Not agreeing with the surgeon.

[Guest Rosalind]

VSG can be converted to a DS. Most docs ask you questions at consultation and suggest what they think based upon how you answer. Knowing that you have a high BMI, the doc knows that you will have to be a very good dieter to get your weight down to normal levels. Bypass does it for you. If you are committed to healthy eating, the sleeve is perfect for you. If you think you are going to eat french fries and drink milk shakes and lose weight, bypass is better. You have to be committed to dieting with the sleeve as opposed to bypass offers malabsorbtion of calories.

I believe that people will still choose bypass because they like that they don't have to diet and their bodies will still lose weight. Bypass lets you not address the problems that got you obese.

[RickM 1,753]

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.

That is pretty much my fallback position if I need it - a revision to a DS, even if it means an open procedure for the second go-around. One word of caution on this plan, however, is that in my surgeon's experience, such revisions work best before any substantial weight regain has been realized - you typically don't get the same level of loss if one waits to return to their old weight than if they do it promptly after they start to regain and realize that they don't have control over it. Not the easiest decision to make at that point, and generally not covered by insurance until the first WLS is a total failure and one gets back to the35/40 BMI level again. For me, with my history, that was worth the risk of doing just the VSG.

[Tiffykins 673]

VSG can be converted to a DS. Most docs ask you questions at consultation and suggest what they think based upon how you answer. Knowing that you have a high BMI, the doc knows that you will have to be a very good dieter to get your weight down to normal levels. Bypass does it for you. If you are committed to healthy eating, the sleeve is perfect for you. If you think you are going to eat french fries and drink milk shakes and lose weight, bypass is better. You have to be committed to dieting with the sleeve as opposed to bypass offers malabsorbtion of calories.

I believe that people will still choose bypass because they like that they don't have to diet and their bodies will still lose weight. Bypass lets you not address the problems that got you obese.

None of the surgeries beat carbs. Not even the heavily touted DS. There are several DS failures out there, and RNY has the same consequence with carbs just like VSG and the band.

I only dieted through my losing stage. In maintenance, I do not diet, and had zero issues maintaining my loss for a year before pregnancy.

The malabsorption of calories/fats/sugars with RNY/bypass only lasts around 2 years. It might not last that long. So, the bypass only gives you an out on carbs/sugar/fats/calories for so long and then the body adjusts and starts to absorb everything that is consumed except for certain vitamins/nutrients.

Being prepared for any weight loss surgery is essential, committing to making a lifelong change in eating habits and behaviors is the only guarantee. Bypass, DS, VSG, the band all have failures. If people do not change their eating habits, even malabsorption will NOT help them.

[RickM 1,753]

VSG can be converted to a DS. Most docs ask you questions at consultation and suggest what they think based upon how you answer. Knowing that you have a high BMI, the doc knows that you will have to be a very good dieter to get your weight down to normal levels. Bypass does it for you. If you are committed to healthy eating, the sleeve is perfect for you. If you think you are going to eat french fries and drink milk shakes and lose weight, bypass is better. You have to be committed to dieting with the sleeve as opposed to bypass offers malabsorbtion of calories.

I believe that people will still choose bypass because they like that they don't have to diet and their bodies will still lose weight. Bypass lets you not address the problems that got you obese.

Unfortunately this turns out to be a false impression for most people - that the RNY allows them to eat as they did before, and is not much different than those who get the idea that the bands will be better because the procedure is simpler and quicker with no GI tract cutting, until they find out the problems that can be caused by that band longer term..

The net longer term result is that the RNY will malabsorb minerals but an insignificant amount of calories. This is why we see so many bypass patients totally failing and regaining all of their lost weight. The DS will usually maintain significant caloric malabsorption for the long term (10+ years) and is not as bad at mineral malabsorption as the RNY (due to the only partial bypass of the duodenum, where the bulk of the mineral absorption occurs), though the DS does malabsorb the fat soluble Vitamins (A,E,D & K) so those usually need to be supplemented with a Water soluble form. Overall, the RNY is no better at tolarating us drinking our calories thru sodas and milkshakes as the VSG. RNY dietary requirements for weight maintenance are pretty much the same as for the VSG, though the RNY has more restrictions on medications and greater need to supplement those minerals.

[ismini9 3]

If I am not mistaken, the excess weight lost via the sleeve surgery is 65% whereas with the bypass it is 70%. So this is not a huge difference. The problem is that with the bypass you are basically telling your body to start doing the work via a different method, which may have negative effects in the long term. With the sleeve however, if you are careful not to start drinking carbonated drinks which expand the stomach you can maintain yourself at a desired weight... Hope this helps! Good luck!

[CT Fats 82]

My bottom line is always My Body, My Choice. Doctors suggest things all of the time and as a healthcare worker I can say there are a lot of alterior motives that come into play. Do your research and select the procedure that is right for you. This is a decision that you will live with for the rest of your life.

[Guest Rosalind]

Please!!! Don't misunderstand me. I have known plenty of people who chose RNY and lost a tremendous amount of weight but ate what they wanted to. To their shock, they started to gain weight when they continued those habits. I am not a fan of RNY, I have chosen the sleeve for myself BUT I realize that I have had to make serious changes to my diet to prepare for that. The fact is young people sometimes don't have the discipline to follow a healthy diet for the rest of their live plus their taste buds are much different than that of an older persons. I was only offering an explanation as to why the doc may have offered that. Tiffkins nor I are doctors. We are offering opinions. Furthermore, most people have not had to overcome 60 BMI. Those people who have lost 100lbs and less have no idea your battle!!!! Go back to your doctor and ask why or get a second opinion. I pray that you get the desires of your heart!

[CowgirlJane 14,261]

You know the saying, "everything looks like a nail to the hammer"

I think we DO need to listen to advice from the surgeons that is why maybe it is even good to talk to more then one as they have their biases too.

My sleep apnea doc pushed me to look into the sleeve. I have not had good results with the band and just was never comfortable with the gastric bypass. This whole pouch thing is for the birds, a smaller stomach is more appealing to me. The first surgeon I went to didn't like the band, felt it was a big money maker but not the best for the patients. He does the gastric bypass and the sleeve, but felt that since I had already "failed" at a restrictive only procedure that he would recomment the bypass. I put all my investigation on hold (this was last year) as I just don't want a bypass.

By chance, I had an encounter with someone who was pretty jazzed about the sleeve and asked me to give it a closer look. I went to a second surgeon, who has done alot of revisions to the sleeve to see if he thought I had good prospects for the sleeve. He really did. He also gave me a real shakeup over the complication rate of for revision from the band to any of the other surgeries. (just another lie about the band, it is reversible, but it comes with possible problems due to scarring etc). I felt both more positive and perhaps a little more scared after meeting with the second surgeon as I was pretty naive about the problems caused by having a band implanted for 10 years.

My personal opinion is that ALL of the surgeries require a great deal of patient compliance to be successful. The bigger you are, the more that is a factor I believe. For people with 50pounds to lose, they get to goal really fast. I have a BMI of 48 or 49 so I know that I will really need to work to get to a "normal" BMI. I am thinking that the sleeve and gastric bypass have fairly similiar results - the weight comes off pretty easy at first so take advantage of that and really work it! After that... it slows way down... and eventually, you really have to watch your diet to keep the weight off. No free ride, but I am sure hoping for something better then I acheived with the band.

Anyway, I think you are asking good questions - keep checking it all out and maybe consider a second opinion.

[samnyc 5]

My personal opinion is that ALL of the surgeries require a great deal of patient compliance to be successful.

This.