Sleeve gastrectomy and Roux-en-Y gastric bypass are two of the most commonly performed bariatric procedures in Australia, along with gastric banding (Shannon et al. 2013).

These procedures are usually done laparoscopically. As with banding, sleeve and bypass operations result in less hunger and reduced portion sizes. Additionally, after a bypass, there is a reduction in energy and other nutrient absorption, as the food skips part of the small intestine.

So, what exactly is the difference between the two?

Sleeve Gastrectomy

Sleeve Gastrectomy involves removing the majority of the stomach, reducing its capacity and leaving only a narrow sleeve. The patient will subsequently eat much smaller portions as they achieve earlier satiety or fullness (ASMBS 2021).

The operation has a hormonal effect on the patient known as reduced ghrelin, which reduces the effects of hunger over the first year or two. As the effects fade in time, it is vital that good eating habits are established early and maintained (TBC 2023).

The sleeve gastrectomy operation carries a higher risk of blood loss and higher mortality than gastric banding. There is also a risk of leakage through the staple line, where the remainder of the stomach is joined together (ASMBS 2021; Mayo Clinic 2022a).

Average weight loss with sleeve gastrectomy is around 60% of the patient’s excess weight (Mayo Clinic 2022a).

After the initial period of loss, patients may regain some of their lost weight. Weight regain can be minimised by maintaining good eating behaviours and food choices (Mayo Clinic 2022a).

Roux-en-Y Gastric Bypass

In roux-en-Y gastric bypass, a small pouch is made from the top section of the stomach and connected to a loop of the jejunum (bypassing the duodenum and the first part of the jejunum). Smaller portions of food are consumed, and as a large section of the small intestine is skipped, the energy absorbed from the food is consequentially reduced (Mayo Clinic 2022b).

As the bypass procedure is a more drastic alternative, many surgeons reserve this as an option for revision surgery for patients who have not had a good result with banding or a sleeve (Johns Hopkins Medicine 2021a).

The risks associated with gastric bypass include bleeding, leakage, infection and bowel obstruction (Mayo Clinic 2022b).

The average result is losing more than 60% of the initial excess weight (Mayo Clinic 2022b).

Postoperative Care

Following a sleeve or bypass operation, oral intake is initially confined to fluids. Under the guidance of a dietitian, a plan for gradually including more solid textures is designed. The patient will often be restricted to fluids for one to two weeks. After this, if tolerated, they can commence purees. Some weeks after that, the patient can try solid foods (Mayo Clinic 2020).

Eating too much food or solid food too soon can lead to vomiting. It is important to give the staple lines time to heal (Mayo Clinic 2020).

Bariatric operations require long-term follow-up consultations to monitor any complications or nutritional deficiencies encountered. Deficiencies are more likely to occur with a sleeve or bypass operation compared with gastric banding. Vitamin and mineral supplementation is advised, commencing with chewable tablets initially (Johns Hopkins Medicine 2021b).

The professional input of a dietitian is invaluable to maximise the nutritional quality of the patient’s meals when such a small volume of food is being consumed.

Other Factors To Optimise Results

Learning to eat slowly and mindfully
Serving oneself small portions
Taking small mouthfuls and chewing them well
Avoiding eating and drinking at the same time
Avoiding liquid calories
Eating a variety of whole foods: grains, legumes, eggs, vegetables/salad, fruit, lean meats, low-fat dairy, and a judicious amount of nuts, seeds and oils
Limiting refined, processed, high-energy foods
Addressing unhelpful eating behaviours such as bingeing or any kind of non-hungry eating
Learning to stop eating when just satisfied rather than continuing to eat until uncomfortably full.

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