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Comparing the Gastric Sleeve to the Gastric Bypass – Which Is Better?

Patients considering bariatric surgery often wonder whether the gastric bypass or the gastric sleeve is a better option for them. First, it is important to mention that I can’t offer any concrete advice without meeting you in person and going over your medical records and previous diagnoses. However, as the bariatric landscape has broadened with new procedures and techniques, we are coming to some very interesting conclusions about which procedures are best for certain patients.

It is worth noting, before we get any further, that both the gastric sleeve and the gastric bypass are extremely effective procedures that can yield incredible long-term weight loss numbers when performed by an experienced surgeon on a qualified patient. Though both weight loss surgeries result in long-term weight loss numbers, the gastric bypass surgery clearly results in more weight loss. Also research shows that the levels of the hunger hormone known as ghrelin declined significantly following both gastric sleeve and gastric bypass surgery.

The benefits of the gastric sleeve

The gastric sleeve is suitable for a wide range of patients, starting with those at a BMI of 35. Because of the simplicity of the procedure along with its effectiveness, it can be very safe for patients even with extreme BMIs (50+). Indeed, the gastric sleeve is also used as the first part of a procedure known as a duodenal switch.

The gastric sleeve also confers a benefit in the form of hunger reduction. Many patients will feel fewer hunger pangs after surgery due to the removal of the fundus which secretes the hunger hormone, ghrelin. Since this part of the stomach is cut away and removed from the body, most of the hunger hormone production is also eliminated (some is still produced in the pancreas, small intestine and pituitary gland in the brain). Before thinking the gastric sleeve has significantly lower weight loss potential than the gastric bypass, it is important to remember that while the weight loss is slower, studies have shown comparable long-term weight loss numbers. Also, the gastric sleeve does not modify any portion of the lower gastrointestinal system. The pyloric sphincter and intestinal tract are left intact, meaning patients will not experience dumping syndrome as readily as gastric bypass patients and malabsorption, or poor absorption of nutrients, is not a significant issue.

The most common long-term complications outside of the inherent risks of surgery include weight regain due to the stretching of the pouch or new or worsened acid reflux. In these circumstances, the gastric sleeve can be modified easily, when warranted. Fortunately, this is not a common occurrence and most patients do very well with their sleeve.

The benefits of the gastric bypass

The gastric bypass involves cutting away 80% of the stomach and rerouting a portion of the small intestine to both restrict the amount of food a patient can eat and limit the number of calories and nutrients absorbed through the sensitive lining of the small intestine. The gastric bypass has been in existence for decades and is widely considered the gold standard in bariatric surgery. For many patients this continues to be the case. The gastric bypass is the definitive bariatric surgery for those who suffer from severe or uncontrolled type 2 diabetes. Amazingly, gastric bypass patients often find their diabetes goes into remission within days or even weeks of surgery, even before they have lost a significant amount of weight. The gastric bypass is also exceptionally effective for those that have severe or uncontrolled gastroesophageal reflux disease or GERD.

Dumping syndrome, the rapid emptying of largely undigested food and drink from the stomach into the small intestine can be very uncomfortable and is often seen as a risk of the gastric bypass. However, for patients needing a little extra help in avoiding “bad” foods, dumping syndrome can actually be a benefit. After the first couple occurrences, patients adapt to avoid the foods that may cause it. These foods should be avoided after surgery anyway.

Much like the gastric sleeve, if there are longer-term complications of the gastric bypass such as stretching of the pouch, or widening of the stoma, there are procedures to correct these problems that are either minimally invasive or non-surgical.

Despite the advantages of bariatric surgery in general, none of these procedures can be fully utilized without proper postoperative care. You will have to modify your lifestyle in the form of improved diet and exercise for the rest of your life to be truly successful. If you want to cheat the procedure you can. That’s why we always say that bariatric surgery is not the easy way out – it still requires a lot of willpower and dedication to a new life.

The most important next step is to watch our online seminar or schedule a consultation with Dr. Tsuda or Dr. Ryan to learn more about the procedures available and whether you may be a candidate for surgery. If we determine that you indeed qualify for bariatric surgery, we will work with you to get the proper preoperative clearances and move forward with your procedure. We will also be there with you during your postoperative life, helping you ensure long-term health.

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