GASTRIC SLEEVE VS.
In the world of surgical treatment of obesity, laparoscopic adjustable gastric banding (LAGB) and laparoscopic gastric sleeve (LGS) surgeries are successful operations that have proven to be effective in achieving weight loss. Improvement also accompanies the weight loss is obesity-associated disease conditions leading to improvement in the quality of life and overall survival.
Nevertheless, they differ in so many aspects and taking a final decision on which one to go for may be challenging, thus, requiring an in-depth knowledge and understanding of the pros and cons of these two surgeries.
Which is Best? Pros and Cons?
- Least Invasive: Gastric Sleeve Surgery
- Highest Expected Weight Loss: Gastric Sleeve Surgery
- Lowest Complications: Gastric Sleeve Long-Term, Gastric Banding Short-Term
- Least Side Effects: Gastric Sleeve Surgery
- Lowest Cost (Typically): Gastric Sleeve Surgery
- Highest Reduction in Comorbidities: Gastric Sleeve Surgery
Renew Bariatrics recommends Gastric Sleeve Surgery for a majority of reasons, primarily that it provides sufficient expected weight loss. Lap-Band removal is also required to be removed about 1 out of 10 patients.
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Gastric Sleeve vs Gastric Banding
|Gastric Sleeve Surgery||Gastric Banding Surgery|
|Method of Weight Loss||Restrictive||Restrictive|
|Duration of Procedure||1.5 Hour||1 Hour|
|Length of Hospital Stay||2 Nights||2-3 Nights|
|Estimated Weight Loss||65% of Excess Weight||45% of Excess Weight|
|Weight Loss at 1 Year||60-70%||40-55%|
|Comorbidities||High Resolved Rate||Some Resolved Rate|
|Quality of Life Improved||93%||Most|
|Common Complications||Staple Line Leaks 0.5%||N/A|
|Common Side Effects||Nausea, Digestive Issues||Band Erosion, Band Intolerance, Band Slippage|
|Recovery||2 to 4 Weeks||4 to 6 Weeks|
|Cost: Self-Pay Average||$18,000||$25,000|
|Cost w/ Renew Bariatrics||$3,899||Not Offered|
Mechanism of action
Both gastric banding and gastric sleeve are restrictive procedures. They both reduce the capacity of the stomach leading to an early feeling of fullness and reduction in the quantity of food intake. In gastric banding, the stomach is partitioned into an upper smaller pouch and a lower larger pouch with the use of a silicone band. This band is inflated with sterile water, and the quantity of the water can be adjusted, hence the name LAGB. The upper pouch functions to accommodate a small amount of food and pass it to the larger portion bit by bit.
In gastric sleeve, the stomach is reduced to 1/5th of its original size by cutting away 4/5th. One significant difference here is that gastric sleeve is accompanied by a reduction in ghrelin (a hunger hormone). However, while LAGB can be reversed, LGS is irreversible.
Methods/duration of surgery
Although open surgery can do gastric banding and gastric sleeve, both procedures are commonly performed by a laparoscopic approach where equipment with the camera is introduced into the abdomen through small incisions. The duration of LAGB is slightly shorter than that of LGS (94min vs. 116min). The average length of hospital stay for LAGB is also shorter than that of LGS by one day. 
Cost of surgery/insurance coverage
This varies by countries and hospitals. The cost of LAGB is $18,000 ($15,000 to $24,000) in the U.S., while that of gastric sleeve surgery is $15,000 ($12,000-$20,000). They may be done at lower costs outside the U.S. most insurance policies cover both with slightly different requirements for approval.
The outcomes of weight loss surgeries are measured by the percentage of excess weight loss, the degree of improvement/resolution of comorbid conditions, the risks of complications and the risk of death. Although both surgeries are safe and efficient, the following differences have been noted as regards their outcomes:
Expected weight loss
Wang et al. in their review of many earlier studies found that the percentage excess weight loss at 12 months after surgeries were 37.8% and 51.8% for patients who underwent LAGB and LGS surgeries respectively.  The average percentage excess weight loss expected in patients who did gastric sleeve surgery was 59% while that of patients who did gastric banding was 49% at 18-24 months after the surgery. Thus, gastric sleeve surgery offers a higher weight loss than gastric banding.
Reversal of comorbid conditions
Diabetes mellitus improved in more patients after gastric sleeve surgery than after gastric banding. Wang et al. reported improvement in type 2 diabetes mellitus is 82.5% of those who underwent gastric sleeve surgery and 61.8% of patients who had gastric banding. Omana et al. also reported a higher resolution in type 2 diabetes mellitus (100% vs. 46%), high blood pressure (78% vs. 48%) and reduction in bad lipids (87% vs. 50%), in people with gastric sleeve surgery than those with gastric banding. The resolutions/improvements in other disease conditions (gastro-esophageal reflux disease, osteoarthritis, sleep apnea) were noted to be the same. 
Complication rates are higher after gastric sleeve surgery than gastric banding. The postoperative complications of gastric banding include nausea, band migration, band leakage and incisional hernia. Common complications of gastric sleeve surgery are leakage from staple line, intra-abdominal bleeding/abscess, heartburn, etc. Nutritional deficiencies are rare and similar in both operations. Although the risk of death from all weight loss surgeries is minimal, that of gastric sleeve surgery is even lower with gastric banding having the most moderate risk of mortality.
In summary, the comparison between laparoscopic adjustable gastric banding and laparoscopic gastric sleeve surgeries is as shown in the table below:
Mechanism of weight loss
Duration of procedure
Length of hospital stay
Estimated weight loss
Reversal of comorbid conditions
Risk of complications
Risk of death
In conclusion, gastric banding and gastric sleeve surgeries are both effective at inducing weight loss and reversal of comorbid conditions. While gastric banding is reversible and has lower risks of complications, it is relatively more expensive than gastric sleeve surgery. On the other hand, gastric sleeve surgery is cheaper, causes more weight loss and better improvement in obesity-associated disease conditions but associated with higher risk of complications.
- Varela JE. Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Adjustable Gastric Banding for the Treatment Severe Obesity in High-Risk Patients. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 2011;15(4):486-491. doi:10.4293/108680811X13176.
- Wang S, Li P, Sun XF, Ye NY, Xu ZK, Wang D. Comparison Between Laparoscopic Sleeve Gastrectomy and Laparoscopic Adjustable Gastric Banding for Morbid Obesity: a Meta-analysis. Obesity Surgery. 2013;23(7):980-986. doi:10.1007/s11695-013-0893-3.
- Omana J, Nguyen S, Herron D, Kini S. Comparison of comorbidity resolution and improvement between laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. Surgical Endoscopy. 2010;24(10):2513-2517. doi:10.1007/s00464-010-0995-0.
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