Both sleeve gastrectomy and gastric bypass are popular weight loss surgeries that can lead to significant and long-term weight loss, in a relatively short period. According to the American Society forMetabolic and Bariatric Surgery (ASMBS), both procedures are extremely safe, with complication rates that are lower than common operations such as gallbladder removal and hip replacement. (1) 

Thanks to advancements in surgical techniques, these procedures have become more refined and are now performed using laparoscopic surgery, which involves 3-5 tiny incisions, each measuring no more than 0.5 to 1.5 cm, leading to faster recovery and fewer complications.

However, weight loss surgery isn't for everyone, and sleeve gastrectomy and gastric bypass have key differences. Each has its pros and cons, with one potentially being more appropriate based on the individual's condition. This article will provide a detailed comparison of both surgeries.

1. Sleeve Gastrectomy

In a sleeve gastrectomy, the stomach is reduced to about 20% of its original size. Around 80% of the stomach is removed, making you eat less and feel full quickly. (2)(3)

Pros:

• Less complicated than gastric bypass.
• Safe for people with serious health conditions like heart disease.
• Helps lose about 60% of bodyweight gradually over 1-2 years.
• Has a relatively lower risk of complications compared to gastric bypass.

Cons:

• Weight loss is slower and less significant compared to gastric bypass, but it is still substantial​.
• Less effective in managing blood sugar and lipids compared to gastric bypass. (1)
• May cause or worsen acid reflux and heartburn. (1)

2. Gastric Bypass

Unlike sleeve gastrectomy, gastric bypass involves changes to both the stomach and the small intestine.

A small pouch, roughly the size of an egg, is separated from the stomach and connected directly to the lower part of the small intestine, bypassing 90% of the stomach and a large part of the small intestine. This limits food intake and decreases the absorption of sugars and fats, which is particularly useful in managing blood sugar and lipids. (3)(4)

Pros:‍

• Faster and greater weight loss, patients lose about 65-75% of their body weight within two years. Most of the weight loss will happen within the first 6 months of the surgery and then gradually over the following one to two years.
• Effective in treating condition slinked to obesity, like diabetes.
• Long-term weight loss maintenance.

Cons:

• More complex surgery.
• Higher risk of vitamin and mineral deficiencies, requiring lifelong supplements.
• Can lead to bowel obstruction.
• May cause "dumping syndrome", where food moves too quickly from the stomach to the intestines, resulting in nausea and diarrhea, especially after eating sweets.
• Higher risk of ulcers, especially in smokers or people who use NSAIDs. (1)

Which is Safer?

Both procedures are generally safe, with sleeve gastrectomy considered slightly safer, with a complication rate of around 3% compared to 5% for gastric bypass. (2)

• Possible complications from either surgery include: (2)
• Severe bleeding.
• Infections.
• Blood clots.
• Cardiac complications.
• Risks related to anesthesia.

Which Surgery Is Right for You?

Choosing the right surgery requires an in-depth discussion with your surgeon based on individual factors like thelevel of obesity and any underlying health conditions. (2)(5)

• If your BMI is over 40 (severe obesity),gastric bypass may be a better option, as it leads to faster and greater weightloss (about 5-10 kg more weight loss than sleeve gastrectomy).
• If you have type 2 diabetes, gastric bypassmight be slightly better because it more effectively controls blood sugar.Studies show that about 75% of people who have gastric bypassexperience remission compared to 35% for sleeve gastrectomy.
• If you have high-risk health conditions like heart or lung issues, sleeve gastrectomy may be a safer choice.
• If you have frequent heartburn or acid reflux,gastric bypass could be more beneficial.
• If you're on medications that may not beabsorbed well after gastric bypass, sleeve gastrectomy might be the better option.

Weight loss surgery is a major decision and should be made with careful consideration and thorough consultation with a specialized surgeon. At Dr. Soliman Fakeeh Hospital, our experienced bariatric surgeons can help you understand your options and make the best decision. 

References

1. American Society for Metabolic and Bariatric Surgery - Bariatric Surgery Procedures
2. Cleveland Clinic - How To Know Which Type of Bariatric Surgery Is Right for You
3. University of Utah Health - Know Your Weight Loss Surgery Options: Sleeve vs. Gastric Bypass
4. MSD - Metabolic and Bariatric Surgery
5. Verywell Health - Gastric Sleeve vs. Gastric Bypass: Which Is Right for You?