Sleeve vs. RNY

[HarleyGirl4 3]

Hello everyone! I am currently scheduled for surgery on the 19th of November. My surgeon stated that he just needs to know which surgery I want to have before he makes the incision. So, I have a week and half to decide. His opinion is that because the sleeve is newer, there just isn't as much data as there is for the RNY to know the long term success rates. He would prefer the RNY as he states that, in his experience, he sees faster and more weight loss from the RNY vs. the sleeve. But he also admitted he doesn't have as much long term data on the sleeve as he does on the RNY. He also stated that the risk of leakage is higher in the sleeve. The place I am doing this with is considered a Center of Excellence and the team of doctors there has been doing these surgeries for ten years, so I do not doubt his opinion. I doubt my own. I am trying to figure out which of the two surgeries would be best for me. I would like to hear from anyone that had to make this decision and what were the deciding factors for you? For me thus far, I am leaning towards the sleeve. My thoughts are

1.) Less chance of "dumping" syndrome

2.) Less chance of Vitamin deficiencies

3.) If it doesn't work, bypass or DS can be performed at a later time, even if it's at my own expense.

I would be anxious to hear anyone's thoughts on this subject and appreciate any input at all.

Also, please note that I am not having surgery to reverse any type of secondary morbidity disease like diabetes. My cholesterol is slightly elevated and I have sleep apnea. I know both of those will go away with either surgery.

[jjinWA 511]

I agree with all 3 and why I made the decision for the sleeve. There are many factors to consider before you make the final decision and your body is unique and therefore your decision should be based on that primarily. But with that said feedback from others will be helpful. Acid reflux is the main concern for most who eventually decide to do RNY and overall weight loss numbers. Although obviously not the only reasons to consider RNY. Previous surgery caused limitations for me and was also deciding factor for me and my dr to go with the sleeve. He also commented on the limits of tested time for the sleeve and therefore he prefers the RNY. But he also noted that based on patient requests he does more sleeves! Good luck on your journey.

[HarleyGirl4 3]

_jjinWA,

_{Thank you for taking the time to respond. Your input is helpful.}

[bikrchk 1,313]

Those are the primary reasons I chose the sleeve over they bypass. I've never been sorry, but I'd be concerned that the doc who is about to cut on me is less comfortable with that option.

[HarleyGirl4 3]

bikrchk,

Thank you for the response. When I spoke with the surgeon, he was just more concerned about the higher chance of leakage because there are so many more staples but the way I see it, it is a risk either way. He has done several of both surgeries and he just feels overall that the weight loss numbers are greater with RNY. From what I have found online, the numbers are greater for RNY at first, but the long term weight loss is about the same 2-5 years post op. The sleeve is just more "slow and steady". Or do I have the wrong?

I guess my biggest reservation against the sleeve is that, from what I can see, due to less restriction, there is less accountability. In other words, with RNY, I see the mentality as "If I eat this, the consequence is xyz.” With the sleeve, I haven't been seeing people post about getting sick if they ate too much or the wrong thing. Or am I wrong on this fact? I am the type of person that needs that "consequence mentality" and I am afraid that the sleeve just won't be enough for me.

That is where I am struggling as of today.

[nikki9 70]

I always thought RNY was too harsh for me. Going in to this process I wanted lap band. After research I changed my mind.

I feel like I just needed a little help. I just barely met the 40 bmi requirement. I was looking to be proactive and not keep waiting making the same mistakes and then wondering why I didn't do something to help myself.

The first time I saw the surgeon he wanted me to do RNY. That's their gold standard. He said the data is not there for the sleeve. Once we talked about my Migraine medication ... its a NSAID I believe. Then he suggested the sleeve. For that and the top 2 reasons you listed. I hope this makes sense and I'm not rambling.

I'm sure if you post this in the RNY section the will give you good reasons to chose that surgery. I know of someone that was going to have the sleeve and at surgery changed her mind to get RNY. Just felt that if she was going to do it she might as well do the whole thing.

I'm sure once you make a decision you will be happy. Let us know your decision. Good luck!

[Mrs. Reid 392]

I chose the sleeve because I know 4 people who had wls, two had the sleeve and two had the bypass. The two with the sleeve have lost - and kept off - well over 100 pounds each. They could not be happier with their decision. The two with the bypass have lost more weight, but are still having complications even 15 years later. One even had to have surgery 7 years after the bypass because of some twisting in her intestines.

[MisforMimi 760]

@@HarleyGirl4

Hey, I have a couple of thoughts (note I am pre-surgery)

1) If there is any way to go to a (post-surgery) support meeting at the facility prior to making a decision, it will be truly enlightening. I would also say to take your time with this, its a big decision. You want to feel you are making the best choice - like your choice is coming from deep within and like its the loudest voice in your head. Can you move your date back without too much hassle?

2) Ask the surgeon about his stitching technique. Some do one and some do "double-stitching"

3) Without knowing your age and co-morbidities its hard to know but I went thinking I wanted the sleeve but as I began my research, I knew I need a negative feedback loop to keep me away from certain trigger foods. I needed the surgery that would give me the best chances to be a lower weight. I have lost weight before without surgery and maintained it for a while right at the percentage of the average EWL for sleeve patients at 3 years out in my surgeon's practice.

For me, that would put me at about 200 or sdo lbs and frankly I wanted more weight loss because if I'm going to go through surgery for weight loss (and to get healthy, to get off medications) the lower my weight, the better my chances.

Also, my chances of resolution of my high blood pressure is better with the bypass. I want off my meds! in general, the lower my weight, the lower my blood pressure.

[MisforMimi 760]

@

Can you speak to ages, compliance and how many years out the 4 people you are comparing are? I'm curious.

[HarleyGirl4 3]

nikki9,

Yes, I am in the same boat. My BMI is just under the qualifying amount for surgery and only because of the other two diagnoses of sleep apnea and high cholesterol was I approved. My surgeon doesn't even have me doing the pre-op diet. He just asked that I not gain 20 pounds in the next week and half. I also considered the fact that I would be restricted to certain pain medication for the rest of my life and at 38, I don't want to have to fight that battle plus all of the other lifelong restrictions that go along with RNY. I would like to lose 85 pounds and I feel like I can do that with the sleeve.

cynthiarm2000,

The lifelong complications are exactly what I want to avoid. I am finding that there are way less of those with the sleeve than with the RNY. Thank you for those stats. I am curious to your answer to MisforMimi question though as well.

MisforMimi,

Thank you for your feedback. To answer some of your questions, I am 38 and my secondary morbidity diagnoses are sleep apnea and high cholesterol, both of which will go away with either surgery. I have been in the pre-op, non-surgical weight loss plan for over a year now and if I don't do the surgery now, it will be after the first of the year. My deductible is met for the year so my out of pocket expense is very low to keep my date as it is. I have known for months that I will be having surgery; it's just recently that I started to question which one. I really like your idea of going to a post op surgery support group prior to surgery and I will look into that. I will also be sure to ask my surgeon which type of stitching he does. Your thought process for you makes sense for your choice. I appreciate that we are all in the same boat of trying to save our lives in one way or another. Good luck to you!

[Mrs. Reid 392]

@@MisforMimi The two sleeved women were in their 40s when they had it done. They are both medical professionals and were and are still very diligent with their diet and exercise. One had it done in 2011 the other in 2012. They are sisters and my cousins. They are so thrilled with their surgeries and have had nothing but good things to say about it.

One of the bypass women had hers done in 2000 when she was in her late 30s. She had a lot of leaking complications and still experiences pain. She is not as diligent. She is unable to eat large meals, but she eats very often. She has gained back a lot of weight. The other woman had her bypass in 2006 and follows the diet and exercise guidelines like it's a religion. She had to have surgery in 2012 because her intestines had gotten twisted up and that caused an obstruction. I understand that is not uncommon in bypass patients. Because of this....it's the sleeve for me!

[HarleyGirl4 3]

So for those that have had the sleeve done already, would you please speak to your expierence with any complications? What were they are how were they resolved?

[auntiemel 275]

RNY was too much for me to handle! Having a blind stomach that could perforate if a medic or doctor tried to scope me...no thanks.

Having my intestines moved around kinda really grosses me out. I figured cutting out a hunk of my stomach and leaving the rest where it was made to be was my best option. I had reflux but that was fixed with my hiatal hernia repair.

There is a 1% chance of leaks with the sleeve and most are from eating and doing what you aren't supposed to.

You can't modify bypass, but you can modify a sleeve. The stretchy part of the stomach is removed with sleeve, and let me tell you, there is a huge difference in eating after you get to solid foods.

I am an overeater! Even if it was heathy I ate too much. Now I can barely finish a few bites of chicken or a taco, granted I am only 6 weeks out, almost 7.

[HarleyGirl4 3]

auntiemel,

Your thinking goes along with mine as well. I am not hearing a whole lot of negatives about the sleeve at this point. And this discussion has helped me make up my mind. Thanks for the input!

[HarleyGirl4 3]

^{Thank you everyone for your input. Although my doctor was pretty confident that my insurance covers both sleeve and RNY, I called the doctors office today to verify that my insurance will cover the sleeve. The lady that handles insurance is out but when she gets back on Monday, if she calls and says yes, I believe that I am going to opt for the sleeve. Thank you all so much for your insight!}