Why is my doctor pushing for bypass?

[green*eyed*girl 170]

Hello!

I am a 39 years old relatively healthy female - well, except my weight! After years or research I have decided to undergo gastric sleeve surgery. I have read and researched it for a long time, so I feel pretty confident that this is the procedure I need. I understand that I will have to carefully watch what I eat after surgery, I know everything about the Protein first rule, I am commited to excersize as soon as I lose a few pounds. I feel I am ready.

So I went to see the choice of my surgeon and he is absolutely pushing for the bypass! I know because of the malabsorption it is probably easier to lose weight (?), he is also saying weight loss will last longer and with the sleeve I will only lose a little and I will come back to him for the bypass. I was pretty confused, and felt uncomfortable, because I have already made up my mind, and it is almost like me against him and his expertise? But exactly what he likes about the bypass is the thing I do not like : abnormality in absorption. I do not want to take Vitamins and have injections til the end of my life. He says Vitamin deficiency only occur in 50% of the cases...

We agreed that I will think about the type of surgery I want til my date. I am self pay and my DOS is 14th of April.

But I already know I want the sleeve and I will make it work for me.

Why is he so against it? Any idea?

[woo woo 872]

Honestly? My suggestion is to get another surgeon -- or at least a second opinion on the issue. Aside from certain specific health concerns, the choice of surgery is normally left to the patient.

ETA: The reason he is pushing it is possibly just that he really likes the bypass and feels it is the superior surgery for whatever his reasons may be. Or in his experience, outcomes have been better for his bypass patients? Who knows.

Edited February 21, 2014 by woo woo

[2Big2Skate 328]

My PCP was recommending bypass to me as well. He said "you can outeat the sleeve and the band, but the malabsorptive aspect of the bypass increases your odds of success greatly." It's probably just being conservative on his part. PCPs have no idea WHY we overeat, so naturally they assume the behavior may reappear.

[gohelpyourself 377]

Second Opinion is in order. The sleeve is becoming the WLS of choice. Perhaps he hasn't done that many and if that is the case.... find another surgeon. The more sleeves the surgeon has performed.. the less chance of complication (read an evidence based article on that). I wouldn't want bypass. That's just me. I do not think I would have had WLS if that was my only choice... didn't want lap band either. I am a fan of the sleeve.

[sassypants 674]

I had the exact same thing not by my actual surgeon but by one od the doctors on that team who saw me 1 time for pre op assessment.
She tried to push it on me and point blank told me if I had the sleeve I wouldn’t lose a lot of weight and put it all back on in 2 years anyway and would end up coming back to them for the bypas in the end so why not just do it now and save all that time and money.
When I saw my surgeon and asked him why she wanted me to have it did I have to as in is that my only choice as I do not want it he said no not at all.
He went on to explain they have more data for the bypass its been around longer so they tend to go for that one overall but this one is fast becoming the better option it just doesn’t have as much data to compare it.
Hes been doing wls for 10 years and he didn’t think I needed bypass and didn’t want to give it to me anyway.
So I think you have one of them stuck in his ways doctors who has been doing the bypass for so long goes on the years of data for it over the sleeve and tries to push that overall.
Personally I would get another doctor my fear would be they put me under say some rubbish and I wake up with the bypass instead and that would make me flip the F out!
I just couldn’t pay or trust someone who was pushing something else on me.

[Carlotta1 401]

I have had friends who had the bypass and regained lots of weight, and now they have malabsorption for the rest of their lives. I personally would never have the bypass..too drastic ..but to each his on. Whether we have the bypass or the sleeve..we can lose and put back the weight on ..however we need to remember these surgery are tools. .if we don't change our lifestyle with eating ..exercising and know why we go to food for comfort ..we will have a greater potential to regain the weight back. What we put in this process is wht we reap. It is a journey ..

[Purple Iris 14]

I totally agree with getting a 2nd opinion. Although, when I met with my surgeon, I was convinced the sleeve was the way to go for me. Since I have GERD, my surgeon highly recommended the bypass as the sleeve would only make it worse.

[LipstickLady 25,682]

I went through 4 months of my 6 month process being pushed into bypass by both my original surgeon and his NP. They grudgingly agreed to do what I wanted but made my feel like crap about my decision with each visit. While I was fat as a house, I had no other health issues and all my research pointed to the sleeve. I knew that I would not stick to the "right" diet 100%, that I would NOT take Vitamins forever and that I did not want to risk dumping. (Yes, I know it's possible with the sleeve but much less likely.)

I finally got POed enough to seek out the opinion of a second doctor who, in the seminar, was a huge advocate of the sleeve unless one was diabetic or extremely severely obese.

I switched docs, started the process over and am thrilled with my choice.

The bottom line? My original doctor is an fabulous surgeon who has 30+ excellent years of experience. He's done 1000s of bypass procedures and is well below the statistical average of complications. That said, he's only done about 100 sleeves.

My actual surgeon only has about 15 years of experience, but has done 1000+ bypass and just as many sleeves. He was more up on the newer procedures and is not in a rut of what he "knows". He cared more about ME than about his known "specialty".

I made the right choice and you will, too.

[Dr-Patient 830]

If I may chime in...you should get a second opinion. People can lose weight with either procedure, and regain with either procedure. But with the RYGB, as others have said, malabsorption, etc., can happen.

I can give more info later, but...get a second/third opinion.

And still, in the end, it is YOUR choice for this elective procedure...especially since you are self-pay. Don't pay for an elective procedure that you really don't want.

Edited February 21, 2014 by Dr-Patient

[green*eyed*girl 170]

Thanks everybody who commented.

As far as getting a second opinion I do not see why I should, as my doctor already said that I am a perfect candidate for the sleeve, and he will absolutely do the surgery for me if that's what I really want, but he thinks I will not lose enough weight and I will come back for the bypass. However I do not agree, and I told him my point of view and that feels pretty funny, me the simple PlainJane and the big KnowItAll Doctor hehehe, but I know I will go with the sleeeve.

Also as far as finding an other doctor - it is not going to happen. This one has loads of experience under his belt (gotta admit mainly bypass but he has done plenty of sleeves too), and believe it or not I simply have no other choice, in my country of origin (where I will have the procedure done) he is the only doctor who performs this surgery. So I can not just switch to somebody else coz there is nobody else

I was thinking maybe it is a pride thing for him and for so many other surgeons, as 2Big2Skate's doctor said "malabsorptive aspect of the bypass increases your odds of success greatly", so they want assurance we will lose weight and it will look good on their records...But they do not have to deal with the consequences, we will have to and I would much rather lose 80% of my stomach as it just made me fat and wants me to put food in it all the time, then deal with Vitamin deficieency for the rest of my life.

[Dr-Patient 830]

Green-eyed, you want the sleeve; he will do the sleeve. Great. You never want to enter a surgery that you, as the patient, are reluctant to have. Glad it's all in order. You are (only) 250 pounds. You will lose plenty weight with the VSG.

Oh, I may email you to find out if your doc is a certain person, because at a recent obesity conference (with docs from around the world!!), there was one guy from the UK that was an absolute butcher (from the video he showed). It made many of us cringe!! I'll check my materials, pull his name and get back to you.

Good luck and congratulations in advance.

[PS: I just checked; the surgeon of whom I speak has the initials "Ja..... H." Hope that's not your doctor.]

Edited February 21, 2014 by Dr-Patient

[Postop 405]

Not much to add in the way of advice as the previous posters have made some good points. Just one thing, with the gastric bypass the malabsorption lessens greatly after the first year.

Edited February 21, 2014 by Postop

[2Big2Skate 328]

Did he show you a chart with two weight loss curves over time, one for the sleeve one for the bypass? My PCP showed me one he had that showed the bypass lost more weight faster then the two lines stayed parallel with the sleeve never catching up. That was some national data out of some bariatric book, and it mightve been old for all i know.

My Surgeon on the other hand showed me data compiled just in his practice. And his chart did show the bypass lost more weight quicker, but then the sleeve samples caught up at about 18 months. He's in a huge urban university practice so they've done as many sleeves as anybody in the country i'd bet.

That's what sealed the deal for me. I also had an aggressive plan in mind for exercise and sports. I wanted full absorption.

Jay

[green*eyed*girl 170]

You are right, that pretty much sums it up, I know what I want and I will do my best to not fail it.

Green-eyed, you want the sleeve; he will do the sleeve. Great. You never want to enter a surgery that you, as the patient, are reluctant to have. Glad it's all in order. You are (only) 250 pounds. You will lose plenty weight with the VSG.

Oh, I may email you to find out if your doc is a certain person, because at a recent obesity conference (with docs from around the world!!), there was one guy from the UK that was an absolute butcher (from the video he showed). It made many of us cringe!! I'll check my materials, pull his name and get back to you.

Good luck and congratulations in advance.

[PS: I just checked; the surgeon of whom I speak has the initials "Ja..... H." Hope that's not your doctor.]

[Amyllf2 206]

I just got back from my first meeting with surgeon and got on this board to ask why people picked sleeve and not BP. My surgeon does all 3 and says he will do whatever procedure the patient wants, as long as the decision is a well informed one. He's not fan of the LapBand but said he did one just last week.

I walked in to his office sure I wanted the sleeve. Now I am having doubt. He said the weight loss difference between the 2 could come down to only 10 pounds which is not a factor for me. What he emphasized to me was the leak rates are higher for the sleeve because of the amount of stapling. Now, he said it's a difference between 1% for the BP and 2.5% for the sleeve. But higher is higher. He also mentioned heartburn and reflux. He said the BP is better for anyone with heartburn and actually can cure it. While the sleeve can actually leave people who did not previously have heartburn with an issue that will need medicated long term.

He asked me why I walked into his office with a sleeve on my mind. The only reason I could provide is that the bypass part kind of bothers me and I worry about dumping and intestinal issues.

Why have all of you picked the sleeve and not the BP?