Evening all,

I had my appt. with my Surgeon today and he felt strongly that I should consider the bypass over the sleeve.

Here are my stats:

Current and high weight: 340lbs

Height 5'9

BMI 49

34 years old

PCOS

The visit was good over all and while the doctor felt I was an excellent candidate for the WLS he was recommending that I opt for the bypass. He felt that the data out there today indicates that the bypass is more successful than the sleeve for patients with BMI over 45 (mean higher percentage of excess weight loss at 5 years.)

So I've been doing some searching and most of what I'm seeing data wise for percentage of excess weight loss is about 55-65% at 5 years for sleeve vs. 65-75% for bypass.

I know a bunch of folks here have struggled (and posted) and I was hoping for some of that lovely reassurance this place is so great for. I don't have expectations for the kind of success some folks around here have had (you guys rock!) but I would hate to go through all of this (including the burden on my family) just to weight 250lbs in the end. I would love to be somewhere between 200-225lbs. For me that seems like a reasonable place.

I've been staring at reports and sites and re-reading books all day and I feel like my brain is mush!

Just an FYI the sleeve is the first step in a duodenal switch. So you could try the sleeve and if you are not progressing as well as you like then you can get the second portion on the surgery that would include the malabsorption (DS).

Lily

There are so many people who have had gastric bypass and gained their weight back. The gastric bypass stomach stretches out

and the malabsorption of calories does not last forever. I know a lot of people who have gastric bypass who wish they could

get the sleeve now.

There are plenty of people who have gotten down to goal weight with the sleeve as a stand alone procedure but you could always revise

to a DS like the above poster suggested.

There are so many people who have had gastric bypass and gained their weight back. The gastric bypass stomach stretches out

and the malabsorption of calories does not last forever. I know a lot of people who have gastric bypass who wish they could

get the sleeve now.

There are plenty of people who have gotten down to goal weight with the sleeve as a stand alone procedure but you could always revise

to a DS like the above poster suggested.

Miss Daisy, i keep seeing over an over about how the bypass patients regain, and their malabsorbtion tendencies dissapear. what i don't understand is if their stomach is "bypassed", how is it not better than the sleeve when we still have part of our stomach? i'm confused, why wouldnt we gain our wt back too. tsvm...vicki:blink:

The stomach is not bypassed with a gastric bypass. Part of the intestines are bypassed and sewed to a smaller stomach. They make a

"pouch" from a different part of the stomach ( which is still stretchy) than the part of our stomach that remains. The part of our stomach that remains is the muscular part of the stomach that does not stretch very much.

I am 18 months post op. My daughter had gastric bypass and she can eat at least 4 times more than I can eat. My stomach is stretched all that it's going to stretch at this point.

Just wanted to throw out there that my starting BMI was over 49, and now look at it ! ! !

I wouldn't really be too concerned with a 10% of EWL after 5 years, think of what's going to happen in 5 years with bypass vs. VSG in ways of nutrient/vitamin deficiencies. Don't sell the sleeve or yourself short! ! !

I know that statistics are a great resource, but let's be honest, those stats are only as good as the people questioned. I would recommend checking out the revision and complication forum on obesityhelp.com so you can see for yourself the number of people that are looking at revising from RNY to either DS or ERNY because of weight gain or pouch issues.

I won't try to convince you that the sleeve is your best option because you have to make the choice that is best for you, but I challenge you to really think about the fact that with RNY you get only 2 years of malabsorption of calories/fats then after that time period, the intestines adjust and start absorbing everything you eat calorie/fat/carb wise and you get a lifetime of vitamin/nutrient malabsorption. Plus a pouch can and does stretch, our stomach stretching is so minimal and we get to keep our pyloric valve which is a big plus. . . Also, no medication or food restriction for VSG. So, with VSG, you get a non-stretching stomach, no malabsorption, can take all meds, no food restrictions, and you get to keep your pyloric valve (I know I said that twice, but it's really important LOL). . . I had a pouch with my band, and it sucked. My body hated it, it wasn't natural, and nothing feels as good as being able to eat all foods without issue.

I know I'm biased, but it's hard to argue that I might have made the wrong decision with VSG when I stare my size 0 Gap jeans ! ! !

I love, love, love my sleeve. Granted, my BMI was low compared to some others, but I have more than a few friends that have had bypass surgery. All but one (and she has had it most recently) have had substanstial regain. I have a 32 bougie, 85% of my stomach was removed FOREVER. I know if I had not made changes BEFORE sugery....I.E. grazing mainly, I would not have been as successful as I've been as quickly, but I don't possibly see how I could have the regain that my bypass friends have. (COULD WE TIFF??) Anyway, that's my two cents worth!!! All doctors have their opinions and bypass is STILL considered the gold standard of WLS, but I think that will end. I personally think that as DRASTIC as DS is, it would be considered the gold standard, I don't EVER hear about those folks regaining, but then again, you don't really run across many people going to that extreme very often. I know of one, and it is a co-worker of a friend. Good luck....and don't give in, find another doctor if need be. Do what FEELS right to YOU.

I wanted to add about the Pyloric valve. My mother had the bypass 22 yrs ago. (not sure if it is exactly the same...but has the pouch/new pyloric). She has gained..but is about 60 lbs below her high weight. BUT when she recently had a gi done..they said there is nothing there to keep the food IN her pouch anymore. She feels full when her intestine is filled to a point AND her pouch. The valve is stretched out.

I personally don't want this and I have to take NSAIDS (ibuprofen, aleve, etc) for my TMJ so I am not a candidate for RNY.

Good luck in the decision. =)

What about seeing another surgeon to get a second oppinion?

Honestly, you couldn't pay me enough to get an RNY. I've heard to many stories about the pouch and the stoma (opening from the pouch to the intestines) stretching out. I'm a lightweight so I'm thrilled to death with my sleeve, but if I were bigger and felt like I needed malabsorption, I'd do the DS in a heartbeat.

When your surgeion says "bypass," is he talking about the DS or the RNY?

My surgeon pushed for the bypass. In fact so did my friend's surgeon. We came up with the reason that its because they get paid more from insurance companies.

My Sister types for doctors and she had the Gastric bypass. When I asked her about the Sleeve she said she wishes she would have done the Sleeve instead of the Bypass. She has had a lot of problems with her bypass....gallstones, kidney stones...leakage and had to be cut open. She has gained a lot back...not as big as she was but she has gained. She had her surgery three years ago. She said the doctors in her area are leaning more for the Sleeve now because of the success they are seeing and less complications.

I would suggest you read as much as you can! I'm sure you can google pros and cons! I haven't had my surgery yet but I'm EXCITED to be SLEEVED in December! My doctor told me....He will give me the TOOL to lose weight but it will be up to ME to use it correctly! SO, if you are Sleeved or Bypassed it will be up to you to keep off the weight.

GOOD LUCK!!!!

I just wanted to let you know that I started my journey with a BMI of 53. I was sleeved on June 22, 2010 and have only lost 57 pounds so far. I know I am losing slower than most people with higher BMIs but I feel really good and in control of my eating. I have not lost all hunger as some people have but I can say it is greatly diminished. Even when I feel hungry I can only consume a few ounces at a time. It's very empowering. I think sometimes I get frustrated when I see my husband losing faster than me but just this week I realized that I only have to lose 95 more pounds to be my ideal body weight. I can do that! It may take me the full two years but it will happen. And having the sleeve means my stomach will be tiny FOR LIFE. My doctor actually recommended the sleeve over the bypass. He felt that a bypass was unnecessary when I could get the same results from the sleeve. I hope I haven't added to your confusion because the others are correct when they say you have to make the right choice for you. The sleeve was absolutely the right choice for me but for you, only you can decide. I just didn't want you to toss it out because of your BMI. Good luck with whatever you choose.

I'm with poster #1 - Do the sleeve (because I really believe you can do this) and you can always get the 2nd part later if you truly need to. Even if it's a few years later. Although my starting weight was lower than yours, I am shorter, so my BMI was higher. I started at 310 lbs with a BMI of 52. I am 5 months post op and have already lost 93 lbs. My goal weight is 160, so I have 150 lbs of excess weight. So at 5 months I have already lost 62% of my excess weight!! I'm already beating the odds. True, I don't know what is going to happen later on... but there is that comfort that I COULD complete the DS procedure IF I chose to. Don't be convinced that because you are larger, you can't do this without bypass. YOU CAN.