Head - General, MI & Bariatric Surgery, Artemis Hospitals, Gurgaon, India
Part 4 of 9 in Diagnosis and Management of Obesity and Metabolic Syndrome: The Role of Bariatric Surgery
Intragastric Balloon, Sleeve Gastrectomy or Gastric Bypass: Comparing the Weight-Loss Surgery Options
September 6, 2026
Three weight-loss procedures dominate Dr. Rakesh Durkhure's practice at Artemis Hospitals, and each carries a different relapse profile.
Intragastric Balloon: Fast but Temporary
The balloon is swallowed as a capsule, then inflated inside the stomach to around 500 millilitres. It removes 15 to 20 percent of excess body weight, but because it must be removed after four to six months, roughly 80 percent of patients regain the weight once it comes out.
Sleeve Gastrectomy: A Restrictive Procedure
Sleeve gastrectomy is a restrictive procedure: the surgeon removes the larger part of the stomach laparoscopically using a stapling device, leaving a narrower stomach that physically limits how much a patient can eat. It typically achieves a 30 to 40 kilogram weight loss, with around 40 percent of patients reporting weight relapse within two years.
Gastric Bypass: The Lowest Relapse Rate
Gastric bypass is malabsorptive: patients can eat a somewhat larger amount than after a sleeve, but absorb less of what they eat. It carries the lowest relapse rate of the three options, just 5 to 10 percent, and Dr. Durkhure specifically recommends it once a patient's weight passes around 125 kilograms.
← Who Qualifies for Bariatric Surgery? Patient Selection Criteria | Series index | How Bariatric Surgery Reverses Type 2 Diabetes →
This article is based on a Jivo Masterclass session conducted by Dr. Rakesh Durkhure, Head - General, MI & Bariatric Surgery, Artemis Hospitals, Gurgaon, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Rakesh Durkhure taught doctors across Africa on May 4, 2025.
FROM THE LIVE Q&A
Moderator
Does that cost range apply to all four surgical options, or just the one with the lowest relapse rate?
Dr. Rakesh Durkhure
That figure is for the option with the lowest relapse rate, gastric bypass. The other options cost somewhat less, roughly $1,000 less.
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Frequently Asked Questions
What is the risk of internal hernia following surgery, and what about the risk of leakage?▼
I can say with complete confidence that I have never seen an internal hernia, because every possible site where one could form is repaired during surgery. Leakage is the most feared complication, and we haven't seen that either, because we run a puncture test during surgery to check for any leak before closing. I also record the video of every surgery and give it to the patient at discharge, so they can show it to their own doctor back home.
Given that some patients trust surgery while others fear relapse, how can African doctors approach counseling patients on this?▼
Dr. Durkhure pointed to his own track record: he has operated on patients referred from Kenya, Nigeria, Mozambique, Ghana, Chad, Rwanda, Burundi and Congo. Those success stories can be shared directly with patients, and follow-up online consultations can address whatever questions remain.
How does the cost of surgery compare with the lifetime cost of medical management, in terms of return on investment?▼
Ozempic and Mounjaro cost about $500 a month in India and have to be taken indefinitely. The cost of surgery is recovered within about a year of what that ongoing medication would have cost. After that, the only requirement is vitamins and good nutritious food.
Beyond bariatric surgery, what other conditions can African doctors refer to your service?▼
The scope goes well beyond bariatric surgery. It includes hiatus hernia, where the stomach moves from the abdomen into the chest, gallbladder stones, particularly complicated cases where a stone has slipped into the bile duct, and problems of the colon and small intestine. It also covers complex abdominal hernias, including inguinal, umbilical, and recurrent hernias that have come back after a local repair, as well as rectal prolapse, complex piles and haemorrhoids, and fistulas near the back passage. All of these can be managed and the patient sent back with a satisfactory outcome.
What are the early signs of obesity?▼
A waistband that keeps needing loosening is the earliest sign. A partner reporting loud snoring at night is another. And marked breathlessness after something as minor as running 100 metres is a third.
Which weight-loss surgery has the lowest relapse rate?▼
Gastric bypass, with only 5 to 10 percent of patients reporting weight regain, compared with around 40 percent after sleeve gastrectomy and roughly 80 percent after the balloon is removed.
Why does the intragastric balloon have a high relapse rate?▼
Because it must be removed after four to six months, after which around 80 percent of patients regain the weight it helped them lose.
In This Series: Diagnosis and Management of Obesity and Metabolic Syndrome: The Role of Bariatric Surgery
- 1.Diagnosis and Management of Obesity and Metabolic Syndrome
- 2.Metabolic Syndrome: The Five Components and the Early Warning Signs of Obesity
- 3.Who Qualifies for Bariatric Surgery? Patient Selection Criteria
- 4.Intragastric Balloon, Sleeve Gastrectomy or Gastric Bypass: Comparing the Weight-Loss Surgery Options
- 5.How Bariatric Surgery Reverses Type 2 Diabetes
- 6.Bariatric Surgery Outcomes: What the Data Shows on Sleep Apnea, Blood Pressure and Quality of Life
- 7.Inside a Safe Bariatric Surgery Program: Team, Technique and Complication Rates
- 8.Cost of Bariatric Surgery in India Versus a Lifetime on Weight-Loss Medication
- 9.Beyond Bariatric Surgery: When to Refer a Patient for General and GI Surgery