Doc advising Gastric Bypasd vs sleeve... Anyone have that happen?

[Poorehouse 18]

Went to see DrProvost today (I have second with Dr Cribbins Wed)... I told dr provost I wanted to revise band to sleeve. He said he will do band to gastric bypass. He said the sleeve is not good for banders. Had I never had a band he would do a sleeve but because I do have a band he recommends the bypass. Which I am scared to death of. He said people with bands that have sleeves

I told him I didn't like the thought of bypass because of re routing everything and dumping syndrome. He said dumping happen when you eat sugar or high fat foods. If you eat that you will feel very sick, and faint like you want to pass out.

All the things I worried about. He said well I should not be eating that anyway so I should do bypass.

I fully understand that I must change my eating habits and that sugar and high fats are off limits... However the thought of NEVER having sweets really bothers me. I think if every ONCE IN A WHILE I want to share a piece of birthday cake with my son I would like to be able to have that option once I react my goal weight. Hopefully I'm not wrong feeling that way.

My question is has anyone else been advised to so gastric bypass vs sleeve and what did you decided an how did it turn out? Also, has anyone had leaks since sleeve revision. Advice needed and appreciated

[Catherine707 253]

Every surgeon seems to have their own protocols for what surgery they do in a give set of circumstances. I know there are a lot of folks on the support site that had band to sleeve revisions. Good that you are getting another surgical consult next week. I would wait to see what that doctor recommends before making any decisions.

[CowgirlJane 14,259]

This happened to me - 1st surgeon i went to told me that since i failed at the band i would fail at the sleeve.

I went down the path of the bypass, researched, started the preop process and just decided it isn't what I wanted.

I went to a surgeon who believed in the sleeve, even for "failures like me". I have had what i think is remarkable success for a revisionista, but i know that not everyone has this happen.

[LipstickLady 25,682]

The first surgeon I went to insisted that the best thing for me was bypass even though I told him that I was absolutely not interested in that at all. He grudgingly said he would sleeve me if I insisted, but every visit, he rammed bypass down my throat. I am NOT a band revision, but he could give me no good reason why bypass was better than sleeve other than his thought that I should want to dump if I ate bad things.

Uhmmm....no. I want to live a fairly normal life. I am not a huge sweets eater, but I do want to have a bite of cake or a scoop of ice cream from time to time. His nurse was a bypass recipient and she was also extremely pushy about having bypass over sleeve for the same reason. When I told her my feelings on it, she acted as if I was nuts and just like the doctor, told me that dumping was desirable. WHUCK!?!?!!

I changed doctors and I am SO glad I did. SO GLAD.

Edit to add: I was 4 months into a 6 month process and had to start all over. Still glad I did it.

[RickM 1,747]

It sounds like your first doc is simply more comfortable doing the RNY when things get a bit complicated, so your instincts are right with having a second opinion lined up.

There are reasons that the sleeve may not be the right choice to replace a band. As they are both similar in using restriction to limit your intake to lose weight and maintain the loss, if the problem with the band was that you were able or inclined to eat around the band (and any surgery can be ate around if one tries!) but it otherwise worked as intended, then the sleeve may not work any better for you. However, if the sleeve failed in one of the many ways that they do - slippage, erosion, ulcerations, etc.- but you otherwise lost with it, then the sleeve will likely be a good move.

Overall, there isn't much difference in the performance of the sleeve vs the RNY. The RNY might allow you to lose a bit quicker than the sleeve due to its malabsorption; however, caloric malabsorption is only temporary with the RNY, so after the first year or two, its regain performance is little different than the sleeve. Unfortunately, mineral malabsorption is lifelong with the RNY.

When considering WLS revision, one should look closely at all of the various options to avoid having to go through this again. The different procedures have somewhat different personalities, and some are a better fit for some patients than others; that's one of the major reasons for revisions - a simple mismatch in character whereby the procedure fails the patient. As you are going through this research process, also look into the duodenal switch (DS) as well. It may or may not be right for you, and a doc who doesn't do them is unlikely to discuss it seriously, but it is worth considering and consulting a doc who does do them. I know several people who revised from bands to RNY and ultimately to the DS in order to get what they needed - it's best to avoid that if you can and get what best suits you, rather than the surgeon.

Good luck in your continuing journey,

[Ms.Cali 56]

Follow your gut feeling - it's your body after all.

Get a second or third opinion.

I don't have any sugar or fat in my diet - barely enough time and room for my Protein. But I made sure I had a few bites of my birthday cake. I had no problem with it. Had another few bites the next morning too for Breakfast. :-)

[Poorehouse 18]

All of you are such a great help! I am going for second opinion.

I will say I did cheat the band I guess you could say but it was more because it was literally easier to eat than the food good for you! Crazy. I never felt full. And hated the stuck feeling. I really am thinking if I physically could not eat more than 6 ounces and felt full then I would be a success.

I did come across the DS and wondered about that...

What is the difference in that and the sleeve?

[nyorker 67]

Lots more money made on the gastric bypass. Hate to say it but it is.. Mr Dr said pick whichever you like.. I was gonna do the band but decided on the sleeve.

[RickM 1,747]

I did come across the DS and wondered about that...

What is the difference in that and the sleeve?

The DS uses the sleeve as its basis (usually a bigger version), and adds an intestinal rerouting like the bypass, though of a different configuration. The net result is a more normal diet and eating style than the bypass (things don't get stuck in the sleeve as they can in a bypass pouch, and dumping syndrome is very rare), and the caloric malabsorption lasts for the long term so regain resistance is better than any of the other major WLS procedures. Diet is more forgiving with the DS than with the sleeve as the caloric malabsorption compensates for some of our sins, though my sleeve diet at 2 1/2 years out is also quite forgiving (so far!) due in large part to my fairly high guy metabolism; my wife had a DS 8+ years ago and she isn't as disciplined as I am, but she is maintaining her weight much better than most shorter women who have lost 200lb with a sleeve or bypass.

The flip side of the DS is, like the bypass, that greater discipline in routine labs (typically annually once things have settled down) and appropriate supplements as indicated is required. The bypass is heavy on mineral malabsorption - Iron and Calcium in particular - which can be particularly problematic for the ladies as they get into the age when Iron and osteoporosus problems come into play. The DS's malabsorption is less mineral intensive, but adds more malabsorption of the fat soluble Vitamins - A,E,D, and K - which overall tends to be easier to supplement than the narrower but more extreme profile of the bypass.

A good short summary would be that the DS requires less eating discipline than the sleeve, but more supplement and lab follow up discipline. A good starting point for research on this is

http://www.dsfacts.com/

[LeanerLena5426 61]

My surgeon also recommended bypass, which was actually my first choice. His reasons were simply that the bypass is sort of the gold standard for WLS because it's been around so long it has proven its success, whereas the sleeve is promising but just hasn't been around quite as long. I wanted bypass, because I actually wanted dumping syndrome because I was afraid without it I would sabotage myself and eat sugery/fatty foods till I gain weight back. But my surgeon said that he could only do the bypass if it was safe to do so, once he opened me up. He said there may be a lot of scar tissue, and if there is, he won't do a bypass because he wouldn't risk my health (whether I want bypass or not). When I woke up from surgery and learned I had the sleeve, I was devastated actually. He explained to me that my stomach was a mess from the band--prolapsed and pouch dilated and erosion and all those things that tend to go wrong with the band--and VSG was the safest thing he could do. And though I was EXTREMELY disappointed at the time, so far I'm very happy with the sleeve! I'm only 7 weeks post-op, but already I can eat a better variety of foods than I could with the band. The sleeve is exactly what I wanted: let me eat whatever I want, but just stop me after a small portion. So if you want that piece of birthday cake with your son, the sleeve is the way to go. I must admit, it's actually a relief to not have to worry about dumping, and be able to enjoy those kinds of treats on special occasions. I'm like you, and wonder if a little bit is a healthy, balanced, joyful, part of life! As long as it's not excessive and preventing you from maintaining a healthy weight.

I think it's great that you're consulting with two different surgeons. Get both opinions, maybe even a third if you're still confused. And then do what YOU feel is right, for YOU. Good luck!!

[sanks51 214]

After two years of having issues with my band, I went to see a consultant. I really, really wanted a bypass as I had failed miserably with the band!! Straight out he said he would do the sleeve! The bypass was not even an option he mentioned. I was absolutely distraught and cried and cried. However, today I'm the happiest I've been for a very long time. I'm almost 7 months post op and have lost 104lbs. My start weight was 397lbs. My sleeve has been a Godsend and I'm so happy he never entertained the thought of a bypass. Band to sleeve revision peeps are having great successes

[Poorehouse 18]

UPDATE: second opinion... Band to sleeve revision Oct 25th. He feels he can do it in one surgery. I told him if he needs two that was fine with me but he said my band is high up and looks great thought it was safe enough to do one revision.

Now the challenge ... Two full weeks all liquid diet! 6 weeks post op... liquid to mush .... I won't be chewing food for two months LOL

I will be posting this a new topic ... Suggestions on what to drink for 2 months lol

[asauv 6]

did you see Dr. Cribbins? mine is monday! good luck!

[Poorehouse 18]

I did and wants to do band to sleeve revision in one surgery oct 25th

2 week all liquid diet PRE-op and then 4-6 weeks liquid to mush after!

Good luck to you !!! Tell me how it goes!!!

[trenya07 6]

I had the band to sleeve revision and wish my doctor had advised me otherwise! I had surgery 4/22 and have only lost 20 pounds. To me, this is beyond being a slow loser. I'm so disappointed with MY sleeve and wish I had bypass...oh well, life goes on.