Gastric Banding vs. Gastric Sleeve: What’s the Difference?

Dr. Christopher McGowan
September 25, 2020

If you’ve ever looked into bariatric surgery procedures, you know there are a number of different options to choose from. It can be difficult to know which might be best for you, particularly if it comes after repeatedly struggling to find success with traditional weight loss methods like diet and exercise. You might be fed up with the demoralizing process, and you’re looking for a more effective solution. At True You Weight Loss, we believe strongly in a non-surgical approach that is less invasive and has a quicker recovery time, but it can also be helpful to be aware of the alternatives for the sake of comparison. Two such alternatives are gastric banding and gastric sleeve. 

How Are Gastric Banding and Gastric Sleeve Different?

One of the main goals of many types of weight loss surgery and the non-surgical procedures offered by us at True You is to create a sense of fullness more rapidly than normal. This is achieved through various methods, but in general it means limiting the amount of food that can actually enter the digestive system. In this way, it becomes easier to maintain an ongoing caloric deficit; that is, consuming fewer calories than you’re burning through just being alive and getting through your day. Over time, having your metabolism work while in a caloric deficit will force the body to burn excess fat for energy in addition to the calories consumed.   

The main difference between the gastric banding and gastric sleeve surgeries is the mechanism that creates that feeling of fullness. Gastric banding involves an adjustable gastric band (also known as a LAP-BAND) being placed around the top part of the stomach near where the esophagus enters it. The constrictive silicone band encircles this narrow part of the stomach and effectively creates a small stomach pouch that limits the amount of food that can be ingested in one sitting. The band itself is attached to a tube that is connected to a “port” made through the skin on the abdomen; through the port, the surgeon can inflate or deflate the band with a harmless saline solution. It is through this inflation and deflation that the doctor can control the width of the opening from the new pouch to the rest of the stomach. 

By contrast, the gastric sleeve procedure (known as a sleeve gastrectomy) works by actually reducing the size of the stomach. Like gastric banding, the gastric sleeve surgery is performed through the use of a laparoscope, a specialized surgical camera that allows a surgeon to operate on a person with only a few small incisions. Once inside, the surgeon actually removes about 80% of stomach tissue along the greater curvature. The remaining portion of the stomach is reformed and stapled together into a banana-shaped “sleeve.” With only around 20% of remaining stomach volume, the feeling of fullness after eating occurs much more quickly.  

The other significant difference between the two surgeries is related to whether or not the procedure can be reversed. A consequence of the gastric sleeve surgery involving the removal of so much stomach tissue means that it is permanent; there is no way to replace the part of the stomach that was removed. On the other hand, the adjustable gastric band in LAP-BAND surgery can actually be removed if you don’t want it anymore. Additionally, since the inflatable band is connected to the port in your abdomen, it allows a surgeon to make adjustments to the size of the opening in your stomach. In some cases, the doctor will start out with a wider opening and then gradually reduce it as you get more used to eating less food.

What are the Pros and Cons of a Sleeve Gastrectomy?


  • Solid Results: Gastric sleeve patients have been known to lose up to 60% of excess body weight over the first year after the surgery.
  • Comparatively Simple: Compared to gastric bypass surgery, which used to be referred to as the “gold standard” of bariatric surgery, gastric sleeve surgery is more straightforward and has less chance for complications.
  • Fewer Dietary Concerns: Some surgeries can negatively impact the absorption of nutrients when food is ingested, but with the gastric sleeve, nutrient malabsorption isn’t a problem.


  • Permanent: As noted above, the surgery is permanent and can’t be undone.
  • Complications: Though sleeve gastrectomy is relatively safe, there can potentially be complications such as bleeding from the incisions. There is also a risk of leaks through the sutures in the newly formed stomach.
  • Recovery Time: After an overnight hospital stay, full recovery and a return to normal activities can take up six weeks.
  • Dumping Syndrome: Though rare, dumping syndrome is more likely to be a factor with gastric sleeve surgery. Dumping syndrome is when undigested food in the stomach moves too quickly into the small intestine, causing problems with the small intestine and diarrhea. 

What are the Pros and Cons of Gastric Banding?


  • Reversible: The gastric band is designed to be both adjustable and removable. So if, after a period of time, you aren’t happy with the band, you can go through another laparoscopic surgery to remove it.
  • Decent Results: While generally not as effective as gastric sleeve or gastric bypass, adjustable gastric banding can help you lose up to 50% of excess weight.
  • Fewer Complications: Because the only incisions are those used to insert the laparoscope and place the abdominal port, gastric banding typically has fewer complications.


  • Slower Results: After gastric band surgery can take longer to see results compared to some other methods. Additionally, the weight loss can come later in the process; as a result, some patients are prone to losing motivation to continue with the kind of dietary changes that are necessary for it to be successful.
  • Foreign Device: Even though it is demonstrably safe, many people just aren’t comfortable with a “device” residing in their body over a long period of time. Also, because it’s a device, malfunctions can potentially necessitate reoperations to correct the problem.

Alternative to Surgery

It’s important to remember that any type of bariatric surgery carries various risks and potential side effects. Moreover, even laparoscopic surgery, which is considered minimally invasive, still involves a recovery process that can take up to six weeks. For all these reasons, we at True You believe there’s a better way to reach your weight loss goals that doesn’t involve surgery. 

Perhaps our most popular weight loss procedure is called endoscopic sleeve gastroplasty (ESG). As opposed to the other two surgeries explored here, ESG involves the use of an endoscope that is carefully inserted down the throat while you are under sedation; in fact, the entire procedure is performed through the use of tiny tools mounted to the end of the endoscope and without the need for any incisions. Once in the stomach, we will use a suturing tool to create a sleeve that is similar in shape to the gastric sleeve surgery. In this case, though, the smaller stomach cavity is formed by making the sutures from inside the stomach.  

The ESG procedure usually takes between 30 and 45 minutes, and the end result is a stomach that is approximately 80% smaller in size. As with the gastric sleeve surgery, the smaller stomach size keeps you feeling full sooner after meals, thereby creating the caloric deficit that will have you on your way to losing weight. The procedure isn’t the only aspect that’s faster, though: the procedure is outpatient, so you’ll be able to go home that same day and be able to return to normal activities usually within a couple days. The best part, though, is that most of our patients will be able to lose 70% of their excess weight—all without the need for actual surgery.

Freedom is Waiting

If you’re tired of relying on traditional weight loss methods to get the body you’ve always wanted, it’s time to think differently. At True You, we understand the challenges of trying to lose weight, and we want to help you achieve your goals. request a consultation today to speak with a weight loss expert; we’ll be thrilled to talk with you about ESG or any of our other weight loss solutions, and we’ll help you find the right path for you.

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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