How To Know Which Type of Bariatric Surgery Is Right for You

When you’re trying to live your healthiest life, trying to achieve a healthy weight is an important part of the equation. But it’s not always something you can do on your own.

Obesity is a medical condition, and not everyone can diet and exercise their way to a slimmer self. In these cases, bariatric surgery — also known as weight loss surgery or metabolic surgery — may be just what the doctor ordered.

“These procedures are the most effective treatment for obesity,” says bariatric surgeon Ali Aminian, MD. “They induce weight loss and influence your metabolism by changing your gastrointestinal (GI) physiology.”

But how can you decide which weight loss surgery is best for you? Dr. Aminian breaks down the options.

Differences between gastric bypass surgery and gastric sleeve (or sleeve gastrectomy)

The two most common weight loss procedures are Roux-en-Y gastric bypass and sleeve gastrectomy. “Sleeve is a bit safer, while gastric bypass is a bit more effective,” Dr. Aminian says. “But both procedures help people lose large amounts of weight, and they both have profound metabolic effects.”

Gastric bypass surgery is an operation that shrinks your stomach, along with the amount of calories and fat your body absorbs. After gastric bypass surgery, any food you eat will enter your small intestine directly. It literally bypasses 90% to 95% of your stomach.

“We disconnect the top part of the stomach and make a small pouch there,” Dr. Aminian explains. “Then, we move the small intestine up and connect it to that pouch, which reroutes the GI tract.”

Sleeve gastrectomy surgery, on the other hand, is an operation on only your stomach. Surgeons remove around 80% to 85% of it, leaving a smaller “sleeve” in its place. “The shape of the stomach typically looks like a football,” Dr. Aminian illustrates. “After surgery, it looks more like a banana — narrow and tubular.”

Benefits of both

For the most part, both procedures offer similar results and outcomes. Here are some of the benefits of bariatric surgery:

• Weight loss: The obvious benefit of weight loss surgery is, of course, weight loss. “Most people lose about one-third of their body weight, usually within eight to 12 months of surgery,” Dr. Aminian says. If, for example, you weigh 300 lbs. before surgery, you’ll likely get down to about 200 lbs. after surgery.
• Fewer health risks: Losing weight decreases your risk for a variety of health issues, including Type 2 diabetes, cardiovascular disease, fatty liver disease, kidney disease, cancer and more. “There are about 200 medical problems that are significantly improved after weight loss surgery,” Dr. Aminian says.
• More energy and mobility: Weight loss is also associated with a decrease in sleep apnea, asthma and joint pain, which can raise your energy levels and help you become more active.
• Longer lifespan: Bariatric surgery may help you live longer. For most people, it’s associated with an average of six extra years of life. If you have diabetes, that average goes up to nine years. “That is a huge benefit,” Dr. Aminian notes. “You can live six years longer after undergoing a two-hour surgery.”

That said, there are some considerations that might tip the scales in favor of one over another. Dr. Aminian answers your questions about some of the differences between the two procedures.

Which procedure results in more weight loss?

Gastric bypass is a more powerful tool than sleeve gastrectomy and typically leads to losing more weight. On average, people who’ve had gastric bypass lose 10 to 25 pounds more than people who’ve had sleeve gastrectomy.

“For the most part, though, whichever procedure you have, most people are able to keep the weight off for a very long period of time,” Dr. Aminian says.

Which procedure is safer?

Sleeve gastrectomy is a bit safer than gastric bypass, Dr. Aminian says, but only by a little. “On the whole, these are extremely safe operations.”

The risk of all complications is 3% after sleeve gastrectomy versus 5% with gastric bypass. That means that for every 100 patients, three to five may develop post-surgical issues, like:

• Bleeding.
• Infection.
• Blood clot.
• Heart attack.
• Anesthesia-related issues.

Which procedure has a shorter recovery time?

It’s a tie: Both procedures take about the same amount of time to recover from. Today’s surgeons perform almost all bariatric surgical procedures using minimally invasive techniques, which means smaller incisions and faster recovery time than ever before.

Both operations take about two hours to perform, and people typically stay in the hospital for one night, maybe two. “It usually takes about two or three weeks to recover,” Dr. Aminian adds, “and after that, you’re able to get back to your normal life.”

Which procedure is better for people with diabetes?

Gastric bypass is generally a slightly better option for people with diabetes because rerouting the GI tract leads to some hormonal changes that can increase your chances of diabetes improvement.

“In more than half of patients, diabetes goes into remission,” Dr. Aminian notes, “which means they don’t need any medications to control blood sugar for many, many years.”

How to decide what’s best for you

Figuring out the right procedure for you requires an in-depth discussion between you and your bariatric surgeon. “Together, we’ll consider your medical history, conditions and expectations,” Dr. Aminian says. “Then, we come up with a plan together.”

Some medical conditions and concerns may mean that sleeve gastrectomy is the better choice for you, like if you:

• Have had multiple abdominal surgeries. It’s impossible for surgeons to perform gastric bypass if there’s a lot of scar tissue around your small intestine. But that’s not the case for sleeve gastrectomy. “The upper part of the abdomen is usually less affected by scar tissue,” Dr. Aminian says.
• Weigh more than 450 pounds. Surgeons need room to reroute your GI tract, but fat in your abdomen can limit the amount of space for them to work with. In these extreme cases, gastric sleeve can be a more feasible option, from a technical standpoint.
• Are a high-risk surgical patient. If you have severe heart disease or lung problems, or if you’re a candidate for or recipient of an organ transplant, sleeve gastrectomy is often a safer option. The anesthesia time is shorter, and overall, it’s a bit easier on the body than gastric bypass.
• Take medication for psychiatric illness. Gastric bypass can affect the way your body absorbs and responds to certain medications. “If someone with severe depression or anxiety is stable on multiple psych medications, we don’t want to perform a procedure that could alter their medication’s absorption and effectiveness,” Dr. Aminian explains.

Historically, bariatric surgery has been viewed as a last option for people with severe obesity. But within the last 20 years, the field has progressed significantly.

“These operations are much safer and more effective than ever,” Dr. Aminian clarifies, “and they’re not just for people with a severe form of disease. New guidelines mean that people with mild to moderate obesity are now also good candidates for bariatric surgery.”

Talk to a healthcare provider to learn whether bariatric surgery is a good fit for you.