Not agreeing with the surgeon.

[kygal1982 4]

So......I'm new to the verical sleeve website. I complete all my pre-surgery counseling and requirements next Friday August 19th at which time I can submit to my insurance company and wait for my date. I'm very excited but nervous too. I have decided on the sleeve, even though it seems my surgeon would prefer me to have the bypass. I'm 29 and have no real health issues except for my weight and it confuses me that in my situation he would think the bypass would be better than the sleeve. I do have a very high BMI of 60.1 so that is why he says the bypass would be more successful. I'm just curious to if anyone else out there has encountered this issue with their surgeon and also decided on the sleeve.

[Fat4now 7]

They usually tell you that because truthfully I think the bypass is more successful with a large amount of weightloss. I think it should ultimately be up to you. But I will tell you that a lot of drs do feel that the bypass is more reliable and more successful. I see a lot of success stories on here though so I have a slightly different opinion.

[samnyc 5]

My doctor suggested the bypass at first as well because of my high BMI but I flat out said no and that was that.

[kellyw74 258]

I think they like to do bypass on people with really high BMI's. People with BMI's under 50 are usually suggested the sleeve. I think it is because with the bypass you tend to lose faster. However, with the bypass it seems people can gain back easier than we can. We can gain, but not as easily.

It is ultimatley up to you, if you don't want a bypass, then say NO WAY!! I told my surgeon in the beginning I didn't want that, eventhough he never wanted to do it, I made it clear I wasn't doing it. It is your body and if you don't want to do it, you don't have to!

Good luck to you!!

Kelly

[mamaof4boys 1]

When I talked to my surgeon, I told him I had decided on the sleeve, unless he thought I should get the bypass. He said since I asked him, he said they are both good surgeries. But if he had to have surgery himself, he would choose the sleeve. He also said, if he could only do one type of surgery for the rest of his life, he would choose the sleeve. My doctor is one of the top bariatric surgeons in Florida. He is a center of excellence doctor.

I hope this helps. I agree with Kelly, its your body, and your decision. Good luck!!

[kygal1982 4]

Thanks so much guys for the responses! I am for sure doing the sleeve. To me it makes more sense and feels safer even though my BMI is high. I can't wait to get a surgery date!

Sam, when did you have your surgery? I saw your starting BMI was higher also so I was just curious.

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[Driver Deb 10]

I dropped out of Kaisers program when all they offered was the lap band or the bypass, now that they offer the sleeve I am back in the program. It meant 4 more years of being fat, but I was not comfortable with the rerouting of the plumbing...

[Beth323 13]

You have to make the decision that you think is right four you. You are the one that is going to have to live with it for the rest of your life. Whether it was a good or bad decision you are the one that needs to deal with it. That being said I think one of the Big differences between the 2 surgeries is that the bypass has a higher success rate of maintaining the weight off. Basically because of the dumping syndrome with overeating of high sugar content kinda makes you not want to over eat and make better food choices. The sucess of either one though depends on us. I do think though if you are not successful with the desired weight loss of the sleeve they can go back in and convert to a bypass. The sleeve use to be part one of a two part bypass procedure.

I am doing the sleeve my BMI is 54. I know the weight will come off the first 18 months. I am really afraid that I will have a problem maintaining. Like so many others I have lost large amounts of weight ie WW and put it all back on plus more. The psychologist I saw for my pre surgical gave me her cell # I think I might need it for maintainance to get my head on straight.

Good luck to you!

[AutumnLily 77]

I had a high BMI and doing really great with the sleeve. I wanted the sleeve vs the bypass because I did not want problems with eating certain foods or having to take a million Vitamins and minerals the rest of my life. Plus no being able to take certain kinds of drugs.

I love my sleeve and know that I will be able to maintain my weightloss.

Note: if you check SammyNYC post the signature line has the date of surgery posted as 11/23/2010

[RickM 1,753]

Many docs feel the same way, in part because they are most familiar with the bypass, and in part because it is the most sophisticated procedure that they offer (unless they do the DS, in which case that is what they would usually recommend for their high BMI patients). Some docs feel that the threat of dumping from the bypass will help as a behavior modifier for their patients (yeah - fat people need to be punished for being fat...) There is not a lot of long term data yet on the VSG regarding weight regain, but what is there suggests that it is no worse than the bypass, which isn't all that impressive to start with, and some docs feel that there is reason to believe that it will be somewhat better due to its functional pyloris. There are quite a few on these boards (and on obesity help, too,) who started in the 60+ range and have good success so far. Probably the best procedure for the high BMI people is the DS which offers statistically better loss and better long term maintenance, however, it is a more technically challenging procedure so many of the docs don't do it, though to the patient the downsides are generally less than that of the bypass. Many prospective patients don't like the idea of the added intestinal rerouting that goes along with the DS and bypass and that is a fair perspective, though with many that is the price of long term success - only you can decide for yourself what is best for you. Bias disclaimer - my wife was a 60+ BMI when she had a DS a little over six years ago and is still maintaining a weight of around 135, while I opted for a VSG since I was a 40+ BMI and had already lost and maintained a reasonable amount of weight on my own through the requisite diet/exercise/lifestyle changes, but couldn't get the rest of the way due to volume issues.

I never considered the bypass as, overall, it has all of the downsides of the DS (often more severe,) without the DS's better weight loss and maintenance performance, or looking at it from another angle, the bypass offers similar loss/maintenance performance to the VSG at a much greater cost in side effects and lifestyle restrictions.

[samnyc 5]

Thanks so much guys for the responses! I am for sure doing the sleeve. To me it makes more sense and feels safer even though my BMI is high. I can't wait to get a surgery date!

Sam, when did you have your surgery? I saw your starting BMI was higher also so I was just curious.

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My surgery was on 11/23/2010. The BMI and starting weight I have listed are as of that date. Actually just today I hit a big milestone and my BMI fell under 40!!

[MLeena 0]

My surgeon told me the same thing... that if your BMI is over 50, then you might not get all the weight off with the VSG. However, I talked to my primary care doctor and he told me that it is true, but there are a lot of other issues (malnutritrian etc) with the GB. He said that he has about 20 patients that had the GB over 10 years ago and only 3 are still happy they did it. He has had to deal with a lot of problems that came up as a result of the GB. He said that the surgeon is going to recommend it because you do lose more weight, but after that year they are no longer involved, it is up to him (the primary care doctor) to pick up the pieces and treat the residual problems.

That said, he strongly recommended the VSG. He also mentioned that since it is really the first part of the GB, if you are not satisfied with the weight loss on the VSG you can always go back and have the GB completed.

I took that all in and not surprisingly, I am scheduled for the VSG on 8/22.

Good luck... it is a hard decision.

[CowgirlJane 14,261]

Thanks for sharing this info. It is great to hear that your wife is doing so well so many years out. My thought is that if i really can;'t keep the weight of with the sleeve, i would consider the DS, but not the bypass, for the reasons you mention.

Many docs feel the same way, in part because they are most familiar with the bypass, and in part because it is the most sophisticated procedure that they offer (unless they do the DS, in which case that is what they would usually recommend for their high BMI patients). Some docs feel that the threat of dumping from the bypass will help as a behavior modifier for their patients (yeah - fat people need to be punished for being fat...) There is not a lot of long term data yet on the VSG regarding weight regain, but what is there suggests that it is no worse than the bypass, which isn't all that impressive to start with, and some docs feel that there is reason to believe that it will be somewhat better due to its functional pyloris. There are quite a few on these boards (and on obesity help, too,) who started in the 60+ range and have good success so far. Probably the best procedure for the high BMI people is the DS which offers statistically better loss and better long term maintenance, however, it is a more technically challenging procedure so many of the docs don't do it, though to the patient the downsides are generally less than that of the bypass. Many prospective patients don't like the idea of the added intestinal rerouting that goes along with the DS and bypass and that is a fair perspective, though with many that is the price of long term success - only you can decide for yourself what is best for you. Bias disclaimer - my wife was a 60+ BMI when she had a DS a little over six years ago and is still maintaining a weight of around 135, while I opted for a VSG since I was a 40+ BMI and had already lost and maintained a reasonable amount of weight on my own through the requisite diet/exercise/lifestyle changes, but couldn't get the rest of the way due to volume issues.

I never considered the bypass as, overall, it has all of the downsides of the DS (often more severe,) without the DS's better weight loss and maintenance performance, or looking at it from another angle, the bypass offers similar loss/maintenance performance to the VSG at a much greater cost in side effects and lifestyle restrictions.

[Tiffykins 673]

This is just my opinion, and from years of reading around the boards so I hope no one takes offense to this:

Surgeons that push RNY over VSG typically do not have the high volume of experience with the sleeve that they have with RNY. Also, RNY costs almost double the sleeve when it comes to surgical charges.

As for high BMI patients, check out obesityhelp.com I can name at least 5 members over there that are less than 3 years out, and have lost a tremendous amount of weight, Jimbo has dropped 330lbs in 20 months, MissEye dropped 200lbs in less than 18 months, Frisco has dropped 190lbs in less than 18 months.

While you're there, check out the revision forum, and see just how many RNY patients are seeking revision because of 2 main reasons 1) Significant weight regain (I'm not talking 30-50 lbs, I'm talking 100+ pounds) 2) Major complications with Vitamin deficiencies and stretched pouches and stomas.

They are getting revised to DS. Converting their RNY Pouch to a Sleeve with the switch part for the malabsorption.

The long term stats on the VSG vs. RNY for long term weight loss staying off, and keeping it off at 5yrs out, are within a 3% difference.

You have to decide with what you are willing to live with for life. The assisting surgeon tried to convince that I "needed" RNY as I lay in the holding area of the surgical floor about to head back for my revision to VSG. There is NO way I'd live with RNY. It's not for me, my lifestyle, my wants/needs out of a surgery.

I've added my standard reply when people ask why I chose the sleeve over RNY:

1) No blind stomach left behind that can be difficult to scope yet can still get ulcers and cancer.

2) 2 years max on calorie/carb/sugar malabsorption, but a lifetime of vitamin/nutrient malabsorption. This process is called adaptation, and it happens with intestinal bypass surgeries.

3) I had a pouch with the band, and it sucked. I'm pretty fond of my pyloric valve and the sleeve let me keep it. I love having a normal functioning stomach, just smaller in capacity.

4) Regain stats and #of RNY patients seeking revision truly scared the poop out of me, check out the revision forum on here. . . Go back several pages and see just how many RNY patients are looking to revise due to weight regain. ERNY and Band over Bypass to get back some malabsorption and/or restriction

5) I have too many friends in real life that struggle with Vitamin deficiencies post-RNY, and most of them either never got to goal, or have gained back a significant amount of their weight.

6) The long term complications with RNY were too numerous for my comfort level. Pouch or stoma dilation, strictures, vitamin/nutrient deficiencies, ulcers,

7) I researched gastrectomies that had been performed for stomach cancer and ulcer patients, and found comfort in the long term results and minimal complications of patients that had lost most or all of their stomachs had dealt with over several years.

8) I was a volume eater, and knew a restrictive only procedure would work for me. That was my thought process when I got the band, and I thought I could beat the odds on complications. Sadly, the band only lasted 8 months before I had to revise.

9) I did not want to have food or medication restrictions. I chose WLS to have a "normal" life, and I think it's normal to eat a couple of Cookies. With RNY, I wasn't willing to go through the possibility of dumping if I wanted to have a couple of Cookies, or a slice of cake on occasion. The big scare for me is medication restrictions for life. NSAIDS and steroids are a NO GO for life with a RNY pouch. I realize that I may never be diagnosed with a condition or disease that requires steroid use, but it is possible. I want the best long term results with the least amount of complications. Malabsorption is not anything to play with in my mind, and I was not willing to take that risk.

I lost all my weight in my ticker with the exception of 7lbs with the sleeve, and I did it in 10.5 months. The 115lbs fell off the first 6.5 months, and then the rest I lost as I was getting into maintenance over another 4 months.. It's been a fabulous journey, and I'm easily maintaining with zero issues for nearly a year at this point. I want to add that every WLS regardless of your choice will require discipline. Only a percentage of RNY patients dump on sugar/fat, pouches and stomas stretch, then you have the medication restrictions. I'm not trying to convince you, but these were my concerns when I knew I had to revise from the band. I started at 263 the day of my revision and today I weigh 127lbs. I bounce on the scale 125-130lbs any given week, and I couldn't be more ecstatic!

Best wishes in your research!

[lob1999 0]

I never considered the bypass as, overall, it has all of the downsides of the DS (often more severe,) without the DS's better weight loss and maintenance performance, or looking at it from another angle, the bypass offers similar loss/maintenance performance to the VSG at a much greater cost in side effects and lifestyle restrictions.

I agree with this and my reasoning for wanting the VSG (even though my BMI indicates I should look at DS). Eventually I think RNY will fall out of favor when more VSG long-term results are available. Then I think it will come down to DS or VSG for surgery options.