- Four standard operations under the Dutch guideline: sleeve, bypass, mini bypass and SADI.
- The gastric bypass is the most common first operation in the Netherlands.
- The gastric band is hardly ever placed any more.
- The gastric balloon is temporary, non-surgical and rarely reimbursed.
- Revision surgery is a follow-up operation when results or symptoms disappoint.
How many types of weight loss surgery are there?
Articles that mention two or three types usually mean the sleeve and the bypass, sometimes with the mini bypass added. Those are the three operations nearly every Dutch centre offers as a first procedure. The Dutch surgical guideline on obesity (NVvH) lists four standard operations: the SADI belongs to them as well, although it is mainly used as a second step after a sleeve.
The gastric band used to be on that list, but it has been abandoned as a standard treatment because many bands had to be removed again after a few years. The gastric balloon is not an operation at all: it is placed through the mouth and removed again after six to twelve months.
The real difference: stomach only, or stomach and intestine
A gastric sleeve only makes the stomach smaller; the intestine is left alone. With a gastric bypass, a mini bypass or a SADI, part of the small intestine is also bypassed. That rerouting changes the gut hormones, which explains why bypass procedures have a stronger effect on type 2 diabetes, and also why vitamin and mineral deficiencies are more common afterwards.
Which type suits which situation?
You choose together with the team during the screening. A bypass is the logical option with type 2 diabetes, reflux or a strong preference for sweet food. A sleeve is often chosen with many abdominal adhesions, a BMI above 60 or an intestinal disease such as Crohn's disease. The SADI is mostly a second step, for example about two years after a sleeve when the starting weight was very high.
If you do not qualify for surgery, or do not want it, there are other routes: a combined lifestyle programme (GLI), weight loss medication with supervision, or a gastric balloon.
Advantages and drawbacks per type
Advantages
| Advantage | Explanation |
|---|---|
| Gastric bypass | most experience in the Netherlands, strong effect on type 2 diabetes and reflux |
| Gastric sleeve | intestine stays intact, technically simpler |
| Mini gastric bypass | one connection, few internal hernias |
| SADI | most additional weight loss after an earlier sleeve |
Points of attention
| Point of attention | Explanation |
|---|---|
| Gastric bypass | dumping, internal hernia, lifelong supplements |
| Gastric sleeve | irreversible; reflux can increase |
| Mini gastric bypass | slightly more bile reflux |
| SADI | strictest follow-up; fat is poorly absorbed |
Cost and insurance (2026)
The four standard operations are covered by the Dutch basic health insurance (basispakket) if you meet the criteria and have a referral. The gastric balloon is almost never reimbursed.
| Item | Amount or arrangement |
|---|---|
| Sleeve, bypass, mini bypass or SADI (covered) | €385 mandatory deductible (eigen risico) 2026 |
| Self-pay in the Netherlands | roughly €7,000 to €11,000 |
| Gastric balloon (Vitalys) | €3,995 + €65 intake, not reimbursed |
| Revision with a medical reason | basic package, deductible applies |
Types of weight loss surgery: key figures
| Feature | Value |
|---|---|
| Standard operations in the Dutch guideline | 4 |
| DATO-certified centres | 20 |
| Serious complications nationally (2024) | 1.4% |
| Criteria | BMI ≥ 40, or ≥ 35 with a related condition |
| Gastric band | abandoned as standard |
| Gastric balloon | temporary, no surgery |
All types at a glance
| Type | Intestine bypassed | Status in the Netherlands |
|---|---|---|
| Gastric sleeve | no | standard |
| Gastric bypass | yes, two connections | standard, most performed |
| Mini gastric bypass | yes, one connection | standard |
| SADI | yes, long bypass | standard, usually a second step |
| Gastric band | no | abandoned as standard |
| Gastric balloon | no | not surgery, not reimbursed |
Step by step
- Read up. Understand the options and check your BMI.
- GP referral. Your GP (huisarts) refers you to a bariatric centre.
- Screening. The team assesses whether and which surgery fits.
- Choice. You and the surgeon agree on the procedure.
- Surgery and aftercare. Keyhole surgery, then at least five years of follow-up.
Read next
- Gastric sleeve in the Netherlands — how it works
- Gastric bypass explained — the most common operation
- Cost and insurance coverage — what you pay in 2026
- Eligibility criteria — who qualifies
Frequently asked questions about the types of weight loss surgery
Four standard operations: the gastric sleeve, the gastric bypass, the mini gastric bypass and the SADI. You may also read about the gastric band, which is no longer a standard option, and the gastric balloon, which is not surgery. Revision surgery is a follow-up step rather than a separate type.
The gastric bypass. Dutch centres choose it most often because they have the most experience with it. The sleeve comes next, mainly when a bypass would be technically harder or riskier for you.
Among first operations the bypass procedures: roughly 30 to 40 percent of total body weight, compared with about 20 to 30 percent after a sleeve. After an earlier sleeve, the SADI gives the most additional loss, but it also needs the strictest follow-up.
All four have a favourable risk profile; nationally, 1.4 percent of patients had a serious complication in 2024. The sleeve and mini bypass are technically slightly simpler, but the team decides based on your situation, not on technique alone.
You are involved in the decision, but the final choice is medical. The team looks at your BMI, related conditions, eating pattern, reflux and earlier abdominal surgery before recommending a procedure.
Not strictly. The stomach is not surgically reduced: a balloon temporarily takes up space so you feel full sooner. It is removed after six to twelve months and is almost never covered by Dutch insurance.
The four standard operations are, from the basic package, when you meet the criteria and have a referral. You then only pay your mandatory deductible of 385 euros in 2026. The balloon is not covered; revision usually is when there is a medical reason.
The gastric bypass. Because of the rerouting, blood sugar often improves within days. Vitalys calls the bypass the first choice with type 2 diabetes, provided the rest of your medical history allows it.
Yes, through revision surgery. Common conversions are gastric band to bypass and sleeve to SADI or bypass. A second operation carries a higher risk than the first and requires a new screening.
Many Dutch hospital staff speak good English, but the screening, group sessions and written materials are often in Dutch. Ask the centre in advance what they offer in English and whether an interpreter can join key appointments.
Call +31 6 38048347 (Mon–Fri 09:00–17:00) or email info@maagverkleining-info.nl. This page is also available in Dutch.
Sources
- Richtlijn Chirurgische behandeling van obesitas, Dutch Society for Surgery (NVvH)
- DATO Annual Report 2024, Dutch Institute for Clinical Auditing (DICA)
- Vitalys (Rijnstate): types of surgery and FAQ
- WeightWorks: types of bariatric surgery
Search terms leading here: types of weight loss surgery Netherlands, bariatric surgery types, obesity surgery Netherlands, sleeve or bypass.
Author: Gijs Bodenstaff. Last reviewed: September 2026.