Surgery Comparison Centre 2.0
Compare the operation — not just the headline weight loss.
Sleeve, Roux-en-Y bypass, OAGB/mini bypass, gastric band, balloon and ESG compared across anatomy, weight-loss evidence, reflux, diabetes, reversibility, nutrition, recovery, revision and NHS relevance.
A procedure that looks strongest for average weight loss may create a less attractive reflux, nutrition or permanence trade-off for a particular person. The comparison needs to look beyond kilograms.
Procedures at a glance
| Procedure | Type | Relative weight-loss effect | Reversible? | Reflux context | Nutrition burden | NHS context |
|---|---|---|---|---|---|---|
| Sleeve gastrectomy | Laparoscopic surgery | High | No | Can worsen or cause reflux in some people | Long-term vitamin/mineral supplementation and monitoring required | Common NHS bariatric procedure where specialist assessment supports it |
| Roux-en-Y gastric bypass | Laparoscopic surgery | Very high | Technically revisable but not treated as a simply reversible procedure | Often considered favourable where significant reflux is a major issue | Higher long-term micronutrient burden than sleeve; lifelong supplements and blood monitoring are important | Established NHS bariatric procedure |
| One-anastomosis gastric bypass | Laparoscopic surgery | Very high | Revisable but not a simple reversible treatment | Bile reflux is an important procedure-specific consideration | Meaningful micronutrient/protein malabsorption risk; long-term monitoring essential | Offered by some NHS bariatric centres; not universal |
| Adjustable gastric band | Laparoscopic surgery with implanted adjustable band | Moderate | Yes, removable | Can cause/worsen reflux, regurgitation or swallowing symptoms | No intestinal malabsorption, but diet quality and follow-up still matter | Much less prominent in modern NHS bariatric practice than historically |
| Intragastric balloon | Endoscopic temporary device | Low to moderate | Yes, temporary/removable | Can worsen reflux/nausea in some people | No intestinal malabsorption, but adequate nutrition and structured follow-up still needed | Limited/selective availability; not a routine substitute for bariatric surgery |
| Endoscopic sleeve gastroplasty | Endoscopic suturing procedure | Moderate | Potentially revisable/reversible in some circumstances, but not equivalent to simply 'undoing' a band | May be preferable to sleeve in some reflux contexts, but individual assessment matters | Lower malabsorptive burden because intestine is not bypassed | NHS now describes ESG as a weight-loss procedure, but availability is not universal |
Procedure Battle
Pick any two procedures
Big decisions that often change the procedure discussion
Reflux
Sleeve can worsen reflux in some people, while Roux-en-Y bypass can be a more attractive discussion where reflux is significant. This needs surgeon-level assessment rather than a website rule.
Type 2 diabetes
Bypass procedures have particularly strong metabolic evidence. Diabetes severity, medicines and individual anatomy still matter.
Long-term nutrition
All bariatric patients need follow-up, but bypass procedures carry a greater malabsorptive/micronutrient burden than purely restrictive or endoscopic procedures.
Reversibility
A gastric band is removable; sleeve removes stomach permanently. ESG avoids resection but should not be marketed as if it were a zero-commitment procedure.
Recovery
Endoscopic options generally recover faster than laparoscopic surgery, but procedure intensity is only one part of the decision.
Revision
Weight regain, reflux, malnutrition and device problems can all create revision pathways. “One operation forever” is not guaranteed.
NHS assessment threshold
NICE recommends referral for comprehensive bariatric-surgery assessment for adults with BMI 40 kg/m² or more, or BMI 35–39.9 kg/m² plus a significant health condition that could improve with weight loss, subject to the full guideline and specialist assessment. Lower BMI thresholds can apply for some ethnic groups. Referral is not the same as being offered a particular operation.
Direct comparisons
What the NHS now describes
The NHS weight-loss surgery pages cover gastric bypass, gastric band, gastric balloon and sleeve gastrectomy, and its procedure guide also describes endoscopic sleeve gastroplasty (ESG). That does not mean every NHS bariatric service offers every procedure. Procedure choice and local availability remain specialist-service decisions.
Core sources
Chosen a procedure — now choosing where?
Compare UK and overseas surgery on true cost and the complete aftercare pathway.
Compare UK vs overseasSurgery vs medication or lifestyle?
Cross category boundaries in the Universal Comparison Centre.
Open Universal ComparisonNeed help thinking beyond the procedure?
The Shift Programme keeps the wider health, support and maintenance picture visible.
Considering surgery?
Take a structured question list into your consultation.
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