Gastric Sleeve surgery VS. Gastric Bypass surgery

What is the difference between gastric bypass and gastric sleeve?

Can you have gastric bypass after gastric sleeve?

Individuals who are considering bariatric surgery for weight loss have multiple options. From traditional gastric bypass surgery to laparoscopic band surgery to gastric sleeve, each type of surgery has its own benefits and risks.

When deciding which surgery is right for you, it is essential to compare your options. You should understand the similarities and differences between the two types of bariatric procedures. When reviewing gastric bypass vs sleeve, there are a number of factors to consider:

Gastric Bypass Procedure vs. Gastric Sleeve Procedure: The Similarities

Gastric bypass and gastric sleeve are very similar procedures. In both cases, the expected hospital stay ranges from 2-3 days and the procedures are not reversible. Although the methods differ, both operations reduce the amount of food you can eat before feeling full.

Gastric Bypass Procedure vs. Gastric Sleeve Procedure: The Differences

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. Gastric Bypass

. Procedure: A doctor attaches a small pouch to the intestine in order to bypass the stomach.

. Recovery Time: 2 to 4 weeks

. Risks and Complications: Risk of dumping syndrome

. Weight Loss Results: Patients can expect to lose 60 to 80 percent of excess weight within the first year to year and a half.

. Gastric Sleeve

. Procedure: The surgeon removes a portion of the stomach, producing a tube-shaped stomach (sleeve).

. Recovery Time: 2 to 4 weeks

. Risks and Complications: Lower risk of dumping syndrome

. Weight Loss Results: Patients should expect to lose weight at a slower, steadier rate. In the first 12 to 18 months, they may lose 60 to 70 percent of excess weight.

Comparison between Gastric Bypass and Gastric Sleeve Surgery

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What is Gastric Sleeve Surgery?

Gastric Sleeve surgery also known as sleeve gastrectomy or vertical sleeve gastrectomy (VSG) is a weight-loss procedure that induces weight loss by restricting food intake. With this procedure, which is usually performed laparoscopically, the surgeon removes approximately 75-80 percent of the stomach.  This results in the stomach taking on the shape of a tube or "sleeve" which holds much less food.

What is Gastric Bypass Surgery?

Gastric bypass is a restrictive and malabsorptive weight loss surgery procedure. It restricts the amount of food you can eat and reduces the number of calories (and nutrients) you absorb from food. The Roux-en-Y Gastric Bypass – often called gastric bypass – is considered the ‘gold standard’ of weight loss surgery.

If you have high blood pressure or type 2 diabetes, gastric bypass surgery can make these conditions better, or even make them clear up completely. Up to six in 10 people with diabetes who have a gastric bypass find their sugar levels go back to normal after six years. Weight loss surgery may also make joint problems and breathing disorders, such as sleep apnea, better.

Comparing the procedure

How Gastric Sleeve is performed

Gastric sleeve surgery, also called the Vertical Sleeve Gastrectomy (VSG), is performed by removing a large portion of the stomach to create a long pouch that connects the esophagus to the small intestine. The pouch is stapled and the rest of the stomach is removed. Some surgeons take an additional step to reinforce the staple line, although whether that is effective is up for debate.

Why Gastric Sleeve works

. Reduced stomach size makes the patient feel full sooner after eating

. Removed portion of the stomach means fewer hunger-causing hormones are secreted, causing patient to feel less hungry generally.

How Gastric Bypass is performed

Gastric bypass, also called Roux-en-Y gastric bypass or RNY for short, is performed using the following steps:

. Cut and staple the top portion of the stomach to create a small pouch at the end of the esophagus.

. Leave the remainder of the stomach attached to the top of the small intestines.

. Go further down the small intestine, cut it, and attach it to the pouch.

. Take the end of the small intestine that is still connected with the non-pouch portion of the stomach and attach it to the bottom of the “Roux limb.” This allows the digestive juices produced by the stomach to “meet up” with the food in the intestines.

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Why Gastric Bypass works

. Reduced stomach size makes the patient feel full sooner after eating.

. Rearranged intestines causes the body to absorb fewer minerals.

. Dumping syndrome symptoms deter patients from eating unhealthy foods.

Comparing the Advantages and Disadvantages

Gastric Sleeve Advantages:

. Can lead to significant weight loss (average of 66% of excess body weight)

. Can lead to significant improvement of obesity-related health conditions

. Doesn’t use a foreign object (like the gastric band) and doesn’t reroute the digestive tract (like the gastric bypass)

. Short hospital stays approximately 2 days and recovery time due to minimally invasive procedure

. Limits the amount of food that can be eaten

. Causes significant changes to digestive organs and hormones that result in reduced hunger and increased metabolism.

. Permanent (won’t need more surgeries or readjustments, like the gastric band)

Gastric Bypass Advantages:

. Produces significant long-term weight loss (60 to 80 percent excess weight loss)

. Restricts the amount of food that can be consumed

. May lead to conditions that increase energy expenditure

. Produces favorable changes in gut hormones that reduce appetite and enhance satiety.

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Gastric Sleeve Disadvantages:

. Requires lifelong dedication to specific diet and exercise routines

. Permanent (cannot be reversed)

. Can lead to vitamin deficiencies

Gastric Bypass Disadvantages:

. Is technically a more complex operation than the AGB or LSG and potentially could result in greater complication rates.

. Can lead to long-term vitamin/mineral deficiencies particularly deficits in vitamin B12, iron, calcium, and folate.

. Generally has a longer hospital stay than the AGB

. Requires adherence to dietary recommendations, life-long vitamin/mineral supplementation, and follow-up compliance.

Comparing the Risks and Complications

Gastric Sleeve Risks and Complications:

. Leakage from the staple line – this is a rate but serious complication of the gastric sleeve surgery. The reported leak rate is between 0.7-3 percent. In Iran, we pay paramount attention to our surgical techniques to minimize all the complications.

. Stricture/stenosis - In the past, we had one stricture among our first 20 gastric sleeve procedures. We have not had any strictures within the past 5 years.

. Bleeding

. Blood Clot

. Heart Burn – This is a very controversial topic in bariatric surgery and the data from different centers is inconsistent. In our experience, most patients with heartburn before surgery see improvement of symptoms after surgery due to weight loss. Some patients may develop new heartburn, which is treatable with over-the-counter anti-acid medications, in most cases.

. Nutrient or vitamin deficiency

. Weight Regain

After two years, about 1 out of every 20 gastric sleeve patients have gained back some weight from their low point.

At 5 years, the average gastric sleeve patient regains as much as 50% of the weight they lost. Just as bad, the more weight you gain back, the more likely your health problems are to return.

The reasons for weight regain?

. Consuming calories in liquid form, such as protein shakes, pureed foods, smoothies, etc. Your new sleeve stomach works by making you feel full sooner when you eat. Since liquids don’t make you feel as full as solid foods, you’ll eat more and gain weight if you get your calories from liquids instead of solids.

. Overeating or eating the wrong things. This can stretch out the smaller gastric sleeve stomachs over time which will allow you to eat more and gain unwanted weight.

Remember, gastric sleeve is one of the best tools for weight loss, but it is only a tool. To avoid weight regain, you’ll need to eat the right foods and make the right lifestyle choices.

. Sagging Skin

For most obese patients, the skin has been stretched out for so long to accommodate the extra weight that it has lost its elasticity. Gastric sleeve surgery causes most patients to lose a lot of weight very quickly, and your skin simply can’t keep up.

The extra skin may be embarrassing. It can also cause several issues ranging from minor to severe, including:

. Hard time getting dressed

. Uncomfortable to exercise

. Skin problems, such as rashes and infections

In some cases, patients manage sagging skin with body-contouring undergarments. In more serious cases, patients have plastic surgery to remove the excess skin.

. Digestive Issues

About 1 in every 5 patients experience Gastroesophageal reflux disease (GERD) in the first 12 months. The good news is that this tends to be a shorter-term issue. After 3 years, the GERD rate drops to around 3% of patients.

Other potential digestive issues resulting from gastric sleeve surgery include:

. Indigestion (Dyspepsia)

. Gallstones

. Developing an intolerance to some food types

. Vomiting or nausea

. Vitamin deficiency

These digestive issues can often be addressed and fixed with diet and behavior changes.

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Gastric Bypass Risks and Complications:

. Breakage

. Dumping syndrome

. Gallstones (risk increases with rapid or substantial weight loss)

. Hernia

. Internal bleeding or profuse bleeding of the surgical wound

. Leakage

. Perforation of stomach or intestines

. Pouch/anastomotic obstruction or bowel obstruction

. Protein or calorie malnutrition

. Pulmonary and/or cardiac problems

. Skin separation

. Spleen or other organ injury

. Stomach or intestine ulceration

. Stricture

. Vitamin or iron deficiency

Who is a good candidate?

Is a gastric sleeve right for me?

The minimum requirements to qualify for gastric sleeve surgery include:

. A body mass index (BMI) of 40 or more, OR

. A BMI between 30 and 39.9 with a serious obesity-related health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, and many others.

Patients who qualify for gastric sleeve surgery usually:

. Are at least 80 lbs (36 kg) overweight.

. Are between 18 and 75 years old

. Have a history of failed weight loss attempts (example: failed diets)

. Thoroughly understand that the procedure is just a tool; your long-term success requires you to make significant diet and lifestyle changes.

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Is a gastric bypass right for me?

You may be eligible for gastric bypass surgery if:

. Your BMI (body mass index) score is 40 or more.

. Your BMI is 35 or more and you have other medical conditions such as type 2 diabetes or high blood pressure that may be improved by losing weight.

. You are fit enough to have a general anaesthetic and surgery.

. You are committed to losing weight and maintaining your weight loss through lifestyle and gastric bypass diet changes.

. You have tried to lose weight in other ways such as eating healthily, exercising and taking relevant medicines.

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How long does each procedure take?

Gastric sleeve

The operation can take between one and two hours, but this may vary between surgeons.

Gastric bypass

The operation can take between two and three hours, but this may vary between surgeons.

What can I expect during recovery?

Gastric sleeve

During your gastric sleeve recovery, you can expect:

.Timeline: 4 to 6 weeks to full recovery

. Hospital Stay: 2 to 3 days

. Time Off Work: 1 to 3 weeks

. Pain: Same as experienced after any laparoscopic surgery, managed with medication

. Diet: Slow transition from clear liquids to solid foods

. Activity: Slow transition back to regular activity and exercise

. Challenges: Most side effects like nausea, digestive issues, and body changes go away over time or after adjusting diet/lifestyle habits.

Gastric bypass

Your gastric bypass recovery will include:

. Timeline: 4 to 6 weeks to full recovery

. Hospital Stay: 2 to 3 days

. Time Off Work: 1 to 3 weeks

. Pain: Same as after any laparoscopic surgery, managed with medication

. Diet: Slow transition from clear liquids to solid foods

. Activity: Slow transition back to regular activity and exercise

. Challenges: Dumping syndrome, digestive issues & weight regain if you “cheat” on your diet, potential dental issues, gallstones, kidney stones, & short-term hair loss, and sagging skin from rapid weight loss.

Diet

Your gastric sleeve vs gastric bypass diet transition is virtually identical:

. 2+ Weeks Before – Practice your post-surgery diet

. 2 Weeks Before – High protein, low sugar, low carbs

. 1 Week Before – Stop or change some medications

. 2 Days Before – Clear liquids only

. Midnight Before Surgery – Nothing to eat or drink

. In Hospital to 7 Days After Surgery (Varies by Surgeon) – Sugar-free clear liquids only

. Day 1 to Week 2 after Surgery (Varies by Surgeon) – Add thicker drinks & smooth foods

. Day 2 to Week 3 after Surgery (Varies by Surgeon) – Slowly test pureed foods & soft solid foods

. Day 3 to Weeks 4+ after Surgery (Varies by Surgeon) – Slowly test solid food

The foods you’ll need to avoid are also very similar, although gastric bypass has some additional diet-related aspects to consider.

Diet issues unique to gastric bypass include:

. Avoid foods that are likely to cause dumping, including sugar, unnecessary fat, or refined carbohydrates (although you should avoid these after gastric sleeve as well, they won’t cause dumping for sleeve patients).

. Patients who undergo the bypass procedure are at especially high risk of developing Alcohol Use Disorder (AUD).

Following are dietary guidelines for both gastric bypass and gastric sleeve:

. Test one food at a time to make sure you can tolerate it

. Eat proteins first, in solid form (e.g., not protein shakes)

. Eat healthy “whole” foods

. Avoid processed foods

. Avoid sugary foods or drinks

. Eat slowly and chew thoroughly

. No starchy foods like rice, bread, and pasta

. Avoid any food that is difficult to digest (may be able to tolerate over time), such as:

   . Fibrous vegetables like broccoli, celery, and corn

   . Nuts

   . Seeds

   . Skin of any meat

   . Tough meats

. Avoid whole milk products

. Drink 64+ oz (2+ liters) of fluids spread throughout the day

. No drinking 30 minutes before or after meals (other than gastric balloon)

. Alcohol only in moderation

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Comparing cost

Gastric sleeve

The cost of Gastric Sleeve in Iran is between $ 2700 – 3300.

Factors such as the surgeon’s location, credentials, and the type of facility where the procedure is being performed all impact the final cost.

Gastric bypass

The cost of Gastric Bypass in Iran is between $ 3000-3500.

Factors such as the surgeon’s location, credentials, and the type of facility where the procedure is being performed all impact the final cost.