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Gastric Sleeve vs. Gastric Bypass: Comparison of Bariatric Surgeries

Gastric sleeve and gastric bypass are both weight loss surgeries. They help by making your stomach smaller, so you eat less. Even though they sound similar, there are some important differences between them.

Think of bariatric surgery as a helpful tool for losing weight, especially when other methods like diet changes, exercise, or diet pills don’t seem to work.

Now, among all the weight loss surgeries out there, gastric sleeve and gastric bypass are the most talked about. They have some things in common, but they’re not exactly the same.

Want to know more? Let’s dive in and compare these two options, helping you understand which might be the best for you.

What Is Bariatric Surgery?

Bariatric surgery, at its core, refers to a set of medical procedures specifically designed to assist individuals in losing weight. It’s especially tailored for those who haven’t found success with traditional weight loss methods such as diet modification, exercise, or medications.

Here’s a deeper dive into bariatric surgery:

Purpose:

The primary objective of bariatric surgery is to facilitate weight loss. However, its benefits extend beyond shedding pounds. It can also help in managing and potentially reversing obesity-related health conditions like type 2 diabetes, hypertension, sleep apnea, and heart disease.

Methods:

Bariatric procedures work through one or both of the following principles:

  • Restriction: This involves physically reducing the size of the stomach, which in turn limits the amount of food one can consume. As a result, the person feels full sooner and eats less.
  • Malabsorption: Some procedures also alter the digestive system to inhibit the absorption of certain nutrients and calories in the intestines. This ensures fewer calories are taken in from the food consumed.

Types:

The world of bariatric surgery offers various procedures, each with its unique mechanism and outcomes. The most common ones include:

  • Gastric Sleeve: Majority of the stomach is removed, leaving behind a banana-shaped “sleeve.”
  • Gastric Bypass (Roux-en-Y): The stomach is divided into a small upper pouch and a larger lower pouch, with the small intestine rearranged to connect to both.
  • Adjustable Gastric Band: An inflatable band is placed around the stomach’s upper portion, creating a small pouch and a narrow passage to the rest of the stomach.
  • Biliopancreatic Diversion with Duodenal Switch (BPD/DS): A combination of the gastric sleeve and a more extensive bypass of the small intestine.

Candidates:

Not everyone qualifies for bariatric surgery. Typically, candidates have a Body Mass Index (BMI) of 40 or higher or a BMI of 35 or higher with at least one weight-related health condition. Additionally, they must demonstrate a commitment to the post-operative lifestyle and dietary changes and have a clear understanding of the procedure’s risks and benefits.

Aftercare:

Post-surgery, patients embark on a lifelong journey of dietary management, regular exercise, and periodic medical checks. The initial months involve gradual dietary advancements from liquids to solids, and patients often need vitamin and mineral supplements to prevent deficiencies.

In essence, bariatric surgery is not just a procedure but a comprehensive approach to weight management, requiring commitment, understanding, and a shift in lifestyle habits. It offers a lifeline to those struggling with obesity, giving them an opportunity for a healthier, more active life.

Assessment Before Weight Loss Surgery

Before undergoing any form of weight loss surgery, a thorough assessment is essential to determine the suitability of the procedure for an individual and to ensure optimal outcomes. This assessment is multifaceted, encompassing medical evaluations, psychological screenings, and educational sessions.

Here’s a detailed look into the assessment process:

Medical Evaluation:

  • Medical History Review: This involves a comprehensive review of the patient’s past and current medical conditions, surgeries, medications, allergies, and any weight loss attempts in the past.
  • Physical Examination: A thorough physical check-up helps in determining any health risks associated with obesity and assesses the person’s overall health status.
  • Laboratory Tests: Blood tests, including a complete blood count, liver function tests, cholesterol levels, and more, provide insights into the patient’s health.
  • Imaging: In some cases, imaging tests such as ultrasound, X-ray, or endoscopy might be necessary to view the structure of the gastrointestinal system.

Psychological Screening:

  • Mental Health Evaluation: To determine any underlying mental health disorders such as depression, anxiety, binge eating disorder, or substance abuse. It’s crucial to address these issues to ensure post-surgery success.
  • Assessment of Expectations: It’s vital that patients have realistic expectations from the surgery in terms of weight loss outcomes and lifestyle changes.

Nutritional Counselling:

  • Dietary History Review: Understanding the patient’s current eating habits helps in tailoring post-surgery diet plans.
  • Education: Patients are informed about the dietary changes they’ll need to adopt post-surgery, from liquid diets to solid foods, and the importance of nutrient supplementation.

Lifestyle Evaluation:

  • Physical Activity Assessment: Understanding current activity levels helps in suggesting post-operative exercise regimes.
  • Smoking and Alcohol Use: It’s essential to know and advise cessation, as both can impact surgery outcomes and recovery.

Educational Sessions:

  • Understanding the Procedure: Patients are educated about the specific surgery they’re considering, its benefits, risks, and the changes they’ll need to make post-surgery.
  • Post-operative Care: Information about recovery time, potential complications, signs to watch out for, and when to seek medical attention.

Support System Check:

  • Family and Friends: Assessing the patient’s support system is crucial. Recovery and adapting to new lifestyle changes become more manageable with a robust support system.

Financial Counseling:

  • Cost and Insurance: Patients are guided on the cost of the procedure, what their insurance might cover, and potential out-of-pocket expenses.

The assessment process ensures that both the medical team and the patient are fully prepared for the journey ahead. It builds a foundation for a successful surgical outcome and a healthier post-operative life.

What’s the Difference Between Gastric Sleeve Surgery and Gastric Bypass Surgery?

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Gastric Sleeve Surgery

Involves removing a significant portion of the stomach, leaving behind a tubular “sleeve.”
The procedure involves removing about 80% of the stomach. Benefits include significant weight loss and no rerouting of the intestines.

Gastric Bypass Surgery

Combines restriction and malabsorption. The stomach is divided into a small upper pouch and a larger lower pouch, with the small intestine rearranged to bypass a portion of it.

This is a two-part surgery: first, creating a small pouch from the stomach, and second, bypassing part of the small intestine. It offers rapid weight loss and can reverse certain obesity-related health conditions.

Comparison Table of Gastric Sleeve vs. Bypass

CriteriaGastric SleeveGastric Bypass
Helps lose more weight✓✓
Results in quicker weight loss✓✓
Lower risk of complications✓✓
Faster recovery time✓✓
Reversible 
Less likely to cause dumping syndrome✓✓
Less likely to cause GERD✓✓
Fewer issues with nutrient absorption✓✓
Reduces absorption of more calories ✓✓
Suitable for high-risk conditions✓✓
Less likely to need follow-ups✓✓

Recovery Timeline and Process for Gastric Sleeve and Gastric Bypass

Undergoing bariatric surgery is a significant decision, and understanding the recovery timeline and process can help patients set realistic expectations and be better prepared for their post-operative journey. Here, we break down the recovery process for both the gastric sleeve and gastric bypass surgeries.

Gastric Sleeve Recovery:

Immediate Post-Op (Days 1-3):

  • Hospital Stay: Patients typically stay in the hospital for 1-3 days.
  • Diet: Initiated with clear liquids to keep hydrated and avoid dehydration.
  • Activity: Gentle walking is encouraged to promote circulation and prevent blood clots.

First Week:

  • Diet: Progresses from clear liquids to fuller liquids like protein shakes and broths.
  • Activity: Increase in walking, avoiding any heavy lifting.
  • Pain: Some discomfort is normal and is managed with pain medication.

Weeks 2-4:

  • Diet: Gradual introduction of pureed foods.
  • Activity: Incremental increase in physical activity but still avoiding strenuous exercises.
  • Follow-up: First post-op check with the surgeon to monitor the healing process.

Weeks 4-6:

  • Diet: Soft foods are introduced, chewed thoroughly.
  • Activity: Most patients can return to work, barring any physically demanding jobs.

Beyond 6 Weeks:

  • Diet: Slow transition to solid foods, focusing on protein-rich items.
  • Activity: Most patients can resume regular activities and exercises.

Gastric Bypass Recovery:

Immediate Post-Op (Days 1-3):

  • Hospital Stay: Generally, a 2-4 day hospital stay is expected.
  • Diet: Starts with clear liquids.
  • Activity: Mild walking as soon as possible to prevent complications.

First Week:

  • Diet: Transition from clear liquids to fuller liquids, ensuring hydration.
  • Activity: Gentle walking, with avoidance of any strenuous activity.
  • Pain: Managed with medications; incision areas may feel sore.

Weeks 2-4:

  • Diet: Introduction of pureed foods, with an emphasis on proteins.
  • Activity: Gradual increase in activities, keeping any heavy exertion at bay.
  • Follow-up: A consultation with the surgeon to evaluate progress.

Weeks 4-6:

  • Diet: Soft foods make an entrance, ensuring small portions and thorough chewing.
  • Activity: Returning to work becomes feasible unless the job involves intense physical labor.

Beyond 6 Weeks:

• Diet: Gradual introduction to a regular but healthy diet, with a focus on nutrient-dense foods and avoidance of sugary or fatty items.
• Activity: Regular exercises can be resumed, with an emphasis on cardiovascular activities.

For both procedures:

  • Long-term Dietary Changes: It’s crucial to adhere to dietary recommendations, focusing on protein, vitamins, and minerals while minimizing sugars and fats.
  • Regular Follow-ups: Periodic checks with the bariatric team to monitor weight loss, nutritional status, and any potential complications or concerns.
  • Emotional Health: The physical transformation often comes with emotional and psychological changes. Seeking support groups, counseling, or therapy can be beneficial.

While these timelines provide a general guideline, it’s essential to understand that individual recovery can vary based on factors like age, overall health, and adherence to post-op instructions. Always follow the advice and guidelines provided by the healthcare team for the best outcomes.

Risks and Complications of Gastric Sleeve and Gastric Bypass Surgeries

All surgical procedures, including bariatric surgeries, carry certain risks and potential complications. It’s essential to be well-informed about these risks when considering a weight loss procedure. Here we detail the complications associated with both gastric sleeve and gastric bypass surgeries.

Gastric Sleeve Surgery (Sleeve Gastrectomy) Risks:

Immediate Surgical Risks:

  • Bleeding: Like any surgery, there’s a chance of bleeding during or after the procedure.
  • Infections: Surgical site infections might develop, although they’re generally treatable.
  • Leaks: The stapled area of the stomach may leak, potentially leading to infections or abscesses.

Long-Term Complications:

  • Stomach stretching: Over time, the reduced stomach might stretch if large meal portions are continually consumed.
  • Gastroesophageal reflux disease (GERD): Some patients might experience increased acid reflux post-surgery.
  • Vitamin and mineral deficiencies: Since the surgery affects food intake, there could be nutrient deficiencies if a balanced diet isn’t maintained.

Rare Complications:

  • Stricture: Narrowing of the connection between the esophagus and the stomach.
  • Gastric torsion: Twisting of the stomach, which could be a medical emergency.

Gastric Bypass Surgery (Roux-en-Y Gastric Bypass) Risks:

Immediate Surgical Risks:

  • Bleeding: Potential for internal or external bleeding post-surgery.
  • Infections: At the surgical site or internally.
  • Leaks: From the areas where intestines are sewn together.

Long-Term Complications:

  • Dumping syndrome: Rapid gastric emptying causing nausea, vomiting, dizziness, and diarrhea. It often occurs after consuming sugary or high-fat foods.
  • Strictures: Narrowing at the connection sites of the intestines.
  • Vitamin and mineral deficiencies: More pronounced in gastric bypass due to altered food absorption, leading to conditions like anemia or osteoporosis if not managed.
  • Hernias: Internal hernias might develop, sometimes requiring surgery.
  • Ulcers: At the site of the stomach-intestine connection.
  • Low blood sugar (hypoglycemia): Though rare, it can be severe and might require treatment.

Rare Complications:

  • Stomach perforation: Holes in the new stomach pouch.
  • Intestinal blockage: Due to scar tissue or hernias.
  • Kidney stones: Enhanced risk due to changes in digestive processes.

General Risks for Both Surgeries:

  • Thromboembolic Events: Blood clots might form, potentially leading to life-threatening conditions like pulmonary embolism.
  • Anesthesia-related Complications: As with any surgery that requires general anesthesia, there’s a risk of adverse reactions or complications during anesthesia.
  • Gallstones: Rapid weight loss can lead to the formation of gallstones in some individuals.
  • Chronic nausea or vomiting: Some patients might experience prolonged digestive discomforts.
  • Malnutrition: If dietary guidelines aren’t followed or if supplements aren’t taken as recommended.

It’s vital to discuss all potential risks and complications with a bariatric surgeon before deciding on a procedure. Promptly reporting any unusual post-operative symptoms can aid early detection and management of potential complications. Proper adherence to post-operative guidelines and regular follow-ups significantly reduce the risk of long-term issues.

What Dietary Changes Are Required?

Following bariatric surgeries like the gastric sleeve or gastric bypass, patients must significantly modify their diets. These changes are essential to accommodate the reduced stomach size, facilitate healing, ensure optimal weight loss, and prevent complications.

Initially, patients transition through stages of dietary consistency, beginning with clear liquids, moving to pureed foods, and gradually introducing solid foods. As the digestive system adjusts, long-term changes become vital. Meals should be smaller but nutrient-rich, emphasizing protein while limiting sugars and fats. The reduced stomach size and changes in nutrient absorption make proper hydration and vitamin supplementation necessary.

Furthermore, patients are advised to practice mindful eating, paying close attention to fullness cues, and avoiding hurried meals. Given the altered digestive process, some foods and drinks, like carbonated beverages and high-caffeine items, might cause discomfort or be less tolerated.

The importance of these dietary adjustments cannot be overstated. They play a pivotal role in maximizing the benefits of the surgery, maintaining nutritional balance, and enhancing the patient’s overall well-being. However, dietary needs can vary among individuals. It’s crucial to consult and follow the guidance of an expert medical doctor or a registered dietitian familiar with bariatric surgery to ensure the best post-operative dietary plan.

What Are the Pros and Cons?

Bariatric surgery has transformed countless lives by offering effective weight loss solutions and a pathway to improved overall health. Among the various procedures, gastric sleeve and gastric bypass are the most sought-after, each boasting its unique set of benefits and challenges.

As with all medical decisions, understanding the pros and cons associated with each can help in making a well-informed choice. Dive into the following breakdown to gain insights into the advantages and drawbacks of both surgeries, and remember, personalized medical guidance is invaluable in this journey.

Gastric Sleeve Surgery

Pros:

  • Simpler Procedure: Only involves reducing the size of the stomach; no rearrangement of the intestines.
  • Less Nutritional Deficiency: Since it doesn’t bypass any part of the intestines, there’s a lower risk of nutritional deficiencies compared to gastric bypass.
  • No Dumping Syndrome: Less risk of experiencing dumping syndrome (rapid gastric emptying) than with gastric bypass.
  • Fewer Follow-Up Adjustments: Doesn’t involve any foreign objects like bands that might need adjustment.
  • Effective Weight Loss: Patients typically experience significant weight loss, although it might be slightly less than with gastric bypass.

Cons:

  • Irreversible: The portion of the stomach that is removed cannot be restored.
  • Possible GERD Risk: Some patients may experience an increase in gastroesophageal reflux disease (GERD) symptoms.
  • Weight Regain: There might be a potential for weight regain in the long term, although this is possible with any weight loss method.

Gastric Bypass Surgery

Pros:

  • Higher Weight Loss: Often results in slightly more weight loss compared to the gastric sleeve and might be faster initially.
  • Improved Comorbid Conditions: Effective in improving or resolving obesity-related conditions such as diabetes, hypertension, and sleep apnea.
  • Reduced Hunger: Some patients report less hunger due to changes in gut hormones.
  • Long Track Record: Gastric bypass has been performed for decades, so there’s a lot of data on its efficacy and outcomes.

Cons:

  • More Complex: It’s a more intricate surgery since it involves creating a small stomach pouch and rerouting the intestines.
  • Nutritional Deficiencies: The bypassing of part of the intestine can lead to deficiencies in vitamins and minerals, requiring lifelong supplements.
  • Dumping Syndrome: Patients are more susceptible to this condition, which can be triggered by sugary or high-fat foods.
  • More Surgical Risks: Being a more complex surgery, it may come with higher surgical risks than the gastric sleeve.
  • Potential for Bowel Obstructions: There’s a risk of bowel obstructions or internal hernias in the long term.

While both surgeries offer effective weight loss solutions, the choice between them should be based on individual needs, potential risks, and desired outcomes. Consulting with a bariatric surgeon is essential in making an informed decision.

Gastric Bypass vs. Gastric Sleeve: Which Surgery Is Better?

The answer is individual. Some might find gastric sleeve more suitable due to its straightforward nature, while others might prefer the rapid results from gastric bypass.

Cost of Gastric Sleeve and Gastric Bypass Surgeries Across USA, UK, and Europe

The cost varies by region, facility, and additional medical needs.

USA:

  • Gastric Sleeve Surgery: In the United States, the average cost of gastric sleeve surgery tends to range from $15,000 to $25,000. The price fluctuates based on factors such as location, surgeon expertise, and hospital facilities.
  • Gastric Bypass Surgery: Gastric bypass, being a more complex procedure, generally costs more. Prices typically span between $20,000 and $35,000. Again, regional variations, the surgeon’s reputation, and healthcare center quality can influence this range.

UK:

  • Gastric Sleeve Surgery: In the UK, where private healthcare determines such surgery’s cost, the average price range for gastric sleeve surgery usually lies between £8,000 and £15,000.
  • Gastric Bypass Surgery: This surgery, on average, can cost anywhere from £9,500 to £18,000 in the UK, depending on the healthcare provider and region.

Europe:

  • Gastric Sleeve Surgery: Across various European nations, the cost of gastric sleeve surgery fluctuates, but a general average range from €10,000 to €20,000.
  • Gastric Bypass Surgery: For gastric bypass, the price varies more widely across European countries, but it generally falls between €12,000 and €25,000.

It’s important to remember these are approximate figures and can vary depending on numerous factors, including any additional pre-op and post-op care, patient’s specific needs, and any potential complications or extended hospital stays. Always consult with individual clinics or hospitals in the desired region for the most accurate and up-to-date pricing information.

Gastric Procedures in Turkey

Turkey, particularly in the past decade, has emerged as a hotspot for medical tourism, attracting patients from all over the globe. The country’s appeal lies in its combination of experienced surgeons, state-of-the-art medical facilities, and competitive pricing.

Among the various medical procedures that tourists seek in Turkey, bariatric surgeries—like the gastric sleeve and gastric bypass—are notably popular.

Why Choose Turkey for Gastric Procedures?

  • Cost-Effective: One of the major draws for many international patients is the cost advantage. Gastric procedures in Turkey often come at a fraction of the price compared to the USA, UK, or many European nations, without compromising on quality.
  • Highly Skilled Surgeons: Turkey boasts a pool of internationally trained and experienced bariatric surgeons. Many have practiced or received training in countries like the USA and Europe and are members of esteemed international medical associations.
  • State-of-the-art Facilities: Turkish hospitals, especially those in major cities like Istanbul, Ankara, and Izmir, are equipped with the latest technology. They often adhere to international standards, and many have accreditations from global organizations.
  • Comprehensive Care Packages: Many hospitals and clinics offer all-inclusive packages for international patients. These often cover the surgery, pre-op and post-op consultations, accommodation, and sometimes even local transportation and sightseeing.
  • Cultural and Geographical Appeal: Beyond the medical aspect, Turkey offers a rich cultural experience, with its blend of European and Asian influences. This makes the recovery phase more pleasant for many, as they can enjoy scenic views, historic sites, and warm hospitality.

Considerations:

While there are numerous advantages, it’s crucial to conduct thorough research when considering a significant procedure abroad:

  • Credentials: Always check the credentials of the hospital and the surgeon. Look for patient reviews, before-and-after photos, and any international accreditations the facility might have.
  • Communication: Ensure that the medical team and support staff can communicate in a language you’re comfortable with. This is crucial for pre-operative consultations, understanding post-operative care, and addressing any concerns.
  • Aftercare: Post-operative care is vital after bariatric surgery. While Turkey offers high-quality medical care, it’s essential to consider the logistics of follow-up appointments, especially if you’re residing in another country.
  • Travel and Recovery: Traveling post-surgery can be taxing. Consider the length of your stay in Turkey post-operation and the logistics of your return journey. Some patients prefer to stay longer for initial recovery before embarking on long flights.

In conclusion, Turkey presents a compelling option for gastric procedures with its blend of quality healthcare, cost-effectiveness, and cultural richness. However, as with any major medical decision, thorough research and consultations are essential to ensure a safe and successful experience.

How Much Does Gastric Sleeve Cost in Turkey?

Turkey’s rise as a hub for medical tourism can largely be attributed to its competitive pricing. When it comes to bariatric surgeries, the costs in Turkey are considerably lower than in many Western countries, which makes it an attractive destination for many patients seeking quality healthcare at affordable prices.

Average Pricing:

  • Gastric Sleeve Surgery: In Turkey, the average price for gastric sleeve surgery usually falls between €3,500 and €6,500. The wide range in pricing can be attributed to the choice of city, hospital, surgeon’s expertise, and additional services offered.
  • Gastric Bypass Surgery: Gastric bypass, being a slightly more complicated procedure, can cost between €2,500 and €4,500 on average.

It’s important to remember that these are ballpark figures and can vary based on numerous factors, including the specifics of the individual case.

What’s Typically Included:

  • Surgical Fees: This encompasses the surgeon’s fee, anesthesiologist’s fee, and the surgical team’s charges.
  • Hospital Stay: The cost typically covers the patient’s stay in the hospital, which can range from 2 to 5 days, depending on the procedure and individual recovery rate. This includes room charges, nursing care, meals, and routine medications.
  • Pre-operative Tests: Before the surgery, patients undergo a series of diagnostic tests to determine their suitability for the procedure and ensure their overall health. These might include blood tests, ECG, pulmonary tests, and nutritional evaluations.
  • Consultations: Pre-op and post-op consultations with the surgeon and medical team are generally included. This is essential to address any concerns, provide guidance on the surgery, and offer advice on post-surgery care.
  • Follow-Up Care: Some clinics provide post-operative check-ups as part of the package to monitor the patient’s recovery and address any potential complications. This might include wound checks, dietary guidance, and reviews of medication.
  • Additional Amenities: To attract international patients, many hospitals and clinics offer comprehensive care packages that might include airport pickups, accommodation, local transportation, translation services, and sometimes even guided tours or sightseeing.

While Turkey provides an affordable and quality option for gastric procedures, it’s vital for potential patients to inquire in detail about what’s included in the quoted price. This ensures clarity and helps avoid any unexpected expenses.

It’s also recommended to consult directly with the chosen clinic or hospital for the most accurate and up-to-date pricing information and service details.

Is Turkey Safe for Bariatric Surgeries?

With its state-of-the-art facilities and experienced surgeons, Turkey is considered a safe and popular choice for bariatric procedures. However, as with all medical tourism, it’s vital to do your due diligence.

Which One Is Right for You?

Consultation with a bariatric surgeon will help you assess which procedure aligns with your health goals and current medical condition.

These contents may also interest you:

Conclusion

Choosing between gastric sleeve and bypass requires careful consideration. By weighing the benefits, risks, and your personal health goals, you can make an informed decision on your weight loss journey. For expert consultation and further details, contact us now!

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Author:

Prof. Dr. Cemalettin Camcı

Prof. Dr. Cemalettin Camcı is a Turkish general surgeon with a specialization in bariatric surgery and a record of international awards, including US and Norwegian scholarships, surgical practices, research residencies, medical publications and over 2,000 treated patients.

Read More

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