Choosing The Right Weight Loss Surgery: Gastric Bypass vs. Gastric Sleeve

Choosing to have weight loss surgery is a big decision. And it’s quickly followed by another big decision – whether to have a gastric bypass or a gastric sleeve.

There are significant differences between the two procedures including:

• The way they help you lose weight
• Effects on your digestive system
• Long-term outcomes
• Suitability and potential risks.

It’s important that you make this decision based on personal medical advice from your own surgeon. Here are some of the key points to consider when making your decision, starting with an overview of each procedure.

What Is A Gastric Bypass?

A gastric bypass (also known as a Roux-en-Y) is a form of weight loss surgery where the surgeon creates a small pouch at the top of your stomach and connects that directly to the middle part of your small intestine, bypassing the rest of your stomach and the first part of your small intestine.

What Is A Gastric Sleeve?

A gastric sleeve involves permanently removing about 80% of your stomach. You’re left with a small, banana-shaped pouch that can only hold about a cup of food.

Comparing Gastric Bypass And Gastric Sleeve

Gastric bypass surgery and gastric sleeve surgery are both designed to help you lose weight but there are key differences.

Mechanism Of Weight Loss

A gastric bypass is both a restrictive and a malabsorptive procedure. It helps you lose weight by:

• Creating a smaller stomach, which restricts the amount you can eat and makes you feel full after a smaller meal

• Reducing the amount of calories and nutrients you absorb from food – as food spends less time in your small intestine, you absorb less from it.

A gastric sleeve is a restrictive procedure. It also creates a smaller stomach, which limits:

• The amount of food you can eat

• Your hunger signals by removing the part of your stomach that produces ghrelin (the hunger hormone).

Surgical Procedure And Surgical Risks

Any surgical procedure has risks, such as infection or anaesthetic-related complications. Here’s how the two compare.

	Gastric Bypass	Gastric Sleeve
Process	Keyhole or open	Keyhole or open
Complexity	More complex – involves changing the stomach and the small intestine	More straightforward – only changes the stomach
Surgery Duration	Longer	Shorter
Risk of surgical complications	Higher	Lower

Long-term Risks And Outcomes

A 2017 randomised trial found similar rates of weight loss with gastric sleeve or gastric bypass. Both procedures help you lose weight, improving your overall health, longevity and quality of life.

Those are marvellous benefits. But it is also important to be aware of the long-term complications that can occur.

Both procedures increase the risk of dumping syndrome. This happens when your stomach empties its contents into your small intestine too rapidly. Your small intestine receives an uncomfortably large amount of poorly digested food, which leads to nausea, bloating, abdominal cramps, sudden blood sugar changes and diarrhoea.

Nutritional deficiencies are also a risk. Whichever procedure you choose, you need to ensure you follow your dietitian’s advice to ensure you eat a healthy, nutritious diet and take any supplements they recommend. You’ll need to do this for the rest of your life.

Generally speaking, there’s a higher risk of nutritional deficiencies with a gastric bypass because it changes your digestive system more significantly and makes it harder for you to absorb nutrients.

Suitability And Lifestyle Factors

Factors such as your weight, medical history and lifestyle also play a part in your choice. No two people are the same, which is why personalised advice from your surgeon is so important.

How Can Dr Lockie Help?

We follow a multidisciplinary approach to helping you lose weight. Our team includes not only our surgeon, Dr Lockie, but also a skilled perioperative nurse surgical assistant(PNSA), dietitian and psychologist. Together, we help you address the many different factors that affect your weight and empower you to change your lifestyle. We also offfer our free monthly Weight Loss Support Group for all patients.

If you’d like to learn more about the types of surgery we offer and which one might suit you best, please contact us for a free consultation with Shirley Lockie, our SCOPE certified PNSA.

Disclaimer

All information is general and is not intended to be a substitute for professional medical advice. Dr Phil Lockie can consult with you to confirm if a particular treatment is right for you. Any surgical or invasive procedure carries risks.

 

References

• Medical News Today, Gastric bypass – what is it and what to expect, https://www.medicalnewstoday.com/articles/gastric-bypass, [Accessed 27 November 2023]

• Medical News Today, What to know about gastric sleeve surgery, https://www.medicalnewstoday.com/articles/gastric-sleeve, [Accessed 27 November 2023]

• Medical News Today, Gastric sleeve vs gastric bypass – which is better? https://www.medicalnewstoday.com/articles/gastric-sleeve, [Accessed 27 November 2023]

• Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Laparoscopic Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity: The SM-BOSS Randomized Clinical Trial. JAMA. 2018;319(3):255–265. doi:10.1001/jama.2017.20897, https://jamanetwork.com/journals/jama/fullarticle/2669728, [Accessed 27 November 2023]

• Cleveland Clinic, Dumping syndrome, https://my.clevelandclinic.org/health/diseases/17835-dumping-syndrome, [Accessed 27 November 2023]

• Antonis Vlassopoulos; Bariatric Surgery as the Culprit of Malnutrition. Komp Nutr Diet 10 June 2021; 1 (2): 56–58. https://doi.org/10.1159/000515776, [Accessed 27 November 2023]