How Do Gastric Sleeve and Gastric Bypass Surgeries Differ?

A procedure that helps you lose weight is called bariatric surgery. It is an option when you need to lose a lot of weight, especially if you improve your diet, become more active, and diet pills have not worked.


Two of the most common bariatric procedures are gastric sleeve surgery and gastric bypass surgery.


There are similarities between the two procedures, but there are also fundamental differences.


This article will take a closer look at both surgeries and what they entail, including their pros and cons, and when to consider one over the other.




What’s the Difference Between These Two Surgeries?



Gastric sleeve surgery and gastric bypass surgery shrink the stomach from its normal size to a small pouch. This causes weight loss in two ways:


● The bag fills up quickly, limiting the amount of food you can eat before feeling full

● The amount of ghrelin, commonly known as "hunger hormone", is reduced


The two procedures differ in how the new gastric pouch is created.




Gastric Sleeve Surgery


With gastric sleeve surgery, the surgeon permanently removes about 80% of the stomach.


What's left is sewn into a small banana-shaped stomach pocket. No other changes are made.


Gastric Bypass


With this procedure, also called Roux-en-Y gastric bypass, a small gastric pouch is created by removing or "bypassing" most of the stomach and the first part of the small intestine.


The newly created gastric pouch is then reconnected to the remaining small intestine.


The bypassed part of the stomach joins further down in the small intestine, so it still supplies the acidic and digestive enzymes that are produced there.


The part of the small intestine that is removed with the stomach normally absorbs some nutrients and calories.


Since this section is skipped, the absorption of these calories does not occur, promoting weight loss.


Another Option


Gastric band surgery is a third type of bariatric surgery.


With this procedure, a small stomach pouch is created by placing an inflatable band around part of the stomach.


The size of the opening between the pouch and the rest of the stomach affects the amount of weight you lose.


This can be adjusted by inflating or deflating the band through a hole placed under the skin of the abdomen. Gastric band surgery can be easily reversed by removing the band.


Is There a Difference in Recovery?


Gastric bypass is more complicated than the gastric sleeve. This is because gastric bypass is a two-step procedure, while the gastric sleeve has only one step.


Gastric sleeve surgery and gastric bypass surgery are usually performed laparoscopically.


It involves inserting a lighted endoscope with a camera called a laparoscope and other tools through several small incisions in the abdomen to perform the surgery.


Hopefully, you won't have much postoperative pain and will be able to keep fluids low. You will usually go home 1 or 2 days after gastric sleeve surgery.


If you experience a lot of pain after gastric cuff surgery, can't hold any fluids, or have other problems, you may need to spend an extra day or two in the hospital.


Since gastric bypass surgery is more complicated, you will likely spend at least 2 days in the hospital before recovering enough to go home.


You may need to stay in the hospital longer if you experience complications after surgery.


Sometimes laparoscopic surgery is not possible, so open surgery is performed. This requires a much larger incision in the abdomen. This type of incision takes longer to heal than small laparoscopic incisions.


If you are undergoing open surgery, you will stay in the hospital until the incision has healed enough to be able to go home. This often means 4 or 5 days in the hospital.


Some of the reasons you may need open surgery include:


● Had stomach surgery

● You are very overweight

● You have significant medical conditions other than obesity


Once you leave the hospital, you will need time to fully recover. You will need to rest for 3 to 4 weeks before you can resume your normal activities.


What About the Risks and Complications?


Bariatric surgery is a relatively safe procedure.


According to the American Society for Metabolic and Bariatric Surgery, the risk of a major complication is about 4%. This is much lower than the risk of developing serious obesity-related health complications.


Some factors that can complicate any surgery, including bariatric surgery, include:


● Blood loss (Haemorrhage)

● The development of blood clots in the leg (deep vein thrombosis) or in the lungs (pulmonary embolism)

● Side effects of general anesthesia

● Infection from your incision

● Postoperative pain

● Pneumonia





Possible complications after bariatric surgery include:


● Gallstones

● Vitamin and nutritional deficiencies

● Nausea, sweating, and severe diarrhea from eating too fast or eating sugary, fried, or fatty foods or dairy products (dumping syndrome)

● Loose or flabby skin


Complications of the gastric sleeve


Complications specific to the gastric sleeve include:


● Acid reflux

● Loss of gastric fluid

● Narrowing (stenosis) along the stomach pocket

● Stomach obstruction


Complications of gastric bypass


Specific complications of gastric bypass surgery include:


● An increased risk of nutritional deficiencies due to bypassing part of the small intestine

● Increased sensitivity to alcohol

● Stomach ulcer

● Intestinal blockage

● Stomach puncture


What About Dietary Changes?


The dietary changes you will need to make after gastric cuff surgery and gastric bypass surgery are basically the same.


● For about a week after the surgery, you will only drink liquids.

● For the next 3 weeks, you can eat pureed foods and then soft foods.

● Two months after the surgery, you will be able to eat normal food.


The main difference in the postoperative diet is the size of the stomach pouch, which affects how much you can eat.


● Gastric sleeve surgery creates a pouch that holds about 3 ounces, which is about the size of a hockey puck.

● With gastric bypass, your pouch holds about 1 ounce, which is about the size of a golf ball.




Important dietary guidelines you will need to follow after sleeve or gastric bypass surgery include:


● Eat small amounts and stop when full

● Chew your food well

● Eat slowly

● Take recommended vitamins and supplements

● Stay hydrated by drinking enough water

● Sipping fluids instead of drinking quickly

● Avoiding hard-to-digest foods, such as hard meat and bread

● Avoid carbonated drinks


Your bag will stretch over time. It is important not to overeat after bariatric surgery because the stomach can stretch enough to regain the lost weight.



What Are the Advantages and Disadvantages?


One of the biggest benefits, which applies to both gastric sleeve surgery and gastric bypass surgery, is that these procedures significantly reduce the risk of obesity-related diseases, such as:


● Type 2 diabetes

● High blood pressure (hypertension)

● High cholesterol (hyperlipidaemia)

● Heart disease

● Stroke

● Fat liver


Advantages of the Gastric Sleeve


● You can lose up to 65% of your excess weight.

● It is a one-step procedure, which reduces the risk of complications.

● Recovery is faster than with gastric bypass.

● There are fewer problems absorbing nutrients and vitamins.

● Dumping syndrome is less common.


Disadvantages of the gastric sleeve


● There is less weight loss than with gastric bypass.

● Weight loss is slower.

● It cannot be undone.

● This can cause acid reflux.






Advantages of the gastric bypass


● You can lose up to 80% of your excess weight.

● Intestinal bypass involves the absorption of fewer calories.

● Lose weight faster than with the gastric sleeve.

● Although it is difficult, it can be reversed.


Disadvantages of the gastric bypass


● It is a two-stage surgery, so there is a higher risk of complications.

● Recovery is longer than in the gastric sleeve.

● Intestinal bypass causes malabsorption of nutrients and vitamins, which can lead to deficiencies.

● Dumping syndrome is more common.



Which Is Good For You?


The type of bariatric surgery that's right for you depends on several factors, including:


● Your weight

● Your medical history

● Any health problems you may have

● Your expectations


Talk to your doctor about these factors and whether bariatric surgery is an option for you. Together you can decide if one type of surgery is best for you.


The Bottom Line


Gastric cuff surgery and gastric bypass surgery are two types of bariatric surgery. There are similarities between the two procedures, but there are also important differences. There are also advantages and disadvantages to both surgeries.


If you think you may be a candidate for bariatric surgery, talk to your doctor about the risks and benefits of these and other procedures.


With your doctor's advice and knowledge, you can decide whether bariatric sleeve surgery or bariatric bypass surgery is right for you.

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