It’s one of the most common questions our patients ask: if I’m going to have weight loss surgery, should I go with gastric bypass or gastric sleeve?
While both gastric bypass and gastric sleeve are effective weight loss interventions that can lead to significant weight loss, these two popular metabolic and bariatric surgeries differ in terms of their side effect profile, lifestyle management factors, medicinal effect, complexity, recovery time, and cost.
Before we weigh the pros and cons, it’s important to have a basic understanding of how these procedures affect the small intestines and stomach to make you feel full faster, hence reducing the amount of food you can eat.
Both procedures offer distinct benefits in terms of overall weight loss. Gastric bypass typically results in losing 60-80% of excess weight, while gastric sleeve offers 50-70% in 12-18 months. However, gastric bypass has a higher likelihood of long-term, sustained weight loss, especially for those with more severe obesity.
Ideal Candidates and Qualifications
Gastric Bypass:
- Typically recommended for patients with a BMI of 40+, or a BMI of 35+ with serious obesity-related conditions like diabetes or severe GERD.
- Ideal for those who need more aggressive weight loss or have underlying health conditions that will benefit from malabsorption.
Gastric Sleeve:
- Often a better choice for those with a BMI of 35-40 or 30-35 with related health conditions.
- Suitable for patients who want to avoid some of the malabsorption risks associated with bypass and prefer a simpler procedure.
Gastric Bypass vs. Gastric Sleeve: A Brief History
Gastric bypass, often referred to as Roux en Y gastric bypass, is the original weight loss surgery, whose history goes all the way to the 1950s. Although it has evolved over time, the basics remain the same: it’s a two-step procedure involving the creation of a small pouch out of the stomach. This pouch “detours” or “bypasses” around the larger portion of the stomach and a portion of the small intestines, significantly reducing the amount of food you can consume.
In contrast, gastric sleeve is a newer, simpler procedure. It’s a single-step surgery that involves removing a portion of the stomach and sealing the remainder into a “sleeve”. Although its history goes back to the 1980s, it rose in popularity to become the number one weight loss surgery in the 2010s.
Both surgeries have evolved with modern techniques. Gastric sleeve now involves the removal of approximately 80% of the stomach, while gastric bypass creates a smaller stomach pouch and bypasses the first part of the small intestine to reduce calorie absorption.
Gastric Sleeve vs Gastric Bypass Pros And Cons
Determining Your Priorities
In helping patients choose the best procedure for them, we start with their priorities. Are they trying to lose weight to reduce their excess body weight? Are they pursuing a medical goal, like diabetes remission? Is it important for them to minimize downtime so they can get back to work? What kind of recovery are they prepared to commit to? What side effect profile sounds better?
Answers to these questions help us determine each patient’s unique circumstance, allowing us to point them in the right direction.
For patients focused on diabetes remission, gastric bypass may be the preferred option, as it offers an 80% chance of remission, compared to 60% for gastric sleeve. If your goal is to get off diabetes medication, this could be a key factor in your decision.
Gastric Sleeve vs Bypass Side Effects
Gastric sleeve can cause acid reflux in about 20-25% of patients. Sometimes that requires medicine, and less frequently, a surgical intervention (sometimes, a conversion into a gastric bypass).
By contrast, gastric bypass doesn’t pose a risk for acid reflux. However, it does pose a risk for dumping syndrome: when patients eat something on “the naughty list” — foods that are high in sugar and fat — they experience discomfort. Some people think that sounds terrible, while others want the motivation of “the stick” to stay on track with their weight loss goals. Bypass also carries a 4-7% chance of ulcer formation and a 4-6% chance of a bowel issue requiring surgery.
Additionally, dumping syndrome can serve as an unintentional motivator, as it discourages the consumption of sugary and fatty foods, which can further aid in weight loss. For some patients, this side effect becomes an effective tool for long-term healthy eating habits.
Comparison Table: Gastric Bypass vs. Gastric Sleeve
| Aspect | Gastric Bypass | Gastric Sleeve |
| Procedure | Small pouch, rerouted intestines | Removal of large portion of the stomach |
| Weight loss | 60-80% of excess weight in 12-18 months | 50-70% of excess weight in 12-18 months |
| Nutrient Absorption | Significantly reduced | Moderately reduced |
| Recovery Time | 3-5 weeks | 2-4 weeks |
| Dumping Syndrome | High risk | Low risk |
| Long-Term Weight Loss | Slightly higher, more sustained | Effective, but generally less than bypass |
| Reversibility | Complex to reverse | Not reversible |
| Surgery Duration | 2-4 hours | 1-2 hours |
| Digestive Complications | Higher risk (e.g., ulcers, leaks) | Lower risk, but can still occur |
The Role of Recovery Time
In terms of downtime, gastric sleeve patients recover more quickly, making the hospital stay shorter. In fact, sleeve patients can sometimes go home the same day as the procedure, and be back at work in a week. By contrast, one of the classic gastric bypass procedures, entails 1-2 nights in the hospital and about 2 weeks off work to recover.
For some patients, this is the most important factor; they need to get back to work as soon as possible. For others, a longer recovery time might be a non-issue.
Do You Need To Maximize Weight Loss?
Moving down the road, gastric sleeve typically results in 60-65% of extra weight off, while bypass is 70-75% — an additional 10% in poundage. For someone with a fairly low BMI — for instance, 60 pounds of extra weight — that additional 10% (6 pounds) might not make a big difference. However, if you’re 250 pounds overweight, that additional 25 pounds is going to make a big difference.
If maximizing weight loss is your goal, gastric bypass surgery tends to offer more substantial long-term outcomes, especially for those with a higher BMI. Studies show that bypass leads to more sustained weight loss compared to sleeve in severely obese patients.
What About Diabetes Remission?
Some patients pursue bariatric surgery to accomplish a specific medical goal, like diabetes remission. Diabetes remission rates run about 60% with a gastric sleeve procedure and 80% with a gastric bypass. If remission is your goal, that 20% bump may make it worth opting for gastric bypass, maximizing your chances of getting off insulin and diabetes medication.
Weighing the Risks of Bariatric Surgery
Long-term side effects and other risks are additional factors to consider. For instance, gastric bypass surgery poses a 4-7% risk of developing an ulcer, whereas gastric sleeve patients don’t usually form ulcers. Additionally, there is a 4-7% chance of a gastric bypass patient needing a follow-up laparoscopy — an additional surgery that removes obstructive scar tissue so that the procedure can remain effective. A follow-up laparoscopy is not a common risk factor with gastric sleeve surgery.
Risks and Complications:
| Complication | Gastric Bypass | Gastric Sleeve Surgery |
| Leak Risk | Moderate to high | Moderate |
| Dumping Syndrome | Common | Rare |
| Nutrient Deficiencies | Higher risk due to malabsorption | Lower risk, but still requires vitamins |
| Digestive Issues | More common (ulcers, blockages) | Fewer issues, but possible reflux |
| Infection & Bleeding | Risk present | Risk present |
Although these are low percentages, adding them together means that gastric bypass poses a potential 14% greater chance of requiring additional surgery compared to gastric sleeve. For some patients, the benefits of the gastric bypass (additional weight loss, diabetes remission) make that increased risk worth it; for other patients, it’s better to not take the risk.
Additionally, while both procedures are considered safe, it’s important to weigh personal health conditions that may increase the risk of complications. Your bariatric surgeon will conduct thorough assessments to guide you to the most suitable option.
Considering the Costs of Gastric Bypass & Gastric Sleeve Surgery
Here’s the reality: for many patients, the single determinative factor in choosing a procedure will be cost. As of this writing, our self-pay patients can get a gastric sleeve procedure for as low as $9,950. By contrast, a gastric bypass costs around $14,000 — a significant difference for most patients. These costs reflect the greater involvement of the surgery and the additional hospital time.
Get the help you need at BMI of Texas. If you’re concerned about covering costs, we accept options like SurgeryPlus, which can significantly reduce out-of-pocket expenses if your benefits include this service. SurgeryPlus works with certain insurance plans, offering personalized care coordination and lower costs for eligible patients, potentially making your weight loss surgery more affordable. Make sure to check with your employer to see if you qualify for this benefit.
Final Considerations Before Gastric Surgery
Depending on your circumstances, there are a handful of other considerations that might come into play in selecting your procedure.
If a patient has previously had abdominal surgery or history of previous bowel obstructions, we sometimes advise them to opt for the simpler gastric sleeve procedure. Likewise, if you have health issues that make anesthesia a concern, the shorter surgical time of a sleeve can make it a better option. Finally, if your circumstances make it important to minimize potential issues around medication absorption (for instance, if you take psychiatric medicine), we may also recommend gastric sleeve.
Weight Loss Surgery: What Matters Most?
This article has guided you through the main decision tree we use with patients who are considering their options. It starts with the big questions: Why are they in our office? What do they really want to accomplish? What makes them tick?
If you’re considering one of these procedures, ask yourself: what’s most important to you? Are you trying to maximize weight loss at any cost? Minimize time off? Resolve an underlying medical problem like diabetes?
Armed with answers to these questions, we look at a patient’s medical profile. All other things being equal, we typically recommend a gastric sleeve if they don’t have diabetes, and a gastric bypass if they do.
There Is No Wrong Choice
The truth is, there is no “bad choice” when it comes to weight loss surgery. Both surgeries are overwhelmingly safe, and facilitate a massive amount of weight loss. Instead, you are choosing the other factors that matter most in your situation, from side effects to costs.
When battling obesity, the only wrong choice is no choice or status quo — the sooner you act, the sooner you commit to a potentially life-saving treatment to protect your health.