Does anyone feel pressured by their surgeon to do the RNY/bypass over the sleeve?

Like everyone else, I sat through the initial info session my surgeon offered and I felt like she was really selling the RNY. The whole session was about the RNY, in fact, and how it's the "gold standard" and best procedure.

Then, I met with her for my initial appointment. She predictably said I was a better candidate for the RNY. I am 5'2" and weigh 250. Fair enough. I went home and had my mind set on the bypass.

But then I started doing my homework and, after much thought, I decided the sleeve may be better for me for many of the same reasons as others who make this decision: I have no comorbidities, research seems to say it's less invasive, no rerouting, no dumping, no vitamin/medicine probs and it would cut out the hunger hormone grehlin. Equally as important it would restrict the amount I can eat and, according to the many pieces of research I read, offer practically the same amount of weight loss as the RNY over the long term, albeit at a slower rate.

I am also a cancer survivor and I had concerns about the malabsorption that comes with the RNY and whether or not I could effectively be treated in the future (if needed) if my body would no longer absorb medicines (including oral chemo).

That said, I did have a couple of concerns about the sleeve. One, I'm not a necessarily volume eater and this is obviously a purely restrictive procedure. And two, I have a career, a lot of business travel, and a toddler, so I can't commit to constantly exercising like others do. I wondered if I wouldn't lose enough and then regain what I do lose because I won't have that malabsorption so many people benefit from with the RNY.

So, I made a second appointment with my surgeon to discuss all of the above and she was still all about the RNY -- which is totally fine. She is the expert and I am turning to her to help me make an informed decision. However, she mentioned several things that were contrary to everything I've read. She said...

--Malabsorption only lasts six months at the most for both calories and nutrients/medicine (yet, her required nutrition classes talk about the life long Vitamins, etc???)

--People don't lose weight from the RNY because of the malabsorption or restriction; they lose weight because they're bypassing all the hormones in the first part of the small intestine, something you don't get with the sleeve (so malabsorption has very little to do with the weight loss)

--The RNY is safer than the sleeve; the sleeve is actually more invasive and dangerous to recover from because it's more prone to leaks due to the length of cut and pressure that builds in the sleeve.

--The sleeve causes less weight loss and you will regain more in the long term. I have read that the long term results are VERY similar to the RNY. She says no, long term for RNY is much better.

--The least I can ever weigh with the sleeve is 180-190 lbs (currently 5'2" and 250 lbs) and I likely won't get that low.

--I can take time release medicines in the future and they will probably work.

--The sleeve will rarely be performed five years from now because it's not effective; but I thought the sleeve was becoming the WLS of choice

I was confused by what she was saying, so she referred me to the Cleveland Clinic's "Stampede" study, as it compares the RNY to the sleeve. But I read it and it is all about the effects of both surgeries on diabetic patients. I don't have diabetes.

Does any of this sound like what you've understood from your surgeons?

My surgeon is loved by all. She is smart, has great bedside manner, has been doing this for over ten years and has one of the Bariatric Centers of Excellence. I do trust her, but some of this sounds strange to me. In the end, I want solid info so I can make the decision that's best for me.

Any thoughts on why surgeons might try to "sell" the bypass more often?

Also, any thoughts on what she said to me when I went in to ask her about doing the RNY vs. the sleeve?

Thanks!

Drmeow

Yes!!!A good dump should keep me in order....Like a taser!LOL...

I posted this elsewhere, too...

Thank you so much, everyone, for your feedback. This helps a lot.

I'm still very conflicted. I went back to my surgeon today and one of her staff members told me they don't even normally do the sleeve for people of my weight because they just don't see the results they need. All that said, they agreed to do the sleeve for me if I want to go that route.

Honestly, I have a friend who weighed around 350 and she lost over 100 lbs -- so she has been successful, but she is having trouble losing the rest of her excess weight.

So, I'm still really confused -- and I'm not sure how much of it is because my surgeon and her office are encouraging me to do the bypass or what I have seen with my friend and her sleeve.

Also, I spoke with my oncologist and he said that if I were to ever need treatment in the future, I could be treated if I have the bypass or the sleeve.

When I originally went to see my doctor, my BMI was 49; I'm 5'7" and I weighed 315 lbs. He told me that really the only serious option for me was the gastric bypass. He said that a person with as much weight to lose as I have does best with the gastric bypass, because it provides the most weight loss. I have heard other doctors say the same thing.

Second, if you read these boards you will find many people who have had revisions from other WLS (both band and sleeve) to the gastric bypass because of various problems with those other forms. I decided I only want one WLS ever.

Third, as others on this thread have said, the gastric bypass is no more "radical" than a sleeve; both will require Vitamins for the rest of your life, both involve significant changes to your stomach, etc.

The gastric bypass provides weight loss because of malabsorption, restricted pouch size, and possibly reduction in Ghrelin (the hormone that triggers hunger). One of the side effects many gastric bypass patients experience is dumping syndrome when either poor foods (high fat, high sugar, various other bad things) are consumed or too much food is consumed or "stuck" (often because food has not been chewed sufficiently). Although the symptom is unpleasant, it acts as a "teaching tool" to change bad behaviors, which is a very positive outcome.

In the end you will have to make the decision on your own. You are the one who will have to live your life with whatever surgery you choose.

The people on this forum are pro-gastric bypass, since this is a gastric bypass forum. If you are really leaning toward the sleeve, you might want to go on the sleeve boards and ask around there about that surgery, to get a different slant on this issue.

Good luck and best wishes on whatever choice you make.

I currently have the sleeve and am revising to bypass on Friday; enough said about that. I truly wish I had the bypass in the first place. If you have acid reflux I believe your only option is the GB, good luck in your decision.

I totally agree...the only way to get that stubborn metabolism which is that makeup that your body knows...I refer to it as a switchback....diet now but Your body will revert back later...the bypass tricks it and gives you a chance to use it as a tool.My boy fights weight loss...RNY because I want it to be the last surgery...no more alternatives.

Well, I made a decision and we submitted my packet to my insurance company yesterday. I'm opting for the bypass. I had a long talk with my PCP and he felt that the sleeve wasn't a good option for me because my issues are more metabolic. If I were more of a volume eater, he said he could see it -- but since my metabolism is a problem, he thinks I would only benefit from the bypass because it helps reset your metabolism. I'm not excited about the prospect of dealing with dumping, but it looks like this isbwhat I'm going to do...

I wish my surgeon would've done the RNY but he no longer perform the procedure. I had the sleeve gastrectomy 15months ago and sad to say it was a failure I've had so many complication until I regret my decision to have the sleeve. Now I'm looking into a revision from the sleeve to the bypass

I'm so sorry to hear that! Just curious, but why does your surgeon not do the RNY any longer? I mean, since it's billed as the "gold standard" and all...

Because he doesn't want to. Says nobody need the RNY, me personally feel as if I would've done better with the malabsorption procedure rather than the restriction procedure especially since my sleeve is bigger than the average person. My surgeon is a major ahole.

Hmmm...that's basically the way I felt about the RNY. Just seems so invasive when you can simply (haha) have most of your stomach excised. But it just doesn't sound like any of my doctors have much faith in the sleeve -- not my surgeon, not my PCP, not my oncologist, no one. I finally just decided I should do the RNY.

The reason your dr is trying to steer you to the RNY is for a reason.I have the band which has failed and caused me so much pain and my esophagus is "tortured"My acid reflux is outrageous and the amount of tests for this band is horrific.Think about every time the have to inject a long needle to fill you with fluid...My port has distended my stomach...now that is invasive.The sleeve is not an option and I cannot afford a leak or ulceration so that has happened to some.RNY is what I should of went with because My metabolism is screwed and I want a procedure that is proven...this time I am not afraid.I finally get it!RNY!

ive been mostly on the sleeve boards because im considering the sleeve but i have about 140 pounds to lose to be healthy. i think after reading this my mind is changing slightly

I too struggled with the decision between sleeve and bypass. I finally decided on bypass due to its track record and my health issues.

I have a friend who just had the sleeve as well as her younger daughter.They both have about 150 at LEAST to lose and they are first time WLS.They needed to do something.Great Losing weight ...ok.She told me she made some mistakes by waiting to long to eat on several occasions....ok I see in the future where this is going.I have a lap band...I thought it was less invasive back in 2004.Fast forward...I slime and vomit all the time.My port site protrudes and is painful and I Abe GERD and my esophagus has damage...did I mention I have struggled initially lost a minimal amount of weight ..50 pounds when I needed to lose 100.,,I am now an involuntary bulimic because of the band and its complications...trying hard to get a revision to the RNY

@@Mayastone

I am glad to hear you made a decision that you are comfortable with. I wanted to reach out again to simply say, don't worry so much about the dumping issue.

First, not everyone gets it. I don't. Not at all. I actually wish I did because it would definitely help keep me away from stuff I should not eat. Many people on this site don't dump. If you follow the food plan from the very beginning you will do great.

Second, I have read posts from sleevers who dump. There is a version of it even for them.

Third, if you are a dumper, you will learn what to stay away from and will adapt.

You will lose the weight you need to with bypass and will do great. As I think I said in my previous post, I planned to do the sleeve as well and was devastated when RNY was recommended for me. I am so very glad I had the bypass done and the only thing I regret is not doing it 15 years ago.

The best of luck to you and feel free to reach out with any questions you might have.