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!

Whatever makes YOU feel the safest is what it is all about, the rest is just noise. I wish you the best of luck on your journey!!! <3

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!

I forgot one of the most important parts when comparing RNY to the sleeve. Granted you have made up your mind, and that is great. However I would be doing you a disservice if I did not mention this aspect. The sleeve is a restrictive surgery. There really is little to no malabsorbtive aspect to it. RNY has both, so we all understand this. However and this is so critical that I feel I should flog myself for failing to bring it up before. Science has figured out that there are 4 (probably more) main hormones that go along with hunger. Scientists have run test after test and found that in naturally thin people, these 4 hormones/chemicals are in the normal range. The 4 I speak of is Ghrelin, Leptin, Glucogen Like Peptide and GLP-1. In RNY patients typically within a week these 4 hormones are back at a normal level for a normally thin person. HOWEVER, the SLEEVE does not benefit from these hormonal changes.

So, to say my final words on this topic. Why do Doctors tend to push people towards RNY? It's been around a long time. Any possible complication you can imagine, had been dealt with. Weight loss is predictable, and the 'hunger hormones' go back to normal. The Sleeve while promising, lacks a great deal of the advantanges RNY gets. Said another way, Doctors push people to what they know works, and works best. At least good doctors.

Best of luck in your surgery mate,!!

They are both great procedures. If you have diabetes or acid reflux, bypass sounds like a great choice.

I revised band to sleeve 4 years ago and have maintained a massive weight loss. .. I am half my former weight and size and maintaining. Sleeve is more than restriction it helped me change my relationship with food.

They are both great procedures. If you have diabetes or acid reflux, bypass sounds like a great choice.

I revised band to sleeve 4 years ago and have maintained a massive weight loss. .. I am half my former weight and size and maintaining. Sleeve is more than restriction it helped me change my relationship with food.

That's awesome! I was really leaning toward the sleeve until I read more about GERD and the sleeve not playing well together. My surgeon and I agreed that RNY was the best option for me and I hope all surgeons listen to their patients as well as mine did. My first consult/seminar was with a surgeon who said the sleeve would be fine for me, even after I told him about GERD...thank goodness I didn't follow up with him!

My surgeon and case manager both pushed me to get the RNY done. Since I am diabetic and diabetes is very prevalent in my family history, thats what I chose to have. I think doctors want to see numbers and good results from their patients. I figure, just based on that assumption, thats what they see when comparing RNY VS the sleeve.

I'm glad that you've made your decision based upon the counsel of your PCP as well.

I was pressured the opposite way, to have a sleeve rather than the RNY, so I switched surgeons, and talked with the new one at length about what my goals were. I'm right there with you regarding the metabolic issues, I'm also a diabetic, hoping for remission.

It's not an easy choice, but it's done, and now you can work on the future.

I wish my doctor at the time would have urged me to pick Bypass over lapband back in 2004.

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!

Not trying to change your mind, but if you get the sleeve and don't get GERD, then yes it doesn't matter about being irreversible. However, if you get GERD or, worst case, really bad GERD, then the sleeve being irreversible is going to mean a whole lot. There are people who get a revision from sleeve to RNY. And if you develop GERD that will be one of the very choices you have to remedy that GERD.

I hear you on the GERD. I guess I just feel like that you can always move to the RNY from the sleeve, but there's not much that can be done if you start with the RNY and it doesn't work out. Anyway, I don't have GERD or any comorbidities, so I think I'm probably a good candidate for the sleeve -- though, I am concerned I'll lose less weight. I have about 120 lbs to lose.

I really wish my surgeon had told me about the downside to having type 2 diabetes or acid reflux and how terribly wrong the sleeve is for people like me

I'm so sorry to hear that. Aside from those issues, were you successful in your weight loss? Personally, that's my biggest concern.

I know this is an old thread but as I am currently considering revising from a band to RNY it is really interesting.

I find it odd that people will happily have a sleeve wherein a huge portion of their stomach is chopped off and thrown away but they fear the bypass. Personally I think that sleeves, like bands, have had their moment . Whilst they are effective for some there seem to be a lot of people that dont lose or regain and apparently reflux is a major issue.

My surgeon explained in detail why he thought that for me an RNY would be a better and safer long term option and what he said made sense.

Now I just need to get my head around the idea of having another weight loss surgery.

Nope when I told my last one and the creator of Precious Pouch, he approved, think he thought I made the correct choice. An FYI, I had absolutely no gas, not then, nary a root. You don't suppose he did it FreeHand, do you? My liver was nice, smooth and small, but surely OSU uses CO2 gas? Maybe they extract it back out, because my belly was not the least bit blown up. Wonder if they took pictures, I would LOVE to see a video of ME.????

I am still pre-op. I have an amazing surgeon, she performs both RNY and sleeve. Most of her patients choose sleeve surgery over RNY. She allows her patients to choose which surgery is best for them unless there are other health risk for one over the other. I am having a RNY because I am T1 diabetic and it will allow me to lose 70 % - 80% of my weight.

One of the reasons some doctors push RNY is it cost more than the sleeve. I think that is a shameful thing for them to do, but they still do it.

You may want to see another doctor. She may be at a center for excellence but that doesn’t mean anything. Good luck in your decision. Remember she works for you, not the other way around.

I trust my Dr implicitly. We have built up a good relationship over the years from all the band visits. He is patient and always talks and explains things unlike many other Dr's. I don't believe that his advice had anything to do with cost, in fact my quoted out of pocket expenses ( I'm in Aus) are comparable or less to what I have been told it would cost to convert to a sleeve.