Gastric sleeve and gastric bypass are weight loss surgeries that help you eat less by reducing the size of your stomach. They have several key differences in benefits, risks, and recovery.
Bariatric surgery is a procedure that helps you lose weight. It’s an option when you need to lose a lot of weight, especially if improving your diet, becoming more active, and taking medications for weight loss haven’t worked.
Two of the most common types of bariatric surgery are gastric sleeve surgery and gastric bypass surgery.
The two procedures have similarities and key differences.
This article takes a look at what these surgeries entail and when to consider one over the other.
Both gastric sleeve and gastric bypass surgery reduce your stomach from its regular size to a small pouch. This causes weight loss in two ways:
- The pouch fills up quickly, restricting the amount of food you can eat before you feel full.
- Your body produces less ghrelin, commonly known as the hunger hormone.
The procedures differ in the way surgeons create the new stomach pouch.
Gastric sleeve surgery
With gastric sleeve surgery, a surgeon permanently removes about 80% of your stomach.
What remains is sewn into a small banana-shaped stomach pouch. The surgeon makes no other changes.
Gastric bypass surgery
During gastric bypass surgery, a surgeon creates a small stomach pouch by removing most of your stomach and the first part of your small intestine.
Then, they reconnect the newly created stomach pouch to the remaining small intestine.
The part of your stomach that’s removed is attached further down the small intestine, so it still provides the acid and digestive enzymes produced by those organs.
The portion of your small intestine that’s removed along with your stomach typically absorbs some nutrients and calories. Since food no longer passes through this section, those calories aren’t absorbed, contributing to weight loss.
This procedure is also called
Gastric band surgery
Gastric band surgery is a third type of bariatric surgery. It’s less commonly performed than gastric sleeve and gastric bypass surgery.
With this procedure, a surgeon creates a small stomach pouch by placing an inflatable band around part of your stomach.
The size of the opening between the pouch and the rest of your stomach affects how much weight you lose. You can adjust the size by inflating or deflating the band through a port placed under the skin of your abdomen.
A surgeon can easily reverse this surgery by removing the band.
Gastric bypass surgery is more complicated than gastric sleeve surgery. Gastric sleeve surgery only involves one step, while gastric bypass surgery is a two-step procedure.
Laparoscopic surgery
Surgeons usually perform both procedures laparoscopically. This method involves inserting tools, including a laparoscope (lighted scope with a camera), through several small incisions in your abdomen to perform the surgery.
If everything goes well, you won’t have a lot of postoperative pain, and you’ll be able to keep down liquids.
You’ll typically go home 1 to 4 days after gastric sleeve surgery or gastric bypass surgery.
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If you have a lot of pain after either surgery, aren’t able to keep down liquids, or have other issues, you may need to spend a few extra days in the hospital.
Although gastric sleeve and gastric bypass surgery require similar hospital stays, gastric bypass surgery has a longer recovery overall: It may take 4 to 6 weeks to fully recover from gastric bypass surgery and 2 to 3 weeks to fully recover from gastric sleeve surgery.
Benefits of ERAS protocol for bariatric surgery recovery
A 2022 study including 84 participants who underwent gastric bypass found that the use of Enhanced Recovery After Surgery (ERAS) protocol resulted in less postoperative pain, nausea, and vomiting.
The goal of the ERAS protocol is to reduce postoperative stress response and encourage early return of organ function.
ERAS protocol includes:
- minimally invasive surgical procedures (such as laparoscopic surgery)
- the introduction of short-acting anesthetic agents
- optimized pain and nausea/vomiting control
- early oral nutrition
- early walking after surgery
Open surgery
Occasionally, laparoscopic surgery isn’t possible, so a surgeon performs open surgery.
It requires a much larger abdominal incision. This type of incision takes longer to heal than small laparoscopic incisions.
Some reasons you might need open surgery include:
- having a high level of obesity
- having significant medical issues in addition to obesity
- a prior history of stomach surgery
If you have open surgery, you’ll be in the hospital until your incision has healed enough for you to go home. According to the Washington University Weight Loss Surgery Program, this often means 4 to 5 days in the hospital.
Once you’ve left the hospital, you’ll need time to fully recover.
You may have to wait up to 12 weeks before you can resume most of your normal activities.
Bariatric surgery is a relatively safe procedure.
According to the American Society for Metabolic and Bariatric Surgery (ASMBS), the risk of a major complication is about 4%. This is much lower than the risk of developing serious obesity-related health issues.
Some factors that can complicate any surgery, including bariatric surgery, include:
- hemorrhage, or blood loss
- deep vein thrombosis, or the development of blood clots in your leg
- pulmonary embolism, or the development of blood clots in your lung
- side effects of general anesthesia
- infection of your incision
- postoperative pain
- pneumonia
Possible complications after bariatric surgery include:
- gallstones
- leakage of stomach fluid
- nutritional deficiencies, including vitamin deficiencies
- dumping syndrome (rapid gastric emptying), which is nausea, sweating, and severe diarrhea from:
- eating too quickly
- eating sugary, fried, or fatty foods
- consuming dairy
- constipation
- saggy or loose skin
The following table lists specific complications related to gastric sleeve and gastric bypass surgery.
| Complications from gastric sleeve surgery | Complications from gastric bypass surgery |
|---|---|
| gastroesophageal reflux disorder (GERD), which causes acid reflux | increased sensitivity to alcohol |
| narrowing along the stomach pouch | stomach perforation |
| stomach obstruction | stomach ulcers |
| bowel obstruction |
The dietary changes you’ll have to make after gastric sleeve surgery and after gastric bypass surgery are generally the same.
Postsurgery diet changes
According to the U.K. National Health Service (NHS):
- You’ll only take in liquids for the first few days after your surgery.
- Shortly after, you can eat puréed food and then soft food. You’ll continue this diet for the 4 to 6 weeks following your surgery.
- Six weeks after surgery, you’ll be able to eat regular food.
Long-term diet changes
Important dietary guidelines you need to follow after your gastric sleeve or gastric bypass surgery include:
- eating small amounts and stopping when you’re full
- chewing your food thoroughly
- eating slowly
- taking the recommended vitamins and supplements
- staying hydrated by drinking enough water
- sipping fluids rather than drinking quickly
- avoiding food that’s difficult to digest, such as tough meat and bread
- avoiding carbonated beverages
The main postoperative difference is the size of your stomach pouch, which affects how much you can eat.
With gastric bypass, your pouch holds about 1 ounce (oz) of food, which is slightly smaller than a golf ball. Gastric sleeve surgery creates a pouch that holds 2 to 5 oz of food.
Your pouch will stretch over time. It’s important not to overeat after bariatric surgery because your pouch can stretch enough for you to regain the weight you lost.
Most bariatric centers recommend long-term care with a bariatric nutritionist to support people in following a diet that won’t cause nutritional deficiencies and assists in healthful weight loss.
According to the AMBS, around 90% of people who undergo bariatric surgery lose 50% of their excess body weight. They can maintain much of their weight loss in the long term.
Success rates vary depending on the type of surgery.
One 2014 study focused on 240 people with severe obesity who had bariatric surgery between 2008 and 2010. Researchers found that participants who had laparoscopic gastric sleeve surgery lost, on average, 49.2% of their excess body weight after 6 months. During that same period, those who had laparoscopic gastric bypass surgery lost an average of 52.9% of their excess body weight.
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One of the biggest advantages of gastric sleeve and gastric bypass surgery is that they significantly reduce your risk of obesity-related conditions, such as:
- type 2 diabetes
- hypertension, or high blood pressure
- hyperlipidemia, or high levels of cholesterol and triglycerides
- heart disease
- stroke
- fatty liver disease
- sleep apnea
- knee or hip pain
In many cases, bariatric surgery can also help improve physical function, mood, and quality of life. According to a
Bariatric surgery could also reduce your risk of premature death.
On the other hand, bariatric surgery has several risks that are important to consider.
In addition to surgery-related complications and side effects, a
Bariatric surgery can also affect nutrient absorption. Over time, this may lead to health problems, such as anemia and osteoporosis.
| Gastric sleeve surgery | Gastric bypass surgery | |
|---|---|---|
| helps you lose more weight | ✓ | |
| results in quicker weight loss | ✓ | |
| has a lower risk of complications | ✓ | |
| has a faster recovery time | ✓ | |
| is reversible | ✓ | |
| is less likely to cause dumping syndrome (rapid gastric emptying) | ✓ | |
| is less likely to cause gastroesophageal reflux disorder (GERD) | ✓ | |
| causes fewer issues with nutrient absorption | ✓ | |
| reduces the absorption of a greater number of calories | ✓ | |
| is appropriate for certain high risk medical conditions | ✓ | |
| is less likely to require follow-up procedures | ✓ |
A 2017 review found that costs could range from $7,423 to $33,541, with an average cost of $14,389 for bariatric surgery.
The cost depends on several factors, including:
- your geographic location
- whether you have any complications during surgery
- the type of surgery
Because gastric bypass is more involved, it’s typically more expensive than gastric sleeve.
The amount covered by medical insurance depends on your insurance provider and state.
Certain types of insurance, such as Medicare and Medicaid, may cover the procedure if you meet specific criteria and have a recommendation from a healthcare professional.
Other insurance providers may require you to use an approved surgeon or healthcare facility and prove that you couldn’t lose weight through other methods. This often means completing a nonsurgical weight loss program.
Consider consulting a healthcare professional or contacting your insurance provider for more details about costs and specific coverage requirements.
The type of bariatric surgery that’s best for you will depend on several factors, including your:
- current weight
- weight loss goals
- medical history
- preexisting health conditions
- expectations
- preferences
Talk with a doctor about these factors and whether bariatric surgery is appropriate. They can help you determine your eligibility and which procedure might be the best choice.