Gastric bypass versus gastric sleeve

Overall, the sleeve and bypass offer similar results, both in overall weight loss as well as regain potential, but have somewhat different characteristics that can make one or the other more appropriate for different patients. Likewise, diabetes remission rates are similar. The sleeve has some predisposition towards GERD - somewhere around 30% of patients will experience some problems with it; if one has preexisting GERD, it is best find if there is a cause that can be corrected during surgery, such as a hiatal hernia (common amongst obese patients.) If so, that evens the odds out; if not it is usually better to go with the bypass to start with.

The bypass is predisposed to dumping and its reactive hypoglycemia cousin, with a similar 30% of patients experiencing some problem with that. It is also predisposed to marginal ulcers around the stoma, which is the root of the "no NSAID" rule (while the sleeve based procedures remain more flexible in that regard.)

The sleeve is somewhat more flexible with future treatment options should something need to be done - if GERD doesn't resolve satisfactorily with medication and/or lifestyle treatment, it can be revised to a bypass to (usually) correct it. Likewise, if if inadequate weight loss or substantial regain become an issue, it can be readily revised to bypass (usually with fairly poor results) or the stronger DS or SADI configurations. The bypass is more difficult to deal with surgically if problems arise, so options there are more limited. Often a total reversal is called for, leaving the patient without the bariatric help they had originally, as revisions to other configurations are usually too complicated for most bariatric surgeons.

The sleeve leaves a more "natural" straight through configuration that leaves things easier to diagnose or treat endoscopically in future (whether WLS related or not,) while the bypass leaves the remnant stomach and upper GI in a "blind" loop that is inaccessible with an endoscope, so more complex surgical procedures may be necessary for otherwise simple diagnostics. This, along with the potential for more limited pharmaceutical options, can be important considerations as we get older (and older....)

The malabsorption of the bypass is minor, as bariatric procedures go, but can provide a bit of a boost to weight loss, at least in rate if not overall level. However, the caloric malabsorption tends to dissipate after a year or so as the body adapts, leaving one metabolically in a similar state to a sleeve, which is why the overall weight loss and regain results tend to be similar. The nutritional malabsorption persists long term, so the bypass will remain somewhat fussier on supplements than the sleeve.

Overall, those are the basic tradeoffs that led me more toward the sleeve. Had diabetes been in the picture, then the DS would have been the choice as it shows demonstrably better results than the overall "good" results of the sleeve or bypass. Likewise, had I been an unresolved "yo-yo" dieter or very high BMI, then the DS would also have been preferred. Not suffering either of those two problems the sleeve offered similar results at a lower "cost" in negative trade off potential.

Thank you do much for your time in writing that all, I do have acid reflux so leaning towards gastric bypass but wonder if the sleeve would have less complications . Do you know what the rates are for gall bladder problems in each? I can't really find info on that. Did you have any complications?

I had no complications at all.

Gallbladder issues are not a complication of the surgeries. They are a complication of weight loss. If you lost a lot of weight from diet alone, RNY, or VSG, you'd have the same possibility for gallbladder issues. I wouldn't even let that be a factor in the decision.

Statistically, RNY has more complications than VSG, but that said, complications with either surgery aren't that common. I had a stricture early out with my RNY, and according to the PA at my clinic, that's the most common complication after RNY, and it happens to about 5% of patients. I wouldn't consider something happens to 5% of people "common", but at least that gives you an idea of how common complications are. The vast majority of complications are minor and are preventable or "fixable" (strictures are a very easy fix, for example). About 30% of RNY patients have dumping syndrome, but that can be controlled by limiting the amount of sugar you eat in one sitting (which we all should be doing regardless).

Like Grim, I didn't want to go with sleeve because at that time it didn't have much of a history, and I was afraid it might turn out to be "Lapband 2". At this point it's proven itself, so I wouldn't have that particular concern if I had to make the decision today, but I had GERD prior to my surgery, so I would still go with RNY. GERD doesn't get worse for all people who opt for VSG, but the risk of that happening was too high for me. I didn't want to have to go through a revision (which is the standard "cure" when GERD is severe) and long-term use of PPIs (which can control milder GERD) has its own issues.

I've been very happy with my RNY and would go with it again. Other than the stricture (and those always happen early out - within the first three months post-op), I've had no problems whatsoever with it.

Gallbladder issues are primarily a function of rapid weightloss, so aren't really tied to any particular procedure - it's a potential for any WLS procedure. Some programs specify some medication to minimize such problems during the loss phase while others don't. It's common enough (maybe 10%?) that my surgeon routinely removes the gallbladder on his DS patients, as he doesn't want some general surgeon going in there and getting lost in the altered anatomy, but he doesn't do so with his VSG patients as the anatomy isn't significantly altered. So, my wife had hers removed along with her DS, but I didn't with my VSG and never had a problem with it. I do have some minor GERD which is treated with basic OTC meds - Pepcid or Prilosec, the same as are often used by bypass folks to treat minor GERD or ulcer issues.

As with catwoman and grim, there were some concerns about the VSG being new at the time, and there were more problems and revisions then as most surgeons were just learning how to do them. The group I went to had been doing them for around twenty years at that time, under the guise of the DS, so they were well practiced with it.