Sleeve gastrectomy and Roux-en-Y gastric bypass are the two most common weight loss operations in the United States. Both are done laparoscopically, through small incisions, and both lead to significant, long-term weight loss. The right choice depends on your health history, especially reflux and diabetes, and on your goals.
How each surgery works
Gastric sleeve. About 70–80% of the stomach is removed, leaving a narrow, banana-shaped stomach. You feel full on much smaller portions, and levels of the hunger hormone ghrelin fall. The intestines are not rerouted.
Gastric bypass. A small stomach pouch is created and connected directly to a lower part of the small intestine. You eat less, and your body absorbs fewer calories. Bypass also changes gut hormones in ways that strongly affect blood sugar.
At a glance
- Typical weight loss: sleeve, up to 70% of excess weight in the first year; bypass, 60–80% of excess weight over 12–18 months.
- Back to routines: about 2–4 weeks for either.
- Acid reflux: a sleeve can cause or worsen reflux in some patients. Bypass often improves it, so it is usually the preferred option for people with significant reflux.
- Type 2 diabetes: both help. Bypass is often recommended when diabetes is a major concern.
- Vitamins: both require lifelong vitamin and mineral supplements. The risk of deficiencies is higher after bypass.
- Dumping syndrome: more common after bypass. Eating sugary foods can cause nausea, sweating and cramping.
- Reversibility: a sleeve is permanent, but it can later be converted to a bypass if needed. A bypass is considered long-term.
Which one is right for me?
A sleeve is often a good fit for people with a BMI of 35 or more, or 30 or more with a weight-related condition, who don't have significant reflux. A bypass is often recommended for a BMI of 40 or more, or 35 or more with related conditions, and especially for people with reflux or diabetes that is hard to control.
These are general guides, not rules. At your consultation, Dr. Wadiwala will review your health history, medications and goals, and explain which operation he recommends for you and why.
What both have in common
Either surgery works best with long-term follow-up: nutrition guidance, regular check-ins and vitamins for life. At Houston Surgical Weight Loss, our bariatric dietitian works with you before and after surgery.
Related reading
Sources
- Houston Surgical Weight Loss procedure comparison (home page).
- American Society for Metabolic and Bariatric Surgery (ASMBS), Bariatric Surgery Procedures, asmbs.org.
- Peterli R, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss in Patients With Morbid Obesity (SM-BOSS). JAMA. 2018;319(3):255-265.
This article is general information, not medical advice. Talk with your doctor about what is right for you.