Why did you choose the sleeve vs. bypass?

[Pinkbetty 2]

Hi!

So, for me, this is kinda after the fact, since I am sleeved, but why did you all choose the sleeve vs. gastric bypass? They re-route your intestines for bypass, correct?

Just curious why in your opinion, the sleeve is better than the bypass. Thanks!! (My friend's mom just did the bypass and it got my wheels in the brain turning.)

[longer-life 139]

My sister in law had a bypass about 6 years ago and has lost and maintained 140-150 pounds off. She is at a normal weight and has no regrets whatsoever. However, I did not want my intestines touched. Malabsorption (sp?) scares me.

[RickM 1,753]

I'm not particularly concerned or afraid of the intestinal or malabsorptive issues as my wife has had a DS for the past six years or so and we know many DSers who are 5-15 years out, so we are very familiar with all of the issues, major and minor. My objection to the RNY, and why it was never really considered, is that it goes to all the trouble of the intestinal rerouting, and it doesn't really buy you anything positive (compared to the VSG.) All the data available indicates that the weight loss and regain characters are similar but the RNY has a lot more issues. Beyond the more common incidence of dumping (which some surgeons promote as a benefit,) it doesn't significantly malabsorb calories, particularly long term, but does malabsorb minerals due to its bypassing of the duodenum where the bulk of the minerals are absorbed (the DS only bypasses part of the duodenum, so mineral malabsorption is usually not a bad.) The construction of the stomach pouch and connection to virgin intestine means NSAIDS are a permanent no-no, and while men don't typically have the Iron issues that women do, the iron malabsorption is compounded by a typical slow blood loss at the pouch/intestine junction that rarely fully heals due to the exposure of stomach acid to tissues not designed for such exposure. Overall, lots of negatives without a real benefit compared to the VSG. The DS has somewhat different issues, though generally not as severe, but provides, on average, better overall performance, particularly on the regain front. The DS costs more, from an "issue" perspective, but you get something for that added cost. You don't get your money's worth with the RNY. There are probably some individuals for whom the RNY is the appropriate choice (aside from the surgeons promoting it) but they are few and far between now that the VSG has become mainstream.The RNY is rapidly becoming obsolete.

[Tiffykins 673]

This is my standard reply when this question pops up every couple of days. I won't try to sway anyone one way or another, but I'll give you my reasons for choosing VSG over RNY for my revision from the band. You can also check out the revision, failure, and food issue forums on here to get an idea of some long term RNY patients. For me, it was never an option. The cons outweighed the pros.

The VSG was my 2nd, and final WLS. I could have easily had RNY, but I fought to have VSG as my revision from the band. Some factors I considered in deciding on VSG. The pouch that RNY offers is similar to the pouch with the band. Least to say, a pouch sucks, I love having a normal tummy, just less capacity and still fully functioning.

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

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!

P.S. I wrote this before pregnancy. And, just as an update, I'm 8 months pregnant and thriving. I have zero issues consuming enough calories/protein/carbs to support my body and another developing human. My labs have remained stellar throughout the pregnancy, and life is pretty good. I am over 2 years out at this point, and couldn't be happier with my decision to have VSG over RNY for my revision. It's been an amazing journey.

P.S.S.

Since the pregnancy, I have been diagnosed with a genetic clotting disorder and the ONLY treatment (zero cure) is a daily aspirin therapy. With VSG, this treatment is possible, if I would have gone with RNY my doctors (surgeon, 2 ob's, PCM) are unsure how this condition would have been treated especially during the pregnancy. Grant it, I only take a baby aspirin every day of my life, but it is an NSAID. Least to say, when my high risk ob found out I had a partial gastrectomy and NOT RNY, he was elated because there really is zero other option for treatment at this point, and the aspirin therapy is working well with my platelets and if all goes as planned, I will be able to have an epidural for my c-section instead of having general anesthesia. Maybe a small issue to some, but being awake for the birth of my daughter is top priority for me.

[sasicas 194]

I did not like the idea of my intestines being messed with. I also did not like the the idea of so many food restriction many of my RNY friends deal with. I did this surgery knowing I could eat most anything I wanted but in smaller portions. The idea of dealing with dumping over simple things was enough to turn me off.

I had started going to a support group months before I had my surgery and listening to all the RNY issues really made it an absolute no-no to me. I saw many complications. As well as a good friend who had the surgery 3 or 4 years ago and has had so many medical problems as a result, it was quite scary to me.

Take one of my support group friends, she had the RNY 9 months ago. She cannot stand the smell of food period. She cannot cook most things now because it is enough to turn her stomach, though I do believe part of it is phycological. She throws up at least once weekly, generally more than that though over foods she previously could tolerate. She cannot eat bread, Pasta, etc. at all. She cannot eat any meat except chicken meatballs and chicken salad put through a food processor. She cannot deal with any sweets because of the dumping. How miserable would htat be?! Sure I may not be able to eat much but I had a fun sized Kit Kat today with no problem as a treat. I drank my sugared up coffee today too with no problem. I ate ground beef tonight with no problem. I simply did not want those problems.

I also see from our group that there are many who cannot stop losing, while I realize this can be true too with the sleeve I see it far more often with the RNY. 3 people alone in our pretty small group are seriously underweight and unhealthy now. It just was not an option for me. It was the sleeve or nothing.

[Rootman 1,101]

What Tiffy said above - except for the preggers part - I'm a guy

[Pinkbetty 2]

Thanks everyone! I'll sound more educated now when people ask me. All I knew is that it sounded more dangerous and that it was more pricey. Haha.