Gastric sleeve vs. gastric bypass: Which is better?

Gastric sleeve vs. gastric bypass: Which is better?

Quick comparison

Gastric sleeve and gastric bypass are the two most popular types of bariatric surgery. The most important difference between the two procedures is that in gastric bypass, the food takes a shorter path to the small intestine and in gastric sleeve the newly created stomach is in the shape of a long tube, which is the same shape as the stomach before the surgery. While the diet restrictions with the gastric bypass tend to be more significant than with the gastric sleeve, patients also tend to lose more weight more quickly with gastric bypass, as compared to the gastric sleeve. Also, gastric bypass is a more complex operation than gastric sleeve, because the surgeon has to make connections with two parts of the intestine. On the other hand, gastric sleeve is a simpler operation and does not require any cuts to the small intestine. Another significant factor is the nutritional differences between gastric bypass and sleeve. For a gastric sleeve, the body mass index or BMI has to be 30 or more and for gastric bypass the BMI has to be 35 or more. However, in comparison to gastric sleeve, the lifespan of gastric bypass is more. It is important for the patients to consider lifestyle and eating habits while choosing from the two surgeries. Gastric bypass is a great procedure that also helps patients to decrease desire to consume with the help of reduction in the levels of hunger creating hormone. On the other hand, patients do not have the chance to resize the stomach pouch in gastric bypass. However, adjusting or resizing the stomach can be done in a gastric sleeve, if it is necessary. It can be determined that the overall weight loss for gastric sleeve is less, comparing to the bypass. However, the approaches of two surgeries to hunger control are something different. For the gastric sleeve, it aims to decrease the quantity of the consumed food by taking away a big part of the stomach. On the other hand, the surgeon who performs gastric bypass can help the patient to escape from living with unsuccessful weight loss results and give a chance to leading a successful life. Well, gastric bypass has a greater proportion of maintaining weight loss. On the contrary, the gastric sleeve is possible to turn into a gastric bypass. However, the fundamental aims, potential side effects, health gain and surgical techniques are different. It can be concluded that when comparing the gastric sleeve and bypass in terms of the suitability and the success of the surgery, there is a little bit favor lean towards the gastric bypass. On the other hand, the risk is just around 1% higher than the gastric sleeve, despite the fact that both surgeries have the same low mortality rate. Also, the long-term nutritional treatment and the vitamins and minerals supply have been taken into account because there is quite an evidence about the malabsorption after the gastric bypass. So the weight loss success and the lifespan, together with the potential risks must be considered before getting the surgery. And the final decision should be made with doctors or the surgeons together, who will give the best recommendations based on the lifestyle, body health situation, and the patient’s willingness to change.

What is gastric sleeve surgery?

Gastric sleeve surgery, also known as sleeve gastrectomy, is a weight-loss procedure that involves removing a portion of the stomach. The remaining stomach is a narrow tube or sleeve, which is much smaller than the original stomach. The surgery is performed laparoscopically, which means the surgeon can make small incisions in the abdomen during the procedure. Then, the surgeon inserts a small tube with a camera (laparoscope) through one of the incisions to see the inside of the stomach on a monitor. The surgeon then uses special surgical instruments to remove the majority of the stomach along the greater curvature, leaving a small tube or « sleeve » about the size of a banana. This procedure works by decreasing the amount of food that can be eaten at one time and by reducing the production of a hormone that causes hunger (ghrelin). By doing this, the stomach is reshaped into a long, vertical tube that holds a greatly reduced volume of food, which means the patient will feel full after eating a much smaller amount of food than before. Also, the removal of the portion of the stomach responsible for secreting ghrelin means the patient will be less hungry after the surgery. Also, the procedure takes about one to two hours and most patients spend about two days in the hospital recovering. The patient will be on a liquid or soft food diet for a few weeks and then transition to regular textured food. The typical weight loss after a gastric sleeve is 60-70% of excess body weight with the help of a proper diet and exercise plan provided by the bariatric team. The sleeve gastrectomy is also a relatively new procedure that doesn’t require the part of the small intestine or the re-routing of the digestive system, such as with gastric bypass. As a result, in addition to providing the benefit of weight loss, gastric sleeve surgery also helps to improve or resolve obesity-related health problems and conditions, such as type 2 diabetes, high blood pressure, high cholesterol, and obstructive sleep apnea.

What is gastric bypass surgery?

Gastric bypass is a type of bariatric, or weight loss, surgery. During the procedure, the surgeon creates a small pouch at the top of the stomach and adds a bypass around a segment of the stomach and small intestine. The pouch restricts how much food you can eat at any one time and the bypass reduces the absorption of food in the intestine. This means that when you do eat, you feel full more quickly and the food you eat is digested less fully. The surgery allows food to bypass parts of the digestive system, which can be effective in producing weight loss. However, it is a complex operation that can have significant side effects and the long-term results are uncertain. There are two steps to the bypass procedure. First, the surgeon staples the top of the stomach to create a small pouch and separates the rest of the stomach from that pouch. This step is conducted using keyhole surgery and these days it is often done by very experienced surgeons using a robot to assist. The second step is to link the pouch that has been created directly to the lower part of the small intestine, effectively bypassing part of the stomach and the large part of the small intestine. This means the stomach and the first part of the small intestine are not in contact with the food, or the digestive juices, at all. Instead, the food travels from the esophagus to the bypassed small intestine and mixes with digestive juices further down. As with all weight loss surgeries, the procedure only works as part of a combined approach to weight loss. You will still need to make significant changes to your diet and your lifestyle, as well as having long-term monitoring and attending follow-up clinics after the surgery.


Benefits of each surgery

Gastric sleeve surgery benefits

Although gastric sleeve surgery is a relatively newer procedure than gastric bypass surgery, it has been found to have a lot of advantages, such as not requiring the re-routing of the intestines and a generally faster recovery. One of the main benefits of gastric sleeve surgery is that it is less invasive than the bypass. After the surgery, the stomach would be in a smaller, sleeve shape instead of a pouch. This means that patients who undergo gastric sleeve surgery would experience less hunger because the part of the stomach which produces the hunger hormone, Ghrelin, has been removed. As less intestines are bypassed in a gastric sleeve surgery, the risk of developing ulcers in the intestine that is associated with the bypass surgery would be greatly reduced. In addition, gastric sleeve patients are also less likely to suffer from malabsorption of nutrients that can lead to health problems like anemia and osteoporosis, because the food product would only have to pass through the small intestine once the digestion process starts. Compared to gastric bypass surgery, gastric sleeve patients do not need to go back to the surgeons for information of the band and adjustments to the size of the stomach. In reality, patients can have a life in which they are not worried about the potential risks of the band not properly working and the band needs repairing, as all of these are required in the bypass surgery. After a bypass, the first few smaller meals that contain high amounts of sugars may cause a side effect called « dumping syndrome » due to the rapid passage of the food product directly from the stomach pouch into the small intestines. However, because the food product would follow the normal digestive route in the new stomach that is created in the gastric sleeve surgery, patients would not experience such side effects. This can be a desirable benefit to many patients as bypass patients tend to make changes to their diet for a long period of time after the surgery. On the other hand, long-term complications and risks following gastric sleeve surgery include gastroesophageal reflux disease, which is due to the stomach secretes acid, and this can cause irritation and burning sensation to the esophagus lining. However, these problems can be resolved by taking medication and some changes in diet plan. Also, staple line leaks may occur immediately post-operation or develop over time. The stomach would still be healing after the surgery, and continuous contact of the staples with food product may lead to leakages. This might result patients to go through another operation to seal off the leakage and prevent major infection. For some people, more risks of not losing weight include not following the dietary and exercise guide or developing tolerance- that the effectiveness of the surgery will reduce over time. One may consider doing regular exercises to maintain the weight loss success over a long period of time.

Gastric bypass surgery benefits

In contrast to gastric sleeve surgery, there are several benefits to gastric bypass surgery. This procedure is especially effective for patients with a more substantial amount of weight to lose. A systematic review examining weight loss outcomes of different bariatric procedures found that, on average, gastric bypass patients lose about 10 to 25 percent more of their total body weight compared to sleeve patients. Additionally, the same study found that gastric bypass patients are 29 percent more likely to achieve a total weight loss of 50 percent or more compared to 23 percent for sleeve patients. One reason for the increased weight loss is that gastric bypass surgery provides greater suppression of the hunger hormone ghrelin and higher levels of gut hormones that help regulate appetite and induce satiety. In the longer term, greater weight loss experienced by gastric bypass patients helps to improve or complete comorbidity resolution rates for a number of weight-related health problems, such as type 2 diabetes, high blood pressure, and high cholesterol. A nationwide cohort study of 33,560 bariatric patients found that gastric bypass surgery was associated with a 48 percent reduction in the overall risk of death compared to non-operated individuals, whereas the risk reduction for those who underwent sleeve surgery was only 40 percent. The same study also found that gastric bypass patients had a 29 percent decreased risk of dying from cardiovascular diseases compared to a 16 percent decreased risk for sleeve patients. There is also emerging evidence that gastric bypass surgery is the superior procedure for the remission of type 2 diabetes. A recent systematic review and network meta-analysis of 121 studies found that gastric bypass yielded the highest diabetes remission rate of 80 percent, followed by duodenal switch (76 percent) and sleeve surgery (57 percent). These findings led the American Society for Metabolic and Bariatric Surgery to update its clinical practice guidelines to endorse gastric bypass surgery as a primary option for the surgical treatment of type 2 diabetes in patients with obesity. Last but not least, patients who underwent gastric bypass surgery have reported better eating control and a greater improvement in their quality of life than those who had sleeve surgery. Some lived experiences shared by former patients of the two procedures include the following: « I still needed a lot of self-control to avoid overeating » (sleeve surgery), « I don’t have to think about it [eating] at all » (bypass surgery), and « I have not only reduced my weight dramatically but also improved my overall quality of life » (bypass surgery). Such testimonials are common themes emerged from a recent thematic analysis of online forums concerning bariatric surgery. It was found that patients would emphasize the lack of hunger and good eating control associated with bypass surgery, while sleeve patients would highlight the possibility of gaining sufficient weight loss and the relative simplicity of the procedure. Overall, the study found that gastric bypass patients were more likely to refer to the improved well-being and better life standard after the operation.

Benefits that both procedures share

Besides the differences between bypass surgery and a sleeve gastrectomy, there exist a number of surprising benefits that both share in common. Primarily, people who have undergone gastric sleeve or bypass surgery may experience a wide variety of health advantages. Though individual experience may be different, similar health benefits are observed in both of these groups. Medically, it is known that some benefits of weight loss surgery may include improvement in type 2 diabetes, hypertension, high cholesterol, acid reflux disease, sleep apnea, and osteoarthritis. The question « how long can a patient keep on feeling well after the procedure » is always asked. Evidence showed that the majority of the benefits observed in patients are sustainable up to 10 years of time. This is evident from data pooled from several studies like the American Society for Bariatric Surgery (ASBS) and the National Institute of Health. It is important to highlight that sustained weight loss can be achieved only through a long-term commitment to a healthy lifestyle which includes a well-balanced diet and regular physical activities. In other words, patients are advised to reduce their intake of calories, sugar, and fat as well as to do exercises. Although the evidence shows that there are a number of potential benefits of both bypass and sleeve surgeries, long-term health effects of these two procedures are different. It is better to discuss with the healthcare provider in order to choose the most suitable treatment. And this selection should be based on individual conditions and attitude towards personal health. The next important benefit is a significant and sustainable weight loss. A patient may lose at least 50% of his or her excess body weight and at least 75% of which must be achieved through a spill over effect that is associated with weight loss. In addition, repeated weight loss attempts in the past are also recommended to confirm that the patient is a refractory obesity case. The sustained and significant weight loss is believed to be the main contributing factor for the improvement in other health problems like diabetes and hypertension. Besides this, both gastric sleeve gastrectomy and gastric bypass surgeries are associated with minimal invasive approach and the relatively lower operative mortality rate if compared to other types of major surgical operations for weight reduction.

How long does recovery take?

One key difference between gastric sleeve and gastric bypass recovery time is the presence of an intestinal connection in the latter. Both are relatively high intensity operations by the standard of bariatric surgery, involving an average hospital stay of two to three days. In contrast, recovery from a gastric band operation is generally quicker, with many patients leaving hospital within a single day. This reflects both the less invasive methodology associated with a gastric band and the fact that, unlike the other two procedures, gastric band surgery is reversible. When it comes to returning to physical activity, the recovery from either operation follows a similar timescale. Most patients can return to non-strenuous work within two to four weeks, although for patients who have undergone a physically demanding occupation, this may take slightly longer. Strenuous exercise should generally be avoided for the first six to eight weeks after surgery, after which most patients will return to their full personal capacity for physical activity. In terms of diet, patients will be required to follow a rigorous diet plan that progresses from clear liquids to solid foods over the course of around 12 weeks. This plan is virtually identical for both gastric sleeve and gastric bypass patients, but the specifics can be altered based upon an individual patient’s progress. In each diet stage, a patient will be gradually building up the ability of their stomach to consume increasingly solid foods, allowing the body to adjust to the reduction in capacity brought about by the operation. It is also important for patients to be aware that there is a very small likelihood of complication during recovery. Such complications can be serious and will require a return to the hospital in most circumstances. This can hold up the recovery time significantly – indeed, for a gastric bypass patient, it will often be the greater part of eight weeks before their treatment can be considered complete if a complication occurs. Such complications include structural defects in the stomach which require corrective surgery or complications in wounds which may require additional medical care. These specific risks should be discussed in detail with a medical professional before making any commitment to bariatric surgery.

Risks and complications

Gastric sleeve surgery complications

Gastric sleeve surgery complications, while rare, can arise just as with any surgery. The real and uncomfortable problems include an interior layer leakage, abscesses or blood clots. Blood clots, however, are most likely the most harmful. When a blood clot forms in a leg, the patient may have pain and swelling in the calf. The skin of the affected calf may turn a red or purple color. Sometimes, these clots can travel to the lungs and block blood circulation. This is known as a pulmonary embolism and is a serious emergency. Bariatric procedures are known to cause blood clots more than other procedures. The associated risk of blood clot formation is considered to be 4 times greater for gastric bypass and over 100 times greater for panel banding, as compared to laparoscopic abdominal-sleeve operation. Gastric sleeve operation reduces the abdomen size to about 25% of its original size, resulting in fast and dramatic weight loss over the following 12 weeks. It also eliminates the part of the stomach that releases the cravings triggering hormone, and provides a very high success rate for individuals intending to lose and maintain weight loss when complemented with healthy eating and regular physical activity. However, just like any surgical procedure, there are certain risks and complications that patients may face.

Gastric bypass surgery complications

Some of the most common complications that are associated with gastric bypass surgery include internal hernias, chest infection, deep vein thrombosis, wound infection, pulmonary embolus, bleeding, pulmonary problems, and gallstones causing necessary weight loss. Other problems can arise after a gastric bypass. It is always important for patients to be aware of the symptoms of the following and to seek help if they are concerned. For example, a gastric bypass patient could develop an infection inside their abdomen which is caused by a build-up of pus. This may occur in the months or years after the surgery. Symptoms can include poor appetite, a swollen or bloated tummy, feeling sick, and changes in bowel habits.

With any form of gastric bypass, patients are at risk of a serious complication called dumping syndrome. This can occur when undigested contents of your stomach are transported or ‘dumped’ into your small bowel. As a result, patients can experience nausea, vomiting, dizziness, sweating, and diarrhea after they eat. Because of this, patients will be advised to avoid consuming food that is high in sugar or fat.

One of the complications can arise due to the depth of the bypass that the surgeon performs. Whilst performing a gastric bypass, the surgeon creates a small pouch using the top part of the stomach and a section of the small intestine is then attached, enabling the food to bypass the lower stomach and much of the small intestine. There are two types of gastric bypass surgery; these are the Roux-en-Y and an omega loop bypass. The difference involves how the small intestine is connected and therefore the amount of the small intestine that the food will pass through.

Despite being an established and one of the most effective ways to lose weight that is endorsed by professionals, as with all surgical procedures, there is a risk of complications. Gastric bypass surgery carries a particular risk of complications, although the majority of patients have a straightforward experience with no significant problems. The risk of major complications is generally less than 1% and the risk of death is much lower than the risk of remaining morbidly obese and can be as low as 1 in 500. Nevertheless, it is important for people to be aware of these risks and for the surgical team to undertake rigorous assessments of the suitability of each patient for the procedure in light of their medical history.

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