Search the Community

Hello all - new here. I just had my initial consults at the Cleveland Clinic and I am excited/terrified about the gastric bypass procedure. I am not scheduled yet but in the process of getting approved. I have a few questions for the veterans out there: 1) Post bypass, will my remnant stomach growl or ever get hungry?! The docs could not answer this question. And 2) Post surgery, can I ever eat a little pasta ever again? I am anticipating grieving over some of my favorite foods and pasta tops my list. Can I no longer eat carbs at all? Thanks in advance, folks. I have a lot of anxiety over having my digestive system replumbed and am worried about malnutrition. 🤓

you'll likely have to take vitamins with the sleeve, too - maybe not as many because it doesn't have the malabsorption piece, but the sleevers I know in person all take them. I see people above saying not necessarily - that it depends on the person and their lab results. They would know more than I would since I didn't have that surgery, although I think the majority of sleevers do take daily supplements. I didn't have any food restrictions once I got a ways out from surgery. I couldn't eat those things you mentioned when I was early out, but eventually, I was allowed to add those things back to my diet (although I had a regular bypass - not a mini bypass. Not sure if it would be different with a mini or not. I would think not - but then, I'm not familiar with that surgery)

the sleeve is an easier, less complicated surgery and some surgeons are more comfortable doing that one. If you want bypass and she won't do it, you can always go to another surgeon. Yes - there's a greater risk of complications with a bypass, but the risk of major complications with either surgery is pretty low. I've been hanging around on bariatric surgery sites for around seven years, and yes - although some bypass patients need iron infusions because they don't absorb enough iron from oral tablets, I would say that's definitely not the majority. I went with bypass because it has a longer history and I had GERD. I've had no issues with it and have been very happy with my decision.

Actually you only need to continue with vitamin supplements with a sleeve if you personally need to i.e. blood work show you’re low in specific vitamins, etc. The sleeve only changes your tummy not other parts of your digestive system. The additional changes that occur with a bypass does increase the impact on your ability to absorb the necessary nutrients. I had sleeve surgery & haven’t taken a vitamin since month 8 when I was in maintenance. But digestive systems can work differently cause we have different physiologies so you may need to take vitamin supplements regardless of the surgery you have. Generally the post surgical diets for sleeve & bypass are pretty similar. The staged return to eating (liquids, then purées, then soft food & finally more solid foods) is to support your sensitive & healing digestive system. There also are certain foods you introduce more slowly into your diet because they’re just too harsh to begin. Both surgeries tend to focus on high protein, low carbs, low fat, low sugar, nutrient dense foods. This is a lifetime thing if you want to maintain your weight loss. In time you can eat most foods just depends on how your body tolerates them but this generally is an individual thing.

I’m having it done here in Atlanta by a highly experienced and respected bariatric surgeon. He has done many of them and likes them because with only the one hook up, there is less chance of future issues or leaking. Does the same as regular bypass…

I agree. This is a big life changing surgery and you should get the one you want. I have bipolar so meds absorption can be a bigger issue with bypass plus I had lower BMI so he thought bypass would be overkill, but even still my dr said he would do it if I really wanted it (but he also stressed the risks). I think you should consider looking to another doctor if that one refuses to do what you want.

Generally, the sleeve will be less fussy than the malabsorbing procedures when it comes to supplement requirements, however, they will all have some initial requirements for the first few weeks or months as you need some additional nutrition since you won't be eating much for a while. Shakes are a part of it, for a variable amount of time, as that's the only way other than real food to get our needed protein. Over time, there will be little that you can't eat with a sleeve -which is good and bad. Good in that you can, in principle, be able to get all of your nutrition from food if you are so inclined (most aren't, which is why they still need to supplement some.) Bad in that you can still eat junk that goes against your weight maintenance goals. Some people need supplements, even with no WLS at all, simply because that is how their body works. Some programs impose the same supplement regimen on their sleeve patients as they do for their bypass patients, not out of necessity for the sleeve but for their own (the practice's) convenience. Periodic lab checks will tell you what you personally need to stay healthy. Are you having your WLS done here in the States, or in MX? The mini bypass is rarely done here in the US and is rarely covered by insurance and AFAIK has not been endorsed by the ASMBS as an approved, mainstream procedure. I would do some further research as to why this is before proceeding. The mini is done in MX, primarily as a cheaper alternative to the RNY, and is also more commonly done in some other countries. Here in the States, I would shy away from it for the same reason that I wouldn't own a French car (irrespective whatever merits they may have) as they haven't been sold here for decades and finding parts and service is a PITA. Likewise, should you have problems with a mini sometime down the road, finding someone who knows how to treat it can be a problem; if you have a sleeve or RNY, any bariatric practice at any hospital will know what you have and how to treat it.

-It is not an unreasonable position for her to keep, as the bypass does indeed provide very similar weightloss and regain results to the sleeve but at a somewhat higher cost in potential problems, limitations in future medical care and increased fussiness on supplements. The bypass is overall a very good procedure that is mature technology - it has been around as a WLS for some 40+ years, and its basis dates back some 140 years, so it is a well known quantity, both good and bad. Her concern about ulcers is well founded, and that is something that one lives with, or at least the threat of them, with the bypass as it is intrinsic to it. One may never experience one, and most don't, but everyone is living to avoid them - it is the basis of the "no NSAID" policy that is common in the bariatric world as one needs to avoid any medications that promote stomach irritation and NSAIDs are the most common class of drugs that we encounter (but there are others that one may encounter through life.) Occasionally someone will come through with an ulcer problem that defies resolution, and their main course of action it to reverse the bypass. This is rare, but it happens. Marginal ulcers are to the bypass what GERD is to the sleeve - you can't fool mother nature and there will always be potential consequences to fooling around with her. One needs to balance what one gets from a treatment against what might possibly occur on downside. Iron infusions are also a fairly common need after bypass, as it malabsorbs minerals in particular, and while some can get away with simple oral iron supplements, many can't and need periodic infusions. This is rare with a sleeve as there is no particular malabsorption. Another factor that weighs on some is the "plan B" factor - what does one do if things don't work as expected - complications, inadequate weight loss or regain? While we don't like to think in terms of getting revisions, they are sometimes necessary, and the bypass is difficult to revise if it doesn't work right; as noted above in the case of intransigent ulcers, the usual is to reverse the bypass and put you back where you started from, and likely still needing help in weight control. The sleeve, on the other hand, can readily be revised to the bypass if needed - typically for intransigent GERD problems - or to a duodenal switch for continuing weight problems. Again, not something we like to think about, but the options are there. The bypass also presents some additional limitations in future medical treatment, as it leave one with a blind remnant stomach and upper intestine, which can't easily be scoped endoscopically as with the natural GI system or with a sleeve. Again, something that may never come up, but likely will sometime in your future life. A further note, your surgeon is in good company, as my doc rarely does bypasses as well, though his preference leans toward the duodenal switch as his primary, with VSG as a second choice. He does, however, do a fair amount of business revising problematic bypasses to the duodenal switch, and will do the odd bypass when it is specifically indicated for a patient, but that is fairly rare.

That's the weird thing, She has 23 years experience and is a surgeon of excellence in a MBSAQIP bariatric center. I don't want GERD and I don't want to have another surgery down the road. It annoys me a bit that the surgeons are like if this doesn't work out we'll change to a bypass later. Not everyone has the funds to keep getting surgeries.

I would seek another surgeon. Her experience is probably lacking in the gastric bypass arena. If I had my choice over again, I'd go bypass instead of sleeve. It would've saved me years of Gerd and sleep issues because of it. That is just my personal experience, of course. Many do not develop Gerd. I had my revision to bypass a little over 3 wks. ago, and I feel so much better now.

Thanks everyone. Your comments have helped. I'm going to ask more questions and maybe contact the previous bariatric center I was working with before. I was really curious to see if anyone else had received the same feedback from their surgeon, like, perhaps opinions on the bypass were changing among the bariatric community. thanks again and have a great weekend everyone!

She may only be comfortable performing the sleeve. Every surgeon does the surgery a little different in terms of how big they leave the stomach, and in the bypass, exactly how much intestine they bypass. It could be that her method of doing the bypass led to more issues? I would at least talk to another doctor and see what their opinion is. It's pretty silly that they weren't upfront about this when you first started working with them. I chose bypass for pretty much the same reasons you listed. My doctor performs more sleeves (I think there are more of those in the US overall) but didn't object, especially when I had reasonable thoughts about it. This is a big surgery! You shouldn't have to settle for something that isn't exactly what you want.

If the bypass is what you want you’d be better off finding another surgeon instead of trying to force the issue. I know doctors are professionals but I wouldn’t get my car fixed by a mechanic who says “I don’t do many of those” let alone a surgical procedure. In my completely uneducated opinion that has zero value, your reasons for preferring bypass sound legitimate and worthy of pursuing further.

For what it's worth, I went into my consultation leaning toward the sleeve and my surgeon changed my mind to gastric bypass. He does perform both procedures but he recommended gastric bypass to me. I took his recommendation because he's an expert and he had good reasons for recommending gastric bypass, but if you feel strongly that you want the sleeve, consider getting a second opinion. It's a really big decision!

Different surgeons have different preferences and recommendations. Some of them only perform one type of WLS. You have the right to get a second opinion from another surgeon, and go with a different surgeon who will perform a bypass.

Hello, I've just joined and I have a question I'm hoping someone can help me with. I am in a program for bariatric surgery to be scheduled later this year. I just met with the surgeon and was told she will only perform a sleeve, I would like a bypass. She says that she constantly has patients coming back from bypass needing iron infusions or having issues with ulcers and she thinks the sleeve gives the same benefit without the risks. Basically, she only does bypass on rare occasions, like with people who have acid reflux. Has anyone encountered this before? I thought I would be able to choose my surgery and after much debate I opted for the bypass. I'm 53, post menopause, 5-4, and 260. I would like this to be a one time surgery and not have to go back for additional one if needed. I'm also a sugar junkie and like that bypass would eliminate or limit that consumption for me. Thanks in advance for you responses.

I was steered from the sleeve to the mini bypass by my dr. After meeting with a nutritionist this week and saw what all I will be doing daily with vitamins, minerals, supplements, shakes, B12 shots, etc, along with the complicated lists of veggies and other foods I can’t eat, I’m turned off with the mini bypass. Is it just as complicated with the sleeve and are there future medical issues that are different than with the mini bypass?

Best of luck to you! I'm sure it was hard staying in the hospital for so long, but glad to hear you are on the mend. I am having a revision surgery (though it is band to bypass). I've also had gallbladder surgery, so wondering just how much scar tissue there will be because of that and the band. I'm sure you will do great. Again, good luck!

I am in the process of preparing for gastric bypass surgery. I have my first appointment with the dietician today. In advance of the appointment, he sent me the pre-op liver shrinking diet instructions. Upon reading it, I'm very skeptical in terms of how it can possibly shrink my liver. There is nothing about protein shakes, broths or other liquids (other than drinking 8 cups of sugar free liquids per day). Rather, the instructions have me eating 3 small meals a day. There are meals with meat and eggs and veggies. Some of the ingredients seem totally contradictory to shrinking the liver but I'm no doctor. Here are some that raised my eyebrows: Shredded cheese PB2 peanut butter Eggs Sour cream Ricotta cheese Cottage cheese Whole wheat pasta Granted, the diet does not call for a large amount of the above ingredients. But I am wondering if I should follow another pre-op diet - one that calls for at least 2 protein shakes a day and broth, etc. Any opinions on this? Thanks in advance!

I had to switch one of my psych meds from extended release to immediate release after my bypass. Fortunately, I didn’t notice any difference in effectiveness after the switch.

I have CIGNA, but they are just the coordinator (my employer self insures). The requirements they had were ridiculously easy: Letter from my PCP recommending me for surgery. New Patient Orientation / Post-Op Nutrition Education (combined into one) Surgeon Presentation ("This is what gastric bypass is... this is what sleeve gastrectomy is...") Psychological Clearance Attendance at one bariatric support group meeting About 20 pages of forms, quizzes, etc. I had to send in. That was it.

I was 63 when I had bypass surgery. 3 years down 120 pounds and stalled.

Same, I take anti anxiety meds. Havent noticed a difference since the bypass, as in my anxiety is still **** lol.

Unbelievable. Cigna cannot determine whether weight loss surgery is covered or not under my insurance policy. On the phone, I have been told yes, it is covered only be told later that there is a a specific exclusion in my policy for weight loss surgery. I was ready to self pay. I saw the surgeon this week for an initial consult and tentatively scheduled surgery for the first week in November. BUT the bariatric coordinator just called - Cigna called her and said they thought WLS is covered under my policy. The bariatric coordinator let them know that Cigna said it is not covered when she verified my benefits. So the Cigna rep is "double checking" and will get back to her. I can't believe this! How difficult is it to determine whether I'm covered or not. Has anyone experienced this type of thing before? Also, if a miracle happens and I am covered, what kind of hoops will I have to jump through with Cigna? Any experiences with Cigna in this regard would be much appreciated. Thanks in advance!

I take zoloft for antiexy. I've researched a bit on the internet and found that once you do a Gastric Bypass your psych meds will actually work differently. I wanted to know if anyone who has gone thru surgery had any experience with this. Thank you all in advance.