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Weight Loss Surgery Options
We perform two bariatric procedures: gastric sleeve and gastric bypass. Most patients are good candidates for sleeve, which is simpler and has a lower long-term complication rate. Bypass tends to be the better fit for patients with significant acid reflux, a hiatal hernia, or more severe diabetes. The right choice depends on your individual health history, which is exactly what a consultation is for.
Two Procedures, Not a Long List of Options
Some bariatric practices offer a longer menu of procedures, including duodenal switch, SADI-S, or revisional surgery for patients who've had a prior weight loss operation elsewhere. We don't perform those. We offer two procedures: gastric sleeve and gastric bypass.
That's a deliberate scope, not a gap. Sleeve and bypass together account for roughly 90% of all bariatric operations performed worldwide, according to the 2022 ASMBS/IFSO joint guidelines. For the large majority of patients, one of these two procedures is the right fit. This page isn't a deep dive into either procedure. It's here to help you understand the difference between them, so you know what to ask about when you come in for a consultation.
Gastric Sleeve, Briefly
Gastric sleeve removes about 75-80% of the stomach, leaving a narrow tube-shaped sleeve. It's a restrictive procedure: it limits how much you can eat, and it removes most of the stomach tissue that produces ghrelin, the hormone that drives hunger. It doesn't reroute the intestines, so there's no malabsorption.
A Stanford study of nearly 270,000 bariatric procedures found sleeve gastrectomy had a 30-day serious complication rate of 0.96% and a mortality rate of 0.08%. A separate Cleveland Clinic study found sleeve gastrectomy had the lowest reoperation rate of the procedures studied, at 1.5%, compared to 7.7% for gastric bypass. Sleeve is the procedure we perform most often, and for most patients without significant reflux, it's the first option we discuss.
For the full breakdown of how the procedure works, what recovery looks like, and expected outcomes, see our complete guide to gastric sleeve surgery.
Gastric Bypass, Briefly
Gastric bypass creates a small stomach pouch and reroutes part of the small intestine, so food bypasses most of the stomach and the first section of the intestine. It produces restriction along with malabsorption, and a stronger hormonal shift than sleeve alone.
Bypass is a more complex operation with a longer recovery, and it requires lifelong vitamin supplementation because of the malabsorption. It tends to be the stronger option for two specific situations: significant acid reflux or a hiatal hernia, and more severe type 2 diabetes. For the full procedure breakdown, see our complete guide to gastric bypass surgery.
What Actually Drives the Decision
The decision between sleeve and bypass comes down to a small number of factors, not a long checklist. Acid reflux is the biggest one. Sleeve can worsen existing reflux in some patients, while bypass tends to improve it. If you have a hiatal hernia, bypass allows us to repair it during the same operation.
Diabetes severity is the other major factor. Both procedures improve diabetes, but bypass tends to produce a faster, stronger effect for patients with more severe or longer-standing diabetes. For patients without significant reflux or severe diabetes, sleeve is usually the simpler, equally effective choice.
BMI and overall health also factor in, along with your own preferences once you understand the tradeoffs. None of this is something you need to work out on your own. It's the core conversation of your consultation.
Frequently Asked Questions
Do you offer duodenal switch or SADI-S?
No. We perform gastric sleeve and gastric bypass. We don't perform duodenal switch, SADI-S, or revisional bariatric surgery.
I've had bariatric surgery before. Can you help?
We don't perform revisional bariatric surgery. If you've had a prior procedure and you're exploring your options, talk with us directly about what we can help with.
Is one procedure safer than the other?
Both have strong safety records. A Cleveland Clinic study found sleeve gastrectomy had a lower reoperation rate than bypass, 1.5% versus 7.7%. Bypass requires lifelong vitamin supplementation because of malabsorption, which sleeve does not.
Which procedure is better for diabetes?
Both procedures improve type 2 diabetes. Bypass tends to produce a faster, stronger effect, particularly for patients with more severe or longer-standing diabetes. We'll review your specific history to determine which procedure makes the most sense.
Can I switch procedures if sleeve doesn't work for me?
We don't perform revisional bariatric surgery, so this is an important conversation to have before your initial procedure. We'll talk through your full health history during your consultation to help find the right fit from the start.
Ready to find out which procedure fits you?
We'll review your health history and walk you through the tradeoffs so you can make a confident decision.
Sources
- ASMBS/IFSO. 2022 American Society for Metabolic and Bariatric Surgery and International Federation for the Surgery of Obesity and Metabolic Disorders Indications for Metabolic and Bariatric Surgery. asmbs.org
- Stanford University study of bariatric surgery outcomes across nearly 270,000 procedures, reporting 30-day complication and mortality rates by procedure type.
- Cleveland Clinic study comparing reoperation rates across sleeve gastrectomy, gastric bypass, and gastric banding.