Gastric Sleeve Vs. Bypass - All You Need to Know

The most important takeaways when evaluating gastric sleeve vs bypass include:

  • How they work: Both make you feel full sooner while eating. Only sleeve makes you feel less hungry generally, and only bypass reduces the amount of minerals your body absorbs.
  • Qualify: Same requirements (30+ BMI with health problems, 40+ without)
  • Hospital & recovery: Sleeve is a less complicated procedure with a shorter operating time. In-hospital and post-op recovery is similar.
  • Weight loss & health improvement: Similar at 2 years post-op, but bypass patients tend to keep more weight off over the long-term.
  • Insurance: Same (if your policy covers bariatric surgery, both sleeve and bypass will be covered).
  • Cost: Same with insurance, bypass is about 25% more expensive without insurance.
  • Diet & life after: Similar diet and exercise regimen, but bypass requires stricter supplementation and vitamin level monitoring.
  • Complications & side effects: Both have a 99.8% survival rate. Bypass has a higher risk of complications and side effects.
Gastric Sleeve Vs Bypass

Read and click the sections below for everything you need to know to decide which procedure is best for you.

Also Read: Have you decided to go through gastric sleeve? Learn about recovery from gastric sleeve surgery and what it takes to be fully recovered from the surgery.
Gastric Sleeve vs Bypass

Understanding gastric sleeve surgery vs gastric bypass surgery starts with the fundamental differences in how each alters your anatomy:

Gastric Sleeve

Gastric Sleeve

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 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.

Gastric Bypass

Gastric Bypass

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

How Gastric Bypass Is Performed

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

  1. Cut and staple the top portion of the stomach to create a small pouch at the end of the esophagus
  2. Leave the remainder of the stomach attached to the top of the small intestines
  3. Go further down the small intestine, cut it, and attach it to the pouch
  4. 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.
Gastric Sleeve vs Bypass

Patients lose weight quickly after gastric bypass and gastric sleeve, with the low point coming 12 to 18 months after the surgery:

  • 3 months: Lose 30% of excess weight
  • 6 months: Lose 50% of excess weight
  • 1.5 years: Lose 65% to 70% of excess weight

However, bypass patients tend to regain less weight 2+ years after the procedure because:

  • The gastric bypass pouch is smaller and therefore less able to stretch out
  • Gastric bypass is “mineral malabsorptive” while gastric sleeve is not (body absorbs fewer minerals after gastric bypass)

For more information about gastric sleeve weight loss, see our Project Your Gastric Sleeve Weight Loss page.

For pictures of patients before and after each procedure, including women, men, and celebrities, see the following pages:

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Gastric Sleeve vs Bypass

Studies evaluating gastric bypass vs. gastric sleeve have found very similar health improvement for diabetes, hypertension, sleep apnea, and most other obesity-related health problems, depending on which study is referenced.

However, gastric bypass:

  • Has a longer list of improved health conditions
  • Is more likely to improve most obesity-related health conditions

These surgeries can improve joint health. For every pound of weight lost, there is a 4 pound reduction in pressure on the knee joint (1). This improves mobility and reduces pain in the knees.

Both surgeries were part of research on cancer that included over 88,000 participants. Patients who undergo weight loss surgery have 33% less risk of developing cancer (2).

Risk rates were even further reduced for obesity-related cancers, including (3):

  • Colon cancer
  • Postmenopausal breast cancer
  • Endometrial cancer
  • Pancreatic cancer

The chart below compares study results by condition for each procedure:

Co-morbidity
Co-morbidity
Dyslipidemia hyperchole­sterolemia
Dyslipidemia hyperchole­sterolemia
Diabetes
Diabetes
Hyperli­pidemia (high levels of fat in the blood, high cholesterol)
Hyperli­pidemia (high levels of fat in the blood, high cholesterol)
High Blood Pressure (hyper­tension)
High Blood Pressure (hyper­tension)
Joint/Bone Disease (osteoar­thropathy)
Joint/Bone Disease (osteoar­thropathy)
Depression
Depression
Migraines
Migraines
Pseudo­tumor cerebri
Pseudo­tumor cerebri
Cardiova­scular Disease
Cardiova­scular Disease
Venous Stasis Disease
Venous Stasis Disease
Gastroeso­phageal Reflux Disease (GERD)
Gastroeso­phageal Reflux Disease (GERD)
Non-Alcoholic Fatty Liver Disease
Non-Alcoholic Fatty Liver Disease
Mortality Reduction/ Life Expectancy (5 year mortality)
Mortality Reduction/ Life Expectancy (5 year mortality)
Quality of Life Improve­ments
Quality of Life Improve­ments
Metabolic Syndrome
Metabolic Syndrome
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome
Pregnancy
Pregnancy
Asthma
Asthma
Obstructive Sleep Apnea
Obstructive Sleep Apnea
Stress Urinary Inconti­nence
Stress Urinary Incontinence
Co-morbidity
Gastric Sleeve % Improved /Resolved
Dyslipidemia hypercholesterolemia
64%
Diabetes
55%
Hyperlipidemia (high levels of fat in the blood, high cholesterol)
35%
High Blood Pressure (hypertension)
68%
Joint/Bone Disease (osteoarthropathy)
46%
Depression
Most
Migraines
40%
Pseudotumor cerebri
n/a
Cardiovascular Disease
100%
Venous Stasis Disease
95%
Gastroesophageal Reflux Disease (GERD)
50%
Non-Alcoholic Fatty Liver Disease
n/a
Mortality Reduction/Life Expectancy (5 year mortality)
89%
Quality of Life Improvements
93%
Metabolic Syndrome
62%
Polycystic Ovarian Syndrome
Most
Pregnancy
Most
Asthma
90%
Obstructive Sleep Apnea
62%
Stress Urinary Incontinence
90%
Co-morbidity
Bypass % Improved /Resolved
Dyslipidemia hypercholesterolemia
63%
Diabetes
83%
Hyperlipidemia (high levels of fat in the blood, high cholesterol)
73%
High Blood Pressure (hypertension)
69%
Joint/Bone Disease (osteoarthropathy)
43%
Depression
Most
Migraines
57%
Pseudotumor cerebri
96%
Cardiovascular Disease
79%
Venous Stasis Disease
95%
Gastroesophageal Reflux Disease (GERD)
80%
Non-Alcoholic Fatty Liver Disease
90%
Mortality Reduction/Life Expectancy (5 year mortality)
89%
Quality of Life Improvements
95%
Metabolic Syndrome
80%
Polycystic Ovarian Syndrome
Most
Pregnancy
Most
Asthma
80%
Obstructive Sleep Apnea
98%
Stress Urinary Incontinence
88%
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In order to have gastric bypass surgery or gastric sleeve surgery, your body mass index (BMI) must fall within one of the following ranges:

  • Body mass index 40 or above or
  • Body mass index from 35 to 40 as long as you have a serious obesity-related health problem (“comorbidity”) such as diabetes, asthma, hypertension, joint problems, sleep apnea, or one of many others.
  • Body mass index from 30 to 35 may be accepted if certain health issues are present

Use the BMI Calculator above to determine your body mass index.

For more information on gastric sleeve and gastric bypass qualifications, see the links below: