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Gastric Bypass vs. Gastric Sleeve

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How Your Doctor Decides Which Bariatric Surgery Is Right for You

Posted by Eric Velazquez, MD

If you’ve struggled to reach and maintain a healthy weight, or if you have health conditions related to obesity, you may be considering bariatric surgery.

Bariatric surgery is very effective when completed as part of a comprehensive weight-loss program. It can not only help you lose a significant amount of weight, but it can also help to improve or completely resolve obesity-related conditions such as high blood pressure, high cholesterol and diabetes.

Two of the most successful types of bariatric surgery are Roux-en-Y gastric bypass and gastric sleeve. While both can result in significant weight loss within 1-2 years following surgery, there are differences between the two.

Here, I share 4 ways your bariatric surgeon decides which option is right for you.

1. We consider your overall health.

You must meet certain criteria to qualify for both gastric bypass and gastric sleeve. These criteria are based largely on:

  • Body mass index (BMI)
  • Certain obesity-related conditions, such as diabetes and high blood pressure
  • Overall quality of life

The difference is really the degree to which your obesity affects your health. If you’re struggling with a number of obesity-related conditions, such as metabolic syndrome, or if excess weight affects your ability to move or get around, you may achieve better results with gastric bypass.

Here is a look at the criteria for each weight-loss surgery option:

SURGERY CRITERIA GASTRIC BYPASS GASTRIC SLEEVE
BMI over 40
BMI of 35–39.9, plus 2 or more related metabolic conditions
Metabolic syndrome
Obesity affects your day-to-day life, including
your ability to walk

You can check your BMI by using our BMI Calculator.

2. We think about the surgical approach.

Both Roux-en-Y gastric bypass and gastric sleeve are surgical procedures performed by a bariatric surgeon.

During gastric bypass, a small pouch is created from your stomach. This pouch is then connected to your small intestines so that food can essentially take a detour around a large part of your stomach, duodenum (the first part of the small intestine) and portion of your small bowel.

During a gastric sleeve procedure, also known as sleeve gastrectomy, a portion of your stomach is removed, including the part that produces ghrelin, an appetite-stimulating hormone.

We look at bariatric surgery as a tool to help you improve your health. If you have conditions related to your obesity, bariatric surgery may be beneficial to you. Sleeve gastrectomy and gastric bypass can achieve almost similar results, but sometimes we have to make a recommendation based on your obesity-related conditions.

The benefit of both procedures is that you can lose 59% to 70% of excess weight within the first 2 years after surgery.

Key Differences Between Gastric Sleeve and Gastric Bypass

Gastric sleeve is the removal of a portion of the stomach. Weight loss may take longer than with gastric bypass.

In a gastric bypass, a small gastric pouch is created and the small bowel is re-routed. It’s more invasive than the sleeve due to the rerouting of the small bowel. People may drop weight faster in the months following surgery.

Dumping syndrome is more commonly associated with gastric bypass, which can be a side effect of the surgery where you’re more sensitive to high-fat and high-sugar foods.

3. We talk to you about your motivation and your emotional health.

In order for you to achieve your weight-loss goals following surgery, you’ll adapt to a new way of thinking about food, and follow a restrictive diet. We need to understand what’s driving your desire to lose weight. We also have to ensure that we’re selecting an option that you can live with in the long-term.

While you’ll partner with a nutritionist or dietitian, physical therapy team, psychologist and surgeon, you’re at the center of your own success. Bariatric surgery is life-changing, and you’ve got to be ready for the transformation.

4. We consider the benefits and risks of bariatric surgery.

There are many benefits to having Roux-en-Y gastric bypass or gastric sleeve surgery. Of course, any surgery has risks, and it’s important you understand them before deciding to proceed. Your bariatric surgeon will explain the risks associated with both procedures.

Here is a breakdown of the benefits and risks:

Benefits Risks
Loss of 59%-70% of excess weight within 1-2 years
following surgery
Venous thrombosis/DVT
Reversal of Type 2 diabetes Leaking incision, incisional hernia
Improvement in chronic conditions such as
high blood pressure and obstructive sleep apnea
Gastric sleeve stricture
Relief from painful arthritis Intestine/bowel blockage
   Dumping syndrome
   GERD
   Gallstones
   Nutritional deficiencies

You can reduce your risks by learning all you can about your procedure, following your pre-operative surgical plan and losing weight prior to your surgery.

Learn More About Bariatric Surgery at Temple

A lot more goes into the decision — and it’s something we decide together after careful review and consideration.

I always tell patients the best place to learn more is to sign up for one of our online bariatric surgery seminars or join us during a Facebook Live session. Both are free and we welcome anyone to join and listen in.

You can also:

Eric Velazquez, MD

Dr. Eric Velazquez is Assistant Professor of Clinical Medicine at the Lewis Katz School of Medicine. He is Chair of General Surgery at Temple University Hospital – Jeanes Campus, where he is also Medical Director of the Bariatric Program. At the Temple Bariatric Program at Jeanes Campus, Dr. Velazquez performs surgery to help better the health of individuals affected by obesity.

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