Gastric Bypass vs. Gastric Sleeve Surgery: Which weight loss procedure is right for you?
Once you’ve decided to have weight loss surgery, the next step is to determine which procedure is right for you. We discuss the similarities and differences between gastric bypass and gastric sleeve surgery to help you be better informed for this life-changing decision.
Gastric Bypass vs. Gastric Sleeve Surgery: The Similarities
Both procedures are a way to create a smaller stomach permanently. They both also have a profound impact on your hunger by eliminating our body’s main hunger hormone called ghrelin. The procedures are done either laparoscopically or robotically with 5-6 small incisions, take an hour to perform, and require only a one night stay in the hospital. The majority of patients are able to return to work in 1-2 weeks depending on their job.
Recent studies show weight loss and resolution of co-morbidities are similar between gastric bypass and gastric sleeve 5 years after surgery. The excess weight loss is in the 65-75% range (individual results may vary).
Even though both surgeries offer excellent results, they also have risks to consider. With both of these procedures, there is the risk of leakage and other complications directly related to dividing or stapling the stomach. There are also risks associated with major surgery like bleeding, blood clots, infection, pneumonia, and even death in rare circumstances.
Gastric Bypass vs. Gastric Sleeve Surgery: The Differences
The main difference between these procedures is how we go about creating the smaller stomachs and the long-term consequences or side effects of the new anatomy.
Procedure: The stomach is reduced from a football shape to a small tangerine by dividing horizontally high on the stomach. In order to maintain bowel continuity, the intestine is pulled up and attached to the new small stomach pouch. Food goes into the small pouch then directly into the intestine without going through the rest of the stomach or the first few feet of intestine. Since food no longer goes into the rest of the stomach, the term gastric “bypass” was used.
Side Effects: Since we are altering the original design of the stomach anatomy, there are long-term consequences or side effects as a result - some are good and some are bad, unfortunately.
Pros: Full with small meals and elimination of hunger are the biggest benefits of these procedures. In addition, because of the re-routing of the intestine, most gastric bypass patients will get a low blood sugar attack when they consume too much sugar at one time (Dumping Syndrome). Many bypass patients also get bloated and nauseated when they consume too much fat or grease at a meal. These latter 2 effects can really help food choices in the long run.
Cons: Unfortunately, re-routing of the intestine also brings two of the biggest disadvantages of the gastric bypass - malabsorption of certain vitamins and minerals and intestinal obstruction. Patients have to take multivitamins with iron, calcium, and B12 long-term to keep up with malabsorption, and there is a 1-2% risk of bowel obstruction requiring surgery at any point down the road.
Another disadvantage of the gastric bypass is the new pouch is very sensitive to aspirin or ibuprofen type products (NSAIDs) and should be avoided long-term.
Procedure: The stomach is reduced from a football shape to the size of a banana by dividing the stomach vertically and removing 75-80% of the left side of the stomach. The result is a “sleeve” or tube-like stomach. There is no re-routing of the intestine as bowel continuity remains intact.
Side Effects: Again, the original anatomy is being altered so there will be consequences.
Pros: Full with small meals and elimination of hunger are similar to the gastric bypass and are the only side effects which afford weight loss. There is no Dumping Syndrome or fatty food intolerance like gastric bypass because the intestines are not re-routed.
Cons: The main negative side effect of gastric sleeve long-term is reflux disease or heartburn. The new tube shape stomach creates a lot more resistance to flow than the larger low-pressure football shape stomach. This is good for feeling full with small meals but for some people it leads to things getting backed up too much. Studies suggest 10-15% of people are taking medications to control reflux long-term after gastric sleeve. There are also reports of rare patients being converted to gastric bypass for severe reflux not relieved with medication.
Although there is no re-routing of the intestine, removing 75-80% of your stomach can lead to poor absorption of certain vitamins and minerals over time after gastric sleeve. Thus, we recommend our sleeve patients take multivitamins and B12 long-term.
Gastric Bypass vs. Gastric Sleeve Surgery: Which is right for you?
Even though both surgeries offer excellent weight loss results and other benefits, they both have their own distinct advantages and disadvantages as discussed above. I see some patients choose gastric bypass because they have an affinity for sweets and would like to have Dumping Syndrome as a negative reinforcement. Others choose gastric bypass because they have a desire to eliminate the need for reflux medication.
On the other hand, some patients choose gastric sleeve because they don’t want the negative consequences of their intestine being re-routed and are willing to accept the risks of reflux disease. Patients dependant on anti-inflammatory medications may choose gastric sleeve so they can continue these medications after surgery.
For many of the patients I see, it’s as simple as choosing their procedure based on the success of a friend, family member, or co-worker.
In the end, both the gastric bypass and gastric sleeve surgeries are life-changing procedures with lasting results. The type of weight loss surgery you choose should be based on your individual needs, and your understanding of the risks vs. benefits of each procedure.
Contact Nashville Weight Loss Solutions for more information on gastric bypass or gastric sleeve surgery.
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