Bypass or Sleeve?

[DLCoggin 1,788]

FYI the sleeve resolved my type 2 diabetes. I am 8 months post-op and have a non-diabetic A1C. I am actually sitting in the doctor office right now having the two hour glucose tolerance test to prove I don't have diabetes anymore and take it off my record. I have not had a glucose reading over 4.8 since I woke up from surgery, have not had to take metformin. Mostly my glucose readings are around 4.2 now. That is mmol/l but I think it is around 80 mg/dl (the system used in the US). These are non-diabetic numbers.

One downside to RNY is the part of the stomach left behind is very prone to stretching. Several years out many RNY patients can eat a normal sized meal. Of course the sleeve doesn't have a lot of data about patients more than 10 years out.

They are both good surgeries. You need to research the hell out of it and make a choice you are comfortable with. None of us can or should try to make up your mind for you.

Excellent post and very informative. Congratulations on the resolution of the diabetes!

I'd appreciate it if you would expand on "One downside to RNY is the part of the stomach left behind is very prone to stretching." It is my understanding that a portion of the stomach remains following either surgery. With the sleeve, approximately 75%-85% of the stomach is removed. With the bypass, the pouch is created from the upper part of the stomach. In either case, pouch or reduced stomach, the tissue is the same. Patients for either surgery are routinely cautioned that stretching the stomach/pouch is always possible (although I suspect less common following either surgery than is often believed).

Please note that I ask only from the perspective of increasing my knowledge. I don't have any basis for doubting the validity of your statement. I would just like to know more including sources of additional information if you have them available. Thanks so much!

Edited January 15, 2014 by DLCoggin

[mistysj 1,939]

There are different parts of the stomach. The upper curve is called the fundus and it is the part that is really stretchy. That's the part that is removed with the sleeve. With the RNY, the pouch is made using mostly tissue from the fundus. The pouch starts out about the size of a walnut, but is quite prone to stretching. You will see lots of people who have not taken care of their pouch complaining that they can eat a lot when they are several years out. They can have surgery to tighten the pouch back up. Also the opening from the pouch into the roux limb can stretch too which means food can exit the pouch more quickly than is ideal.

This may make the RNY sound like a bad surgery but it is not. You just need to be very aware of "pouch maintenance" and be aware that over time you will have increased capacity. Just because you can eat more does not mean you should.

With the sleeve, you start out with an extremely small capacity because of swelling. You can only hold a couple ounces for the first several weeks. The swelling goes down and you can hold more at around 6-8 weeks. Then the sleeve starts to "relax" by about the 6 month mark and you can hold half a cup to 2/3 of a cup. By the 2-year mark the sleeve is as big as it will probably get and people seem to hold about a cup, depending on the food. So yes the sleeve's capacity increases too but it is not made from a very stretchy part of the stomach so it can only go so far. The sleever's long term struggle is keeping the carbs on the low side because carbs tend to be sliders for many of us. For instance I could eat a whole lot of chips or crackers but can't eat more than 60 grams of lean Protein.

Also it is becoming clear now that sleevers do need to take supplements because we do appear to have some malabsorption. Rather than choosing whether to take supplements based on your surgery type, it is better to have your levels tested regularly and take what you are short of.

Two books that are great to read no matter what surgery you choose are "Success Habits" and "Emotional First Aid Kit."

Regardless which surgery you choose, find some long-term successful vets here and learn from them.

[pupichupi 124]

There are different parts of the stomach. The upper curve is called the fundus and it is the part that is really stretchy. That's the part that is removed with the sleeve. With the RNY, the pouch is made using mostly tissue from the fundus. The pouch starts out about the size of a walnut, but is quite prone to stretching. You will see lots of people who have not taken care of their pouch complaining that they can eat a lot when they are several years out. They can have surgery to tighten the pouch back up. Also the opening from the pouch into the roux limb can stretch too which means food can exit the pouch more quickly than is ideal.

This may make the RNY sound like a bad surgery but it is not. You just need to be very aware of "pouch maintenance" and be aware that over time you will have increased capacity. Just because you can eat more does not mean you should.

With the sleeve, you start out with an extremely small capacity because of swelling. You can only hold a couple ounces for the first several weeks. The swelling goes down and you can hold more at around 6-8 weeks. Then the sleeve starts to "relax" by about the 6 month mark and you can hold half a cup to 2/3 of a cup. By the 2-year mark the sleeve is as big as it will probably get and people seem to hold about a cup, depending on the food. So yes the sleeve's capacity increases too but it is not made from a very stretchy part of the stomach so it can only go so far. The sleever's long term struggle is keeping the carbs on the low side because carbs tend to be sliders for many of us. For instance I could eat a whole lot of chips or crackers but can't eat more than 60 grams of lean Protein.

Also it is becoming clear now that sleevers do need to take supplements because we do appear to have some malabsorption. Rather than choosing whether to take supplements based on your surgery type, it is better to have your levels tested regularly and take what you are short of.

Two books that are great to read no matter what surgery you choose are "Success Habits" and "Emotional First Aid Kit."

Regardless which surgery you choose, find some long-term successful vets here and learn from them.

Thanks misty for the information!!! Its great to know!!! I will find those books and check them out! As for long timers I work with a lady that has had the bypass for like 5+ years and I talk to her all the time about it so she helps!!!! thanks again

[iamsoworthit 430]

There are different parts of the stomach. The upper curve is called the fundus and it is the part that is really stretchy. That's the part that is removed with the sleeve. With the RNY, the pouch is made using mostly tissue from the fundus. The pouch starts out about the size of a walnut, but is quite prone to stretching. You will see lots of people who have not taken care of their pouch complaining that they can eat a lot when they are several years out. They can have surgery to tighten the pouch back up. Also the opening from the pouch into the roux limb can stretch too which means food can exit the pouch more quickly than is ideal.

This may make the RNY sound like a bad surgery but it is not. You just need to be very aware of "pouch maintenance" and be aware that over time you will have increased capacity. Just because you can eat more does not mean you should.

With the sleeve, you start out with an extremely small capacity because of swelling. You can only hold a couple ounces for the first several weeks. The swelling goes down and you can hold more at around 6-8 weeks. Then the sleeve starts to "relax" by about the 6 month mark and you can hold half a cup to 2/3 of a cup. By the 2-year mark the sleeve is as big as it will probably get and people seem to hold about a cup, depending on the food. So yes the sleeve's capacity increases too but it is not made from a very stretchy part of the stomach so it can only go so far. The sleever's long term struggle is keeping the carbs on the low side because carbs tend to be sliders for many of us. For instance I could eat a whole lot of chips or crackers but can't eat more than 60 grams of lean Protein.

Also it is becoming clear now that sleevers do need to take supplements because we do appear to have some malabsorption. Rather than choosing whether to take supplements based on your surgery type, it is better to have your levels tested regularly and take what you are short of.

Two books that are great to read no matter what surgery you choose are "Success Habits" and "Emotional First Aid Kit."

Regardless which surgery you choose, find some long-term successful vets here and learn from them.

This is great info! I am a band to rny conversion and I was wonderibg about my pouch and why it would steetch with time. Thanks for sharibg!

[DLCoggin 1,788]

Thanks for your reply misty!

Some doctors consider stretching of the stoma (pouch opening) more serious than stretching the pouch. In spite of considerable research, I haven't been able to locate any reliable sources for statistical percentages of bariatric patients that experience stretching of the pouch, stoma or stomach (in the case of the sleeve). Probably because accurate data would be difficult to obtain without large scale clinical studies. Patients often mistakenly conclude that their pouch has stretched when in fact it has naturally become more "compliant" over time.

One analogy compares it to a new balloon vs. one that has been inflated many times. When you inflate the new balloon it takes more pressure. When you inflate it for the hundredth time, it's much easier. The volume of the balloon hasn't changed, but it has become more compliant. The exact same thing naturally occurs with a stomach or pouch over time. The volume doesn't change (usually) but it is easier to put more in it if you choose to.

There have been a number of examples on the forum of folks who are concerned that they have stretched their pouch, only to learn from an endoscopy that the pouch still has the expected volume. The pouch is not stretched, but it is more compliant. That may result in delayed signaling of satiety from the stretch sensors in the pouch/stomach to the brain. Bottom line - Portion Control remains crucially important (for life) in order to avoid weight regain.

Thanks again and have a great day!

[Branmuffin 190]

I have two acquaintances who had the bypass. The first friends intestines twisted and fell into the "gap" where they had removed them from and she almost died. The second is in an induced coma right now because she hemmorhaged during the procedure. On the flip side I have 4 acquaintances who had the sleeve and the worst complaint was having gallbladder issues and acid reflux. I chose sleeve and am 10 weeks post surgery now and have lost from 237 to 190 with minimal acid indigestion. It's a huge decision whatever you choose and no matter what your choice, I wish you luck.

[Madelyne Bonthron 128]

There are different parts of the stomach. The upper curve is called the fundus and it is the part that is really stretchy. That's the part that is removed with the sleeve. With the RNY, the pouch is made using mostly tissue from the fundus. The pouch starts out about the size of a walnut, but is quite prone to stretching. You will see lots of people who have not taken care of their pouch complaining that they can eat a lot when they are several years out. They can have surgery to tighten the pouch back up. Also the opening from the pouch into the roux limb can stretch too which means food can exit the pouch more quickly than is ideal.

This may make the RNY sound like a bad surgery but it is not. You just need to be very aware of "pouch maintenance" and be aware that over time you will have increased capacity. Just because you can eat more does not mean you should.

With the sleeve, you start out with an extremely small capacity because of swelling. You can only hold a couple ounces for the first several weeks. The swelling goes down and you can hold more at around 6-8 weeks. Then the sleeve starts to "relax" by about the 6 month mark and you can hold half a cup to 2/3 of a cup. By the 2-year mark the sleeve is as big as it will probably get and people seem to hold about a cup, depending on the food. So yes the sleeve's capacity increases too but it is not made from a very stretchy part of the stomach so it can only go so far. The sleever's long term struggle is keeping the carbs on the low side because carbs tend to be sliders for many of us. For instance I could eat a whole lot of chips or crackers but can't eat more than 60 grams of lean Protein.

Also it is becoming clear now that sleevers do need to take supplements because we do appear to have some malabsorption. Rather than choosing whether to take supplements based on your surgery type, it is better to have your levels tested regularly and take what you are short of.

Two books that are great to read no matter what surgery you choose are "Success Habits" and "Emotional First Aid Kit."

Regardless which surgery you choose, find some long-term successful vets here and learn from them.

Wow i never realized. What great information thank you. Glad i had sleeve

[mistysj 1,939]

People have complications with all surgeries. Don't go by hear-say or anecdotes but look at real statistics. I think it is dangerous to paint a picture that the sleeve is less risky than RNY. Full disclosure, I had the sleeve. But I don't think the RNY is a bad surgery.

[Bellanthin 112]

Sleeve

[iamsoworthit 430]

This thread is ridiculous to me. It's like saying what's better? Lincoln or Cadillac?

Ultimately who cares? All that matters is the surgery is the vehicle that gets us to where we want to be. All of the surgeries work, or doctors wouldn't perform them. As well informed patients it is up to us to figure out (based on sound science and not anecdotal heresay) what we believe will work best with our lives. The rest is just b.s. as far as I am concerned. Just sayen'

[mistysj 1,939]

It matters to pre-ops who haven't made their decision yet. It is not a decision to be made lightly.

[iamsoworthit 430]

It matters to pre-ops who haven't made their decision yet. It is not a decision to be made lightly.

Again, base it on facts not anecdotal evidence. I agree about research and did plenty beforehand too. Having had 2 of the big three wls out there I can safely say there are pros and cons to both but no one should base their decision on what has happened to me.

[aroundhky 1,174]

All I can say is I got the sleeve 2 years ago and I am trilled about having it done. Could I feel the same way with the bypass or band? Maybe, but I know the sleeve has been great to me. For me and my fitness requirements and goals, I needed absorption and sleeve has been great!

[Miss M 4]

Tina, I'm afraid that you doctor is wrong when he said that the sleeve is non-invasive it may not be as complicated as the bypass as far as re-routing the intestines but it is invasive none the less as three quarters of your stomach is completely removed and then stapled to form the sleeve.

Personally I've had all three and there is not one surgery that is better than the other, they all have their good and bad sides.

[pupichupi 124]

Tina, I'm afraid that you doctor is wrong when he said that the sleeve is non-invasive it may not be as complicated as the bypass as far as re-routing the intestines but it is invasive none the less as three quarters of your stomach is completely removed and then stapled to form the sleeve.

Personally I've had all three and there is not one surgery that is better than the other, they all have their good and bad sides.

Thanks MissM see and that's what I don't want is to go threw the sleeve then have that not work for me and then go back and have a 3rd surgery??? I am just getting the bypass!!! I have decided its the best thing for me!!!!