Doctor votes on bariatric surgery

Doctor Debate: Which Is Better, Gastric Sleeve or Bypass?

Is gastric sleeve or gastric bypass better for helping patients resolve obesity and related diabetes? This is the question being debated by two bariatric surgeons in “The Great Debates” column featured in the February 2018 issue of General Surgery News. There are pros and cons to both types of weight loss surgery, and two opposing opinions within the medical community regarding which one is best.

Which side of the debate are you on? To help you decide, GSN asked two well-known weight loss surgery specialists to represent the diametrically opposing positions. Explore their well-considered arguments here!

What is the best first-line treatment for the morbidly obese, diabetic patient?

“Gastric Sleeve Is Best.”

According to Michel Gagner, MD, gastric sleeve (sleeve gastrectomy) is the best surgical option for managing morbid obesity with co-occurring Type 2 diabetes (T2D). Dr. Gagner, a professor of surgery at Florida International University, argues that there is good evidence to support the growing popularity of the gastric sleeve procedure over gastric bypass (Roux-en-Y).

Dr. Gagner cites two randomized studies published in JAMA that showed after five years, people who received the gastric sleeve achieved the same weight-loss results as those who received gastric bypass, and they enjoyed the same degree of resolution for weight-related conditions like diabetes and sleep apnea.

For Dr. Gagner, the benefits of gastric sleeve out-weigh the negatives. Here is a short summary of the pros and cons according to Dr. Gagner:

Pros for Gastric Sleeve:

  • Has lower risk of complications as compared to gastric bypass
  • Delivers same benefits as bypass (per study results at 5- and 10-year points post-surgery)
  • Has fewer negative side effects than bypass (i.e., bowel obstruction, ulcers, gastric dumping, hypoglycemia, hernias, substance abuse, etc.)
  • Lower rate of hospital admissions and reoperations
  • Surgeons can make changes or revisions after initial surgery to ameliorate results

Cons for Gastric Sleeve:

  • Gastric sleeve can result in acid reflux as a side-effect that requires medication (though this effect is less likely among more experienced surgeons)
  • Moderate to high leak rate, though the problem is considered higher for gastric bypass

“Gastric Bypass Is Best.”

According to Ricardo Cohen, MD, gastric bypass (Roux-en-Y, or RYGB) is the best surgical option for managing morbid obesity and diabetes as a co-occurring, weight-related condition. Dr. Cohen, director of the Center for Obesity and Diabetes at Oswaldo Cruz Hospital in Sao Paulo, Brazil, argues that the growing popularity of gastric sleeve doesn’t necessarily mean it is safer or better than gastric bypass.

Dr. Cohen states that gastric bypass delivers better metabolic outcomes and weight loss results than gastric sleeve. He agrees that short-term weight-loss results are roughly the same for sleeve and bypass, but he cites several studies that indicate long-term results are significantly better with bypass.

For Dr. Cohen, the long-term benefits of gastric bypass should be carefully considered. Here is a short summary of the pros and cons of bypass according to Dr. Cohen:

Pros for Gastric Bypass:

  • Longer lasting weight-loss and health benefits at and beyond the 5-year point
  • Antidiabetic benefits of bypass are well-documented—more so than for gastrectomy
  • Better control of blood sugar, hypertension and lipids with bypass vs. sleeve
  • Safety risks of bypass vs. sleeve (i.e., hospital admissions, revisions, mortality) may be overestimated
  • Acid reflux is resolved for more than 90% of bypass patients with pre-existing GERD

Cons for Gastric Bypass:

  • Higher incidence of internal hernias (“post-RYGB internal hernia”)
  • Obesity and T2D can recur after bypass (and after sleeve), and revisional surgery is risky

Join the Conversation!

You can view more detailed arguments (and source references) from each physician by reading the original article published on the GSN website. A visit to the publication’s website also allows you to cast your vote for the bariatric procedure you think is best. You can also post a comment in response to GSN’s original post.

This curated, edited content is provided for readers of miVIP Surgery Centers in the interest of education and information, as part of miVIP’s Healthy Living Recommendations. The opinions expressed here are those of the contributors to the original article on

Learn more about miVIP’s Bariatric Surgeons, General & Bariatric Surgeons, and Bariatrics Program here.

PUBLISHED 11 Jan, 2019

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