Sleeve vs. Gastric Bypass

[LovinLife 0]

I had my surgeon consultation last week and he recommended gastric bypass over the sleeve. :sad0:This was confusing to me because he performs both but feels the sleeve is actually more risky because of the large area that is stapled and the possibility of leaks. I thought it was less risky since the intestines are not involved. He likes the long term results of the bypass and the sleeve is too new to have a long track record. He is entitled to his opinion but I really want the sleeve and I know I have a choice.

So to the sleeve community, can I get some feedback on why you have chosen the sleeve vs. gastic bypass? I would appreciate your thoughts!:biggrin0:

Also, is there a comparable site for gastric bypass patients? It's a big decision and I want to read as much as possible.

[Tiffykins 672]

The risk for a leak with RNY is actually higher because it's a more difficult staple line. If your surgeon has done more RNY bypass staple lines, he may not be comfortable doing sleeves if he doesn't have the experience. Technique gets better with experience, and if he doesn't have a lot of sleeves under his belt then his sleeve patients may not do as well as his bypass patients. RNY immediate complications are practically double vs. VSG. It's been well documented. I've lost just as much if not more that some RNY patients that started out with similar pre-op stats. If I were to consider a malabsorptive procedure, I would not waste my time, money on RNY. I'd go full Duodenal Switch. Grant it, neither of the malabsorptive procedures were an option for me. I didn't entertain either of them, but the DS is by far superior over RNY with long term results.

There are some 5 year results out for VSG that show that VSG results are extremely close to what the weight loss that is seen with RNY.

You do have a choice, and I firmly believe that no one, even a doctor, should not try to convince someone of a different surgery. I had it happen to me. The first time it was my band surgeon trying to convince me to get RNY, and during my revision, the assisting surgeon tried to tell me to do bypass instead of the sleeve.

The one place you can look for more information on RNY is on obesityhelp.com

If you're looking at both, check out the Revision forum, the RNY forum, the Failed Weight loss surgery, and the hunger and food issue forum over there. You'll see that out of all the surgeries, RNY patients are seeking the most revisions along with band patients, and that RNY patients have long term complications with food, hunger, weight regain.

Here are some of the reasons I chose VSG over RNY for my revision from the band.

1) RNY only gives you 2 years of calorie malabsorption of calories, but a lifetime of Vitamin malabsorption which can lead to later complications and deficiencies.

2) I had a pouch with my band, it is not natural, and the RNY gives the same pouch. My body hated the band pouch, and the RNY was not going to be any different.

3) I did not want a blind stomach that could not be easily scoped, but could still develop ulcers and cancer.

4) I wanted no medication or food restrictions.

5) Only 30% of RNY patients dump on sugar, it's not really a guarantee. If I want to eat a cookie, I don't want to suffer negative, self-induced consequences if I happen to be in that 30%.

6) I know several people in real life that have had major regain with RNY. Also, the complications that come 3-8 years later are just scary in my opinion.

7) I like the fact that my stomach is a normal stomach with function, just smaller in size.

I hope this helps.

[jerryvic 3]

Tifftykins forgot to mention the mortality rate of RNY, I have read and had confirmed by my surgeon that it is around 2%. That is two out of a hundred surgeries go bad. With the sleeve the mortality rate is .003% That is an very large difference. I went with the sleeve because of this and the other things Tiffykins commented on.

Have you asked your Dr. "have you had any deaths associated with RNY surgery?" " What was the most major complication associated with RNY you have had?" Ask the same things about VSG. Also ask how many VSGs have you done?

Statistics can and often are manipulated by the person wanting to prove a point. ie.. It does not matter if he has never had a death associated with RNY if you are the first.

I don't want to scare you, but the fact is there are more deaths and complications associated with RNY than Drs will let on. It is your life, so ask him/her. Then make a decision from all the facts you have been given.

Edited June 16, 2010 by jerryvic

[Bornagainbabe 4]

Another point worth mentioning is that gastrectomies, i.e. for stomach cancers etc., have been performed for years with relatively few complications in later years.

[deletedsally 8]

I'm not going to repeat everything that Tiff already posted. If your surgeon is telling you that you are more likely to have complications from VSG than bypass surgery, his statement could be based on his own experience with RNY and lack of experience with VSG.

However, his statement to you is not supported by the medical research that is readily available. I had a surgeon that I interviewed at a Bariatric Center of Excellence tell me that other doctors doing VSG's in Florida didn't know what they were doing, and that he didn't perform "that surgery". I did more research, and then I found another Florida surgeon who has an excellent reputation and 25 years of experience doing bariatric surgeries. This surgeon's son had a VSG. For a doctor who has 25 years experience doing weight loss surgeries to tell me that his son had a VSG, that speaks volumes about which surgery is the better choice.

I chose the sleeve because it is the weight loss surgery with the lowest risk of complications.

[pcindy 8]

All I'm going to say is, as a nurse who has taken care of plenty of bypass patients, I'd rather die of morbid obesity than have a bypass. That's what I think of the surgery and it's track record of complications.

[pumpkin07 32]

Well, this happened to my friend also. But it turned out it was more of an insurance issue b/c he knew her insurance would not cover the sleeve. She loves her doctor and went with his opinion and so far is doing great. Her friend had the bypass and she is also doing great, although lost a little more than she would like to have. She is a size 2. I have a relative that had the bypass 6 years ago and she can no longer absorb Iron so there is a concern of bleed out. She is looking at having hers reversed. If you read on line there are plenty of celebs looking at having their bypass reversed.

For me I wanted caloric restriction just by food volume, not by malabsorbtion. I would never have had the bypass b/c I have a very long life to live and didn't want to be dependent upon more and more surgeries to modify and so forth. The sleeve appeared to be a one stop shop in comparison to the bypass and the band.

Also, the stomach pouch made during the bypass is made from the stretchy part of the stomach, right. The sleeve is made from the tougher muscle that does not stretch easily. So that makes some common sense.

I know there are still doctors that prefer the bypass, I'm just not sure for the patients it is the best bang for the buck. It would be very sad to lose all the weight to turn around and have to have another surgery.......I think the sleeve is the safer bet. I didn't know about the mortality rates after surgery being different. But I think long term that might be true as well.

I would get a second opinion and maybe this is a clue this is not the right doctor. How many sleeves has your doctor done? My doctor had only done like 23. OMG I didn't know at the time that was a problem, but believe me, now I know. They say to get a doctor that has done a lot so you are not his guinea pig. But my surgery did go just fine.

[rani7 1]

I'm so impressed with your weight loss!!! I want to do the same. Can you tell me how many calories were you consuming per day to lose 100 pounds in 4 months?

[Husky2Healthy 1]

I agree with Tiffykins & Katt, sounds like you have doctor not yet completely comfortable performing VSG's. This is your body, and your life, even if you are restricted with insurance issues you can ALWAYS get a second opinion. I changed doctors, on the bright side, most the hoops I had jumped (phych evaluation, sleep apnea testing, ect.) was done and I just had to request copies for the new doctor. Take your time, research wls doctor's in your area or if you are going through insurance, talk to your insurance rep to get help finding a doctor you feel comfortable with.

Don't get discouraged, just consider yourself and experienced patient, make a list of questions and keep going until you find a doctor you feel comfotable with or a doctor who CLEARLY explains why for YOU a different WLS procedure would be better.

Hope this helps,

Steven

[Travis Goodnight MD FACS 3]

Interesting that your surgeon is pushing you toward the bypass. A recent study out of Japan showed that severe diabetics may benefit more from the bypass and have resolution of their diabetes but that study was a "mini gastric bypass" which is very commonly done in the U.S. and the patient population was a bit different. At the International Sleeve Gastrectomy Summit this year, it was discussed whether patients with severe GERD should have sleeves and many thought that gastric bypass would serve them better. There was no consensus on that and I don't push my patients in any direction.

As long as a patient is well informed of the pluses and minuses, I believe it's their choice. Now if you take a lot of NSAIDs for arthritis, then I would stay away from the bypass. Most of us like the sleeve because it can always be converted to a gastric bypass or duodenal switch if needed. Thank goodness most don't need that.

Just talk to your surgeon about your worries. Why does he/she think bypass would benefit you better? And remember, this is your decision and your body.

[sasicas 194]

I have many friends who have done the gastric bypass.

My aunt-had the bypass about 4 years ago, lost tons of weight and was able to walk again, fast forward 4 years and she is regaining at a fast rate

Friend-had the bypass probably 5 years ago, spent a month in ICU, had multiple surgeries since to repair issues she had due to the bypass. Now she is regaining

2 Friends-lost all the weight and then some, both are having to eat junk food daily just to keep their weight from continuing to drop

Friend-Had bypass about a year and a half ago, a few months in she was rushed to the ER for severe pain, she had an ulcer form at the staple line where her intestines were, the ulcer burst. She was immediately brought in to surgery, where they had to repair the damage, remove more intestines, and basically do the surgery all over again. Not long after that, she again had a similar situation and they had to redo the surgery AGAIN! Then she was unable to eat, could only get certain junk foods down, went under 100 lbs. After lots of testing they decided to go back in, they decided that instead of producing too little acid, she produces too much acid, and that was causing her ulcers. They went in AGAIN, did some repairs and now she is on a PPI that seems to be helping and she is finally able to eat real food and gaining weight back. The surgeons told her that if this happens again, she will be on a feeding tube for life.

The biggest issue I have seen with my friends that have had gastric bypass is the food intolerances, I have not seen this with my sleeve friends. There are plenty more who are doing just fine with the bypass, no issues at all but it is not something I wanted to risk.

I did have to laugh at my surgeons intern, he came in first for my consultation, he asked what I wanted and I said sleeve. He then goes on telling me that the RNY was probably a better option, I would lose 10% more weight. Im sorry but a lifetime of issues with Vitamin levels is not worth losing another 8-10 lbs as I started out "low" on the BMI scale. He said I needed to be open and my surgeon would discuss it with me. Surgeon came in and the first thing he said was the sleeve was a good decision and the sleevers lose just about the same amount as the RNY patients.

[disneyfan 0]

Good for you doing your research. My mom had a RNY 9 years ago and has maintained an over 300 pound weight loss with minimal complications. I am looking into the sleeve for myself as I 'only' have 75-100 pounds to lose and minimal comorbidities compared to my mom. Which procedure is better depends on your weight before surgery and your comorbidities.

[SKCUNNINGHAM 298]

In the research I did, it stated that surgeons that have done fewer than 100 sleeves have a higher complication / mortality rate than surgeons who have done more than 100. If your surgeon doesn't have 100 sleeves under his belt, go to another surgeon for your sleeve. Also, if the hospital hasn't done 150 sleeves, their complication / mortality rates are higher. So check out your target hospital's track record, too.

I chose the sleeve because it was a much simpler surgery and had as good of results as the bypass. I didn't want my insides replumbed. I didn't want the longterm side effects of the bypass. And I travel for my work, and I thought it would be easier to travel with a small sleeved stomach than to travel living with a bypass.

[Brian66 85]

That's funny, becasue I had just the opposite experience. I went to my initial consultation with my surgeon to discuss the RNY bypass (I know I did not want the band) and it was the surgeon who convinced me to have the VSG. I had seen mention of the VSG in my research but not paid any attention to it. Certainly, insurance coverage was a factor -- my insurance company had just started covering VSG when I saw my doctor. My sense is he probably wouldn't have mentioned it if he knew my insurance company would not cover the procedure. Once I starting doing the research (including finding this site), I knew that I wanted the VSG.

Here I am -- one year post-op -- and 120 pounds lighter. I am thrilled with my decision and I have never looked back. I will always be grateful to my surgeon, Dr. Mitchell Roslin for recommending the VSG.

All the best to you,

Brian

[Shell77 0]

When I went to the consultation, I went in thinking about getting the Bypass. They went over all 3, the band, sleeve and bypass. Both the dietian and Dr. told me that the risks with the sleeve were much much lower and the wieght loss difference would only be about 10-15 lbs. and I could lose that on my own. They said it was completely up to me but they wouldn't take on all of the other risks with a bypass just for 10-15lbs. The Dr. also told me that there is a greater chance of having a leak with the bypass because there are several incisions, where as the sleeve only has one. I decided to go with the sleeve and get it done on 8-9-11.

You should do what you feel comfortable with and if the Dr. has a problem with it, I would find another Dr.