use with patients who are considering their options. It starts with the big questions: why are they in our office? What do they really want to accomplish? What makes them tick?
If you’re considering one of these procedures, ask yourself: what’s most important to you? Are you trying to maximize weight loss at any cost? Minimize time off? Resolve an underlying medical problem like diabetes?
Armed with answers to these questions, we look at a patient’s medical profile. All other things being equal, we typically recommend a gastric sleeve if they don’t have diabetes, and a gastric bypass if they do.
There Is No Wrong Choice
The truth is, there is no “bad choice” when it comes to weight loss surgery. Both surgeries are overwhelmingly safe, and facilitate a massive amount of weight loss. Instead, you are choosing the other factors that matter most in your situation, from side effects to costs.
When battling obesity, the only wrong choice is no choice or status quo — the sooner you act, the sooner you commit to a potentially life-saving treatment to protect your health.