Sleeve Gastrectomy or Gastric Bypass: Which Bariatric Surgery is Better for You

According to the study based on the National Family Health Survey-5 (NFHS-5) data, approximately 40% of women and 12% of men in India are obese (Source). Annually, approximately 580,000 people around the world undergo bariatric surgery as per UpToDate.

Bariatric surgery is currently the most effective treatment option for Morbid Obesity. Suppose you have already decided to undergo bariatric surgery. In that case, the next question you might encounter is which surgery to choose: Sleeve Gastrectomy or Gastric Bypass?

I will make it very clear at the beginning that for most patients undergoing weight loss surgery, both these surgeries are a valid option. This means you will have the liberty to choose the surgery, depending on your priorities and expectations. However, there are some important things you should know before Bariatric (Obesity) surgery. Certainly, you will need guidance and input from your surgeon to make this decision aligned with your expectations and avoid complications.

In an ideal situation, this decision is taken jointly by the patient and the surgeon after proper discussion. Where the patient discusses their expectations and priorities, and the surgeon discusses the pros and cons of each procedure and how these expectations can be realised with minimal complications and adverse effects. Here, I will discuss both surgical options’ positives and negatives.

What is Sleeve Gastrectomy Surgery?

A large portion of the stomach is removed to create a smaller, sleeve-shaped pouch, helping patients eat less and lose weight.

In Sleeve gastrectomy surgery, also called a Gastric sleeve, a part of the stomach is resected and removed. Making the remaining stomach like a thin tube. This restricts the quantity of food you eat and makes the food pass to the intestines faster. Removing this part of the stomach and food that is reaching the intestine faster changes your GUT hormones. All these help you lose weight, improve your metabolism, improve your medical problems, and maintain your lost weight.

Advantages of Sleeve Gastrectomy (Positive Aspects)

1. Gastric sleeve surgery is technically more straightforward than Gastric Bypass. There are fewer changes in your digestive system, and it has a lesser impact on your overall physiology compared to a Gastric Bypass.
2. There is no bypassing of any part of your intestines, especially the duodenum and early jejunum, which are the sites for absorption of important nutrients. Hence, the chances of malnutrition, i.e., deficiency in vitamins, iron, calcium, and protein, are significantly lower than those of a gastric bypass. This makes it the preferred surgery for young patients (below 40 years of age), especially females who are likely to plan pregnancy in future after bariatric surgery.
3. Endoscopic examination of the remaining part of the stomach and the duodenum is possible throughout life for any other disease of these organs. The same is not the case with Gastric Bypass.

Disadvantages of Sleeve Gastrectomy (Negative aspects)

1. This surgery is a less powerful weight loss surgery than a Gastric Bypass. In some patients, the weight loss can be inadequate. Especially in patients with very high BMI (BMI > 45), or in elderly patients or patients with severely restricted mobility. Suppose a patient continues to eat sweets regularly or drink high-calorie liquids on a regular basis. In that case, it can lead to inadequate weight loss.
2. The metabolic improvement (improvement in diabetes and high cholesterol) is inferior compared to a Gastric Bypass, making it a poor choice for patients with severe Diabetes.
3. For Obese patients with GERD, Acid reflux, or hiatus hernia, sleeve gastrectomy is likely to increase their GERD severity after surgery. A Roux en Y Gastric Bypass (RYGB) would be ideal for such patients.

What is Gastric Bypass Surgery

In gastric bypass surgery, part of the stomach is reduced to a small pouch and connected to the jejunum, bypassing the part of stomach and duodenum.

In a Gastric Bypass surgery, a small pouch is created from the upper part of the stomach. The food pipe opens in this pouch, now disconnected from the rest of the stomach. The intestine is now connected to this pouch so that the remaining part of the stomach and the initial part of the intestine are bypassed. The bypassed stomach and intestine will be in the tummy but won’t be used as food will pass from the food pipe to the pouch and then to the intestine (beyond the bypassed part of the intestine).

This bypassing of the stomach and initial part of the intestine (Duodenum and early jejunum) makes significant changes in the GUT hormones, much more than what occurs after a Sleeve Gastrectomy. These hormonal changes, restriction in diet and reduced absorption all lead to weight loss and improvement in diabetes and other medical problems.

Gastric Bypass Advantages (Positive Aspects)

1. Gastric bypass is a more powerful weight loss surgery than Gastric Sleeve. Making it a preferred option for patients with BMI >45.  Long-term weight maintenance after surgery is also better after Gastric Bypass surgery.
2. Metabolic improvement is much better with a Gastric Bypass than with a Sleeve. Making it the ideal surgery for patients with diabetes, especially if the diabetes is poorly controlled and for many years.
3. Roux en Y gastric Bypass (RYGB) treats GERD and Acid reflux. As acid reflux increases after sleeve gastrectomy, RYGB is the ideal option for Obese patients with GERD. In such patients, RYGB is preferred even if the BMI is lower than 45 and the patient does not have Diabetes.
4. In people who love or crave sweets, there is a behaviour change after Gastric Bypass. Their craving or preference for sweets reduces, making this behaviour change effortless. This can happen in some patients even after a Sleeve Gastrectomy but is a more prominent feature of Gastric Bypass surgery.

Gastric Bypass Disadvantages (Negative Aspects)

1. It is a technically more complex surgery compared to a Sleeve Gastrectomy. Making more significant changes in the digestive system and overall body physiology.
2. Higher chances of malnutrition (it depends on how much length of the intestine is bypassed, which can be tailored to an individual patient’s BMI and medical problems). Hence, patients after Gastric Bypass should be more disciplined in taking supplements, routine follow-ups and blood checkups.
3. Complications like ulcers at the anastomotic site (joint between gastric pouch and intestine), Dumping syndrome and internal hernia are a possibility in patients with Gastric Bypass. Although a rare complication, it may need further treatment or surgery when any of these complications occur.
4. Smokers are more likely to develop anastomotic ulcers. Hence, those smoking regularly and less likely to quit smoking after surgery should avoid Gastric Bypass surgery.
5. Those who consume alcohol regularly are also not the ideal candidates for Gastric Bypass. The liver damage due to regular alcohol intake is in some patients accelerated after gastric bypass. Hence, those who are less likely to quit alcohol after surgery should choose a Gastric sleeve rather than a bypass. The same is the case with patients who have chronic liver disease or very advanced fatty liver.
6. A routine endoscopic examination of the remaining part of the stomach and duodenum is impossible after a gastric bypass. The gastric pouch is completely separated from the remaining stomach. Other options for diagnosing and treating stomach and duodenum must be employed if required.

Conclusion

If you are overwhelmed with so much information and confused, let me summarise this for you in brief.

A Gastric sleeve or Sleeve Gastrectomy is an ideal weight loss surgery for young patients (especially females likely to plan pregnancy in future) with low BMI < 45, not having Diabetes, and not having GERD/Acid reflux/Hiatus hernia. It is also a preferable surgery for those who smoke regularly, consume alcohol regularly, and are not too determined to quit.

There are different types of Bariatric surgery, and a Gastric Bypass is an ideal option for patients with a high BMI (BMI > 45), those with Diabetes (especially if poorly controlled or longstanding), and those with GERD/Acid reflux/Hiatus hernia. It should also be considered in patients who have a habit or craving for sweets and high-calorie liquids. Overall bariatric surgery provides

We believe in helping and guiding patients to as close to normal health as possible and not just aim for weight loss. Hence, we help patients make an informed decision for themselves and guide them to a healthier eating pattern, a good physical activity level, stress management and proper sleep hygiene to achieve this aim.

Patients Experience of Treatment with Dr. Chirag Thakkar

Patient’s Experience After Sleeve Gastrectomy Surgery

Patient’s Experience After Sleeve Gastric Bypass Surgery

FAQs

What is the main difference between Sleeve Gastrectomy and Gastric Bypass?

Answer: Sleeve Gastrectomy involves removing a portion of the stomach, creating a smaller, tube-like stomach. Gastric Bypass, on the other hand, creates a small pouch from the stomach and connects it directly to the small intestine, bypassing a portion of the stomach and the first part of the small intestine.

Which surgery is better for patients with high BMI (over 45)?

Answer: Gastric Bypass is generally preferred for patients with very high BMI as it leads to greater weight loss and a more sustained weight loss compared to Sleeve Gastrectomy.

What are the benefits of choosing a Sleeve Gastrectomy over a Gastric Bypass?

Answer: Sleeve Gastrectomy is considered a simpler procedure with fewer potential complications. It also has a lower risk of nutrient deficiencies compared to Gastric Bypass, making it a better choice for younger patients, especially women who may want to get pregnant in the future. It is also a preferred surgery for those with a habit of smoking and regular alcohol intake.

What is the recovery time after any bariatric surgery?

You would be walking on your own from the day of surgery itself. At the time of discharge you will be able to take care of yourself at home. You should be able to return to work in approximately 8-10 days, though the exact timeline depends on your job/lifestyle. Some individuals may be able to return sooner. The sooner you resume normal activities and work, the quicker your recovery will be.

Is there a specific type of patient who might benefit more from a Gastric Bypass?

Answer: Patients with uncontrolled diabetes or those who suffer from GERD, acid reflux, or hiatus hernia might benefit more from a Gastric Bypass. It is also often preferred for patients who struggle with cravings for sweets and high-calorie liquids.

What factors should a patient consider when deciding between Sleeve Gastrectomy and Gastric Bypass?

Answer: The decision should be made in consultation with a qualified surgeon, taking into account factors like:

BMI: A higher BMI might point towards the Gastric Bypass.

Medical conditions: Diabetes or GERD might favour Gastric Bypass.

Age and future plans: Younger patients, especially women who want to become pregnant, might benefit from Sleeve Gastrectomy.

Lifestyle: Smokers, heavy alcohol drinkers, or those unwilling to make significant lifestyle changes might be better suited for Sleeve Gastrectomy.

Which is the best gastroenterologist hospital in Ahmedabad?

Adroit Centre for Digestive and Obesity Surgery run by Dr Chirag Thakkar is the best gastroenterologist hospital in Ahmedabad. Treating patients from different parts of India. Dr. Chirag Thakkar is the best gastro surgeon having 16+ years of experience helping patients with gastro related treatment in Ahmedabad.