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!

I Def feel pressured by my surgeon

I wish I was pressured by my doctor when I first had WLS 15 years ago.I should of gone with the RNY.I went with the lapband.Fast forward....I am seeking revision to the RNY.

My doctor was trying to push the sleeve on my. Initially I wanted to sleeve but family members and friends had the 3 years ago and only lost 50-70 pounds and. I'm sorry if I go thru all this I wanna see the fruits of my labor. Plus I have acid reflux and a strong chance of type one and two dietbities because both parents have one of each. And my maternal gm. So I picks rny and seemed really mad I picked that over sleeve

I went in to the surgeon with the idea in the back of my mind that sleeve was safer,but told the surgeon I would leave the decision up to him. He said rny and explained the reasons it was safer AND more effective for me. I'm not sure I can recall exactly each reason but the amount of weight I need to lose was a contributing factor. I remember he said because I loved sweets was a reason, due to the malabsorption of the rny - fewer fats and carbs and calories can be absorbed. Also I have really bad arthritis and my excess weight is starting to really break down my bones - I need to lose as quickly as possible. Pain management doc said I would be in a wheelchair on morphine within a year unless I had bariatric surgery right away. Bariatric surgeon convinced me that the rny was safest and quickest way to do it. Said sleeve was more invasive because they cut and actually remove so much of your stomach and because of acid reflux that is often caused by the sleeve. He convinced me that is what I need but each person is different and each surgeon has a different way of evaluating a patient's needs.

Wow. That seems weird he would be mad you want rny over sleeve. Well, maybe not weird. Sometimes I've noticed doctors have problems with patients being their own advocates. What were his reason for wanting the sleeve? From what I hear the band and the sleeve are much less effective with more problems.

He said the rny was more evasive. And that it took longer I could gain my weight back and I could be sicker than getting the sleeve

Very interesting. But that must be what he has seen with his patients. I have a very good friend who had the sleeve and he has done great with it. Has lost all his weight. Exercises all the time (because he likes it). His wife lost her weight by dieting and working out and I think they are having second childhoods because they just feel so great!

Hi Lynda

I would get a second opinion.Sounds weird to me.

I am not a Sleeve canidate due to GERD. However, the sleeve is pretty new as far as surgical procedures go (RNY was first done in the 1960s), and there is not a great deal of long term data in as of yet. Remember when everyone was jumping up and down about how wonderful the Lap Band was? Now look at the actual long term data, it gets worse for the Lap band every year. I think this is where Doctors who performed a lot of Lap bands only to see problems later on, are now sort of sticking with the procedure that actually has a long term history. We will all see how the sleeve does in another ten years. Once long term, statistically significant comparative studies come out. Much like the studies you can find today on the Lap bad Vs RNY.

@@Winkie thing is we don't have the stand alone data for sleeve as a wls but we do have it as part one of the ds wls and the surgery to remove the stomach in cancer patients and in both cases the data shows good things

However part one of the DS it just that, part one. After a year, the DS is completed, thus not yeilding any great long term data. Don't get me wrong, I am not trying to be argumentative. I've just done a great deal of reasearch, and while the sleeve is showing great results, it's going to be years before side by side studies can be done. In short, time will tell. I just remember how it seemed the whole world was RAH RAH Lap Band!!!!! OMG best thing ever.... yeah, that did not work out so well. For some people it did, and still does, however every year when more data comes out, things get worse for the lap band group, as a whole. The Lap band can at least be undone. If you have a sleeve, that's it, I mean, you can even get a RNY undone (it's extraordinarly rare, but surgically it can be done), but with a sleeve, The stomach is gone. So if in 10 years suddenly the results are getting worse over time, those people are out of luck. I guess to conclude, I say what I do out of an abundance of caution.

But why would having a smaller stomach ever be a bad thing? Even if it didn't work well for weight loss in the long run, what's the problem with having a smaller stomach? I can see why rerouting your digestive system would be a concern or why putting a foreign body in your body might be a concern -- but why is having a smaller stomach a concern? No, you can't get the portion of your stomach they removed back -- but why is this not good?

Sleeves can have ulceration so and leakage.Something t consider

But why would having a smaller stomach ever be a bad thing? Even if it didn't work well for weight loss in the long run, what's the problem with having a smaller stomach? I can see why rerouting your digestive system would be a concern or why putting a foreign body in your body might be a concern -- but why is having a smaller stomach a concern? No, you can't get the portion of your stomach they removed back -- but why is this not good?

GERD is particularly bad in the Sleeve group. As said above leaks. I'll have between 100-150 staples used during my RNY, the Sleeve gets something like 600, they make six rows of sleeves and cut off the last one., Stomach stretching back out. If a RNY patient can stretch a stomach that starts off the size of your thumb, it's not a big jump to see Sleeves being super stretched, over time. The RNY is a very safe, very well understood surgery. They have been doing them since the 1960s (they killed a lot of people working out the kinks so to say) but today, it's routine. Outcomes, very long term are predictable, as there is great data very long term. No one knows what is going to happen to a sleeve patient at 20 years as there is no group to study. I suppose it falls under the category of the evil that you know is sometimes better than the evil you don't know.

Thanks -- I get all that. ). My point was that being irreversible isn't as big of a deal as it sounds. In the end, even if you don't lose much or regain what you did lose, the fact that the sleeve is irreversible doesn't really matter. Effectiveness aside, I can't imagine a situation where someone with a goal of losing weight would ever say they wish they had a larger stomach. I can, however, imagine someone wishing they hadn't rerouted their digestive system. I just meant that saying the sleeve is irreversible isn't actually as scary as it sounds. It just means you'll never have a large stomach. In my world, that's a good thing'

Needless to say, I have changed my mind and am now scheduled for the sleeve. I let my surgeon talk me into the bypass twice -- but every time I left her office and started to think about it, I kept coming back to the sleeve. In the end, I consulted another surgeon and he confirmed everything I was feeling on my own -- so I made the switch.

Sorry! That was supposed to be a smiley face above!