Sleeve vs bypass — which bariatric procedure is right?
Sleeve (gastrectomy): simpler, shorter OR, no rerouting, lower long-term complication rate. Expected 60-70% excess weight loss at 2 years. Better for BMI 35-45, no severe diabetes/GERD. Bypass (Roux-en-Y): more effective for severe diabetes, better for GERD, higher initial weight loss (70-80% excess). More complex OR, dumping syndrome risk, nutritional monitoring more intense. Both revert less reliably than sleeve. Revision from sleeve to bypass is common 5-10 years later if weight returns.
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