Myth or Fact: Gastric bypass is more invasive than sleeve gastrectomy

Daniel Cronk, MD

Gastric bypass is more invasive than sleeve gastrectomy. Myth or fact?

One of the most complex decisions our patients must make prior to surgery is to determine what operation they are going to have. Procedure selection is a shared responsibility between the patient and surgeon, considering patient wishes and goals, along with the surgeon’s assessment of the patient’s overall medical condition. By far, the most common surgeries we perform here at Erlanger are the sleeve gastrectomy and gastric bypass, and there are advantages and disadvantages to each of these procedures. Frequently, patients will come to their initial consult with the thought they do not want to have gastric bypass surgery because it is “too invasive.” But what exactly does that mean, and is gastric bypass truly more “invasive” than sleeve gastrectomy?

From my perspective as a surgeon, there are a few ways to define “invasive.” One of these ways is to look at the overall patient experience and recovery from surgery. Gastric bypass and sleeve gastrectomy are essentially the same when it comes to incisions made, post-op pain, dietary changes, and recovery time. In fact, for most patients, there is no difference in their journey through the first few weeks after surgery based on the type of operation. If there is any difference, perhaps ironically, those having sleeve surgery tend to have more nausea and difficulty with hydration very early on.

Another way to define “invasive” is to look at both short and long-term risks after surgery. When you look at the statistics from our program, there is essentially no difference in early complication rate between the two procedures, although medical studies suggest the early complication rate is higher with gastric bypass surgery. On the other hand, there are complications such as staple line leakage that can be much more difficult to deal with after a sleeve than after gastric bypass. From a long-term complication standpoint, the sleeve is a new enough operation that we do not know over many years how it will compare to gastric bypass surgery. While some gastric bypass patients will require repeat surgery for ulcers or bowel obstructions, there is a growing body of information to suggest sleeve patients will require additional procedures for heartburn related issues at a rate comparable to gastric bypass problems. Finally, there may be a perception that gastric bypass is riskier because it is malabsorptive. On the contrary, I would argue the modern gastric bypass operation does not cause significant malabsorption, and the risks of malnutrition after the two surgeries has more to do with keeping up with vitamin and nutrition intake than anything else.

Finally, no discussion of “invasiveness” would be complete without a look at how your surgeon feels about the procedures he or she performs. There are more sleeve gastrectomy procedures performed around our country than gastric bypass, and there are surgeons who essentially offer only sleeve gastrectomy. These surgeons may shy away from gastric bypass because it is something they are not as familiar with. Here at Erlanger, Dr. Sanborn and I perform an equal number of both procedures, and we feel confident in being able to recommend the procedure that is best for your medical needs.

So, is gastric bypass more “invasive”? As we have seen, there are several ways to look at the term “invasive” when it comes to bariatric surgery. And it is an oversimplification to put either sleeve or gastric bypass into a more or less invasive category. I’m therefore going to declare this statement a myth and encourage anyone considering bariatric surgery to be open to learning as much as they can about all the options.

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