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Sleeve Vs Bypass... How did you decide?



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Hi everyone!!

So, my biggest delima right now is what proceedure to choose...The sleeve or the bypass?

Sorry, this may be long..but here is where the issues come from. My PCP is a former sleeve patient & swears by it. My surgeon will do either proceedure. However, he has concerns about the long term effects from the sleeve. He says it hasnt been out that long (vs the bypass), thus doesnt know the long term effects & results (10+ years, lifetime, etc). He used the example that the lapband had great success rates in the early stages (such as where the sleeve is at), but after about 7-8 years there were a lot of failures & revisions needed.

I need to lose at least 90-100lbs. I am worried that the bypass may make me lose too much weight. How does your body regulate and say "okay, this is enough weight off.."?

My PCP is totally against the bypass and says I need the sleeve... The surgeon says the bypass will give best results, has the best documented succecss rate over time, etc. ::facepalm:: now what? Who do I listen to?

Otherwise, I am on month 3 of the 6 month supervised weight loss / diet.. Psych eval scheduled & sleep study scheduled in the next couple of weeks. Nut visit completed... Everything is ready for an approx surgery in Jan - Feb 2015.

Help me decide!

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I just had the sleeve on Sept 10th. I am the worst decision maker known to man! I researched all procedures for almost 3 years!! I was literally one week from my surgery date and still had not completely made up my mind. I have a lot of health issues including diabetes, which the RNY is known to be great for, however at the end of the day, I made a last minute appointment with my surgeon and discussed all my options one more time, with her input I finally landed on the sleeve. For me, I wanted to keep everything where they were, the sleeve had about the same success rate 2 years out from surgery, plus the recovery was shorter. To be honest I had doubts as they rolled me into the operating room. But 2 weeks later and I'm glad I did it. I'm learning to eat an entire new way, I'm losing weight and I know I did the right thing. Good Luck

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MrsB: Only YOU can decide what is best for you and your body/health/situation!!! Things to also consider...how motivated are you? What are your "weaknesses" in losing weight? What are your family supports, influences? What are your health issues?

I had a Lap-Band, precisely because it was less invasive, had good (at that time) results and seemed like a great option. Wrong...I didn't lose much (only 40 #), had severe reflux and feel that I "wasted" that time and money, based on incomplete/incorrect "guidance" from bariatric surgeons.

I had a revision to RNY bypass in November 2014 and I only wish I had done it sooner. I have a healthier BMI, move easier, have no sleep issues, etc. etc. I eat basically anything I want, just in much lesser quantities. I have had a FEW episodes of overeating and/or too much sugar/fat/carbs, which made me sweat, feel faint and nauseous...miserable, but a good behavior modification!! I have kept off 76 pounds for almost 2 years without "excessive" effort. I eat much better; I move more and I feel great!!

I chose the bypass instead of the sleeve because it HAS stood the test of time and is the GOLD standard for a reason! The sleeve SEEMS to be the "next big thing" but, as you noted, there aren't long-term studies yet to confirm or deny it. I did not want to risk having to pay for another surgery, more anesthesia and (psychologically) another "failure". I was self-pay both times, because my insurance has no bariatric coverage...that made a difference in my decision as well.

I personally NEED both the restriction AND the malabsorption; however, I apparently have a very "adaptable" GI system, because I have VERY LITTLE dumping, lactose intolerance, etc. that some others have discussed on this board. Again...everyone is different and there are no hard-and-fast guarantees, so you just have to evaluate every facet and then go with what feels right FOR YOU!

Don't let your MD bully you just because she has done well. Her situation(s) may not be the same...her metabolism/nutrition, etc. may be totally different.

Either option you end up with....best wishes for a successful journey to a lighter, healthier life ahead of you!!! Please keep us posted on your progress.

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I really took a long time deciding between the sleeve and bypass. I was banded in 2005 so I really didn't want to make another mistake again. Thinking back, the band really wasn't the best option for me and in reality I should have gotten the bypass. My surgeon told me that it was up to me which surgery to have. One of my major problems with food is that I have a major sweet tooth. The possible dumping that comes along with eating sugar was one of the reasons I went with bypass. I knew with the sleeve that I probably wouldn't be able to control myself. The malapsorbtion was also another factor so me.

Nobody can tell you what's right for your body. Research, research, and more research.

Good luck!

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One thing I've learned is that if someone has been successful with their own personal results with a particular surgery, that is the one they will praise. Your PCP isn't really unbiased in this situation. Of course he/she thinks it is THE BEST! But one size doesn't fit all. There are lots of things to consider. Do you have problems with GERD - the sleeve can make that much worse in some people. Do you have any conditions that might make having a "blind stomach" left in you a risk? Those are just a couple, there are lots of other things your surgeon will explore with you. Of course not all surgeons are unbiased either, so at the end of the day, you have to go with your best judgement considering all the information you have.

I was in a similar situation - my PCP thought the sleeve was the greatest new thing ever and thought I should do that. My surgeon told me either one would give me great results and it was up to me. I went back & forth for a while, and finally decided that I really needed the malabsorption to help insure I won't be able to gain weight back quickly as I always have in the past. GERD was also an issue, as well as the relative newness of the sleeve. I didn't want to have a revision somewhere down the road because of unforeseen complications with the sleeve - I wanted more of a sure thing (as much as anything like this can be.) Yes, it is more drastic and will require more changes in my life, but I am in a place mentally and emotionally where I believe I can handle those well. So for me, these things tipped the scale.

Only you know what your circumstances, health issues, mental/emotional abilities are, etc. Just keep gathering information and at some point, you will see the scales tipping more in one direction than the other and you will know what is right for you.

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I just had the bypass on 9/22. I was totally set for the sleeve. My sister had it and is at goal doing great! When I went in for the endoscope the surgeon said I had a huge hiatal hernia, with half my stomach in my chest. He said I'd get gerd the rest of my life if I went with the sleeve and he wouldn't do it. I was super disappointed but did my research.

Normally bypass surgery takes 45 minutes. Apparently mind took 6 hours. The hiatal hernia was terrible and had to be repaired. The surgeon showed me photos of what he had to do! Amazing!

Today I'm four days post op and super happy it's all behind me. Do your research. The bypass is still the "gold standard" of WLS. You'll be informed and comfortable once you do that.

Best wishes!

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I went with RNY gastric bypass because of several reasons. First, weight loss is quicker the first year. Second, studies show fewer complications with bypass. Third, bypass is more common and considered the gold standard. Many band patients end up transitioning to bypass later.

The other hand, bypass patients are on Vitamins the rest of their lives. And I often hear the new stomach pouch can stretch over time if you don't stick with your diet.

Happy choosing!

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Jolisue - My endoscopy showed a huge hiatal hernia too so your post made me realize I might need to be prepared for a longer surgery. Thanks!

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My surgeon said that if I was going to let him rearrange my insides, why wouldn't I want him to do the Cadillac of surgeries. He is very pro bypass as you can tell. But when he put it that way it made sense and I want to wake up with no diabetes.

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I am 2 days post op from RNY Bypass. I also went back and forth during my 6 month waiting phase on which to get bypass or sleeve. After meeting with my nutritionist and surgeon several times I decided on bypass because of the amount of excess weight I have to loose. Starting weoght was 349 day of surgery 311. If meeting with a nutritionist or another surgeon for a second opinion is an option that may help you to decide.

So far I am happy with my decision. My surgery went amazingly and the last two days I have had almost no pain, just tenderness. I am up moving around and tolerating liquids well.

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When I first started approaching my doctors about surgery, all were very positive about me having WLS and all three (two endocrinologists and a Gastroenterologist) recommended bypass based on my history of diabetes and GERD. I still did my research and decided that they are right. I 'm four and a half months into a six month insurance mandated weight loss program and in that time haven't changed my mind. (the surgeon also agreed this was the best choice)

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I am a band revisionist. I really wished I had done the other surgeries before I decided on the band. The band wasn't a good fit for my body or life. I am 6 days away from surgery for RNY and I am honestly at peace with it, just nervous and anxious about getting it done already! I say think long and hard, do your research and whatever makes your heart, gut, your feels (what ever you call it) feel at peace then that is the right choice. When you make your mind and are prepared for the good and bad, you come out better in the end.

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AuriP...I think you will be SOOOO much happier with the results of the RNY (bypass) over the LapBand!!! You probably won't have any reflux and "sliming" should also be a thing of the past!!! The trade-off is that, if you eat fats/sweets - in excess - you will feel it and you can't "barf" your way out of it....you have to suffer through it until it passes. (It's a good behavior modiciation!!)

Best wishes on this new journey...expect it to be a big improvement and I think you'll find that it is!!! Please keep us posted on how you're doing along the way!

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I chose RNY because it has a great success rate with diabetes. My other health issues would clear up with either surgery, but when they diagnosed diabetes, that was what really pushed me to consider surgery at all. So I want that diabetes GONE. My husband had RNY 2 yrs ago and he went VERY low weight at first, but has bounced up to a comfortable weight to manage etc. and stayed there for about a year. I think it sounds funny to worry about losing "too much" weight! That has never been a problem before! ha ha. My recovery has been challenging and sometimes I wish I'd done the sleeve. But I didn't have this procedure for a "quick fix", I had it for the benefit of the rest of my life. So if I struggle for a few months but live a long life w/o diabetes or other weight-related health problems, I will consider it a good investment. Good luck with your decision!

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