So I have been attending the support groups that are lead by my surgeon. In the meetings he mentions that gastric bypass is the way to go if you want to lose a lot of weight and keep it off. He literally says that gastric bypass is first choice and second is the sleeve. I have always wanted to do the sleeve but I have around 150lbs to lose... Now I am totally confused!

I will tell you what made my decision for me. It was the fact that, because I have arthritis, I need to be able to take anti-inflammatory medications and pain killers (N-Saids). My surgeon suggested the sleeve for the fact it has less chance of ulceration when taking those meds than the RNY, which he would not let me take if I had that surgery. Now, if your young and don't have those arthritic issues RIGHT NOW, you may wish to think of your genetic history (do you have any rheumatoid arthritis in your family history> How about osteoarthritis?), and ask yourself "if I get arthritis (and more than likely you will - most people as they age will get some form of it), will I want to be able to take pain meds for it?". That's all it took for me to decide. And, as I was in the pre-op stage, not being allowed to take my pain meds before surgery, I was thinking how glad I was to choose the sleeve, because I DON'T LIKE HURTING! And I hurt a lot during the pre-op! Think hard, my dear, and good luck with your decision!

Hey Renee! For me, the decision process came down to a few different factors. If I had some of the severe comorbidities like diabetes I would have considered bypass, but I don't. With bypass, I was worried about the greater possibility of complications like hernias and the whole re-routing of the intestine. Also the malabsorption component which would likely require taking supplements for the rest of my life. I decided on the sleeve because I'm in relatively good health and I want to have a big part of the stomach that produces ghrelin, the hunger hormone, removed because I'm always hungry and I need the limitation to help me not overeat.

I decided on the sleeve since I didn't want the whole malabsorption with the by-pass. The whole dumping thing weirded me out too.

I have seen on this board where plenty of people have lost well over 100 pounds with the sleeve. The sleeve also gives you the option of adding the duodenal switch if you aren't losing enough weight.

To me it seemed less invasive and more flexible than the by-pass.

I would consider talking to other surgeons too. It may be that this surgeon has not done as many sleeves and is therefore more comfortable with the by-pass and by-pass follow-up.

As a VERY general rule, bypass is the standard for people with a higher BMI, but there are so many other things to factor in. You are an individual with your own goals and issues and you need to make the best decision for YOU. My recommendation is to learn as much as you can about both procedures and then weigh the pros and cons against your own personal situation.

The bypass is often called "the gold standard" because it's been around as a WLS longer than the alternatives. There are some really good reasons to choose one over the other but they are all very individual reasons. You should talk with your team about the medical reasons why one procedure is suggested for you over another. If you don't like their answers, by all means get a second opinion! 150 pounds is a lot to lose, but other things aside, you can be successful losing 150 with either procedure. Do your research, get another opinion if you're not comfortable with the first one, learn as much as you can. Best of luck in your decision. Whichever you decide, you'll be healthier for it!

I would add that some surgeons do not allow NSAIDS for life for sleeve patients. You need to find out if your surgeon does. Mine doesn't because she said it could cause ulcers and thin the lining of the stomach. If you get arthritis or any condition which requires an anti-inflammatory drug you are out of luck. Additionally if you have GERD, some surgeons won't do the sleeve as it can worsen GERD or cause it if you didn't have it before. The gastric by-pass can often eliminate GERD.

That being said, you can see many success stories on here of people who lost 100 or more pounds with the sleeve and reversed many of their medical problems.

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Edited March 18, 201511 yr by Garifab_VSG

With bypass, I was worried about the greater possibility of complications like hernias and the whole re-routing of the intestine. Also the malabsorption component which would likely require taking supplements for the rest of my life.

?

You should still take supplements for the rest of your life with VSG, too. The excised portion of the stomach is responsible for storing B-12, Iron and Calcium, so you will have deficiencies in those three things

I would add that some surgeons do not allow NSAIDS for life for sleeve patients.

My surgeon is one of them. No NSAIDS again, ever, after VSG.

I am in a WLS support group that consists of 8 people that underwent geriatric surgery in Oct. 2014. Of these 8 people, I was the only one who chose the sleeve. The rest underwent gastric bypass. My bariatric doctor promotes gastric bypass because he doesn't have much of a history working with sleeve patients (not many choose that route).

I wanted the sleeve because I was worried about anemia, in which I have a history. I want to be able to fully absorb my Vitamins and medications. Also, I knew that with enough determination, I could be just as successful no matter what kind of procedure I chose.

In the end, I was right. I've lost more than anyone so far in my October surgery support group. I lost 100 pounds at my 5 month mark (since surgery) and a total of 110 since

my pre op diet.

It's all about the amount of work you put into it. It is also my opinion that gastric bypass patients SOMETIMES look more haggard and seem to age quicker than sleeve/lap band post op patients. You have to ask yourself how important the malabsorption factor is to you and your well being for the rest of your life.

I meant bariatric, not geriatric. Darn spell check!

With bypass, I was worried about the greater possibility of complications like hernias and the whole re-routing of the intestine. Also the malabsorption component which would likely require taking supplements for the rest of my life.

?

You should still take supplements for the rest of your life with VSG, too. The excised portion of the stomach is responsible for storing B-12, Iron and Calcium, so you will have deficiencies in those three things

I would add that some surgeons do not allow NSAIDS for life for sleeve patients.

My surgeon is one of them. No NSAIDS again, ever, after VSG.

I was told that bypass patients will need to take more supplements for the rest of their lives, while sleeve patients may need to take fewer and may be able to get the nutrients they need from food.

I was told that bypass patients will need to take more supplements for the rest of their lives, while sleeve patients may need to take fewer and may be able to get the nutrients they need from food.

Ah, OK, that makes sense!

I was told that bypass patients will need to take more supplements for the rest of their lives, while sleeve patients may need to take fewer and may be able to get the nutrients they need from food.

This may be the case, but in both instances, patients should be having regular blood work done to make sure they don't develop any deficiencies. I've had two done so far post-op and everything has come back in normal ranges, but I take supplements daily. My nutritionist requires a bariatric multivitam 3x per day, calcium +D3 2x per day, liquid b12 daily, and a probiotic daily. In addition, I take several supplements I was already on pre-op.

Hi all! Thanks so much for the comments, I know that this is such a personal decision, but it always helps to get a little guidance. I am overweight but I don't have any co morbidities YET. I wanted the sleeve because I don't want to re route my intestines and risk malnutrition.

I think you all are right, it really depends on the person and how much work they are willing to put in. My surgeon talked about some people that got the bypass and only lost about 30lbs.

I don't think I can go wrong if I am willing to put in the work and make this tool work with me. I am definitely not going into this blindly thinking that it is a miracle and I can just sit back and do nothing and watch the weight fall off. I think having this site and seeing all of you that have lost weight with the sleeve and the work you put in helps a lot!

Thanks again!