Just posted this in the gastric bypass forum, as well.

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!

My surgeon did not try to sell me on the RNY. I told him I was interested in the sleeve or band and we never even talked about the bypass. I actually saw his original presentation on WLS about 5 years ago but I didn't qualify. He was just starting to perform the sleeve then. He discussed RNY, band and sleeve. I would say he discouraged the band.

My stats are not too different than yours. I was 257 and 5'3" as my starting weight. I had a 6 months insurance mandated diet and was at 242 at the start of my 10 day liquid pre op diet. I am 6.5 months out and am at 174. I am still losing, more slowly that when I first sleeved, but still losing.

There are plenty of people on this board who have had sleeves and are well below the 180-190 that she quoted to you.

If you are not comfortable with what this surgeon is telling you go talk to another one or two. Just because every one else loves her does not mean she is the right one for you. You need to be comfortable with your surgeon and the surgery.

If you do decide on the sleeve I would recommend a different surgeon. You want a surgeon that believes in the sleeve and has a program designed for the sleeve not one modified from RNY. You don't want to have a minor stall or complication and feel like she is thinking "Well this wouldn't have happened it you followed my advise and had RNY". You want a surgeon that has done a large number of sleeves not one that does them occasionally, under duress.

I, myself, am in the process of getting approved for the sleeve. My sister had the RNY 3 years ago and she wishes now she had the sleeve instead. She and I both take several different medications and I did NOT want to fight malabsorption. She really struggled with malabsorption. She had no idea how much medication her body was really getting. I personally NEVER even considered the RNY.

Good luck with your adventure and I agree with the reply above, about getting another opinion from another surgeon.

My surgeon was just the opposite. I'm 4'11 and was 250lbs. At my first appointment he said sleeve was totally appropriate because I didn't have any co-morbs. He said weight loss with bypass was comparable at the 18 month mark but that I would probably lose more quickly with bypass. He also seemed to think that bypass was a riskier procedure because of the re routing that needs to be done (don't know if that is scientifically true but he does both procedures so I don't think it's an inherent bias on his part). He said if it was up to me and that he's be more than happy to perform bypass if that was my choice. I chose sleeve. I'm 14 months post op and down 127lbs

My doctor didn't even really mention the bypass. He was all about the sleeve, which was fine because that's what I wanted. I did inquire about the pros and cons of the bypass surgery, but there was never a feeling of being pressured into one option over another.

I felt the opposite. He said by-pass was outdated and had far more complications than the band and sleeve.

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Wow. That your doc is stating things that go so obviously against the research is a major red flag to me. I would consider a second opinion. My doc religiously pushes the duodenal switch because it costs more, has patients coming back to see him more often (he hates sleeve patients because they go on their way and he loses money on the lack of follow ups), and the weight loss can be higher (but the complications/malabsorption issues are also higher).

When in doubt, shop around.

Hello there I'm 6 months post op sleeve in western ny state my surgeon didn't push bypass or sleeve with me but did discourage the band once I found out the risks and how it can slip etc fills and u fills etc I said hmm naw not doing that I went with sleeve as I wasn't interested in re routing my insides and having all that dumping I wasn't a big sugar eater anyway do that doesn't affect me much I will tell you that many ppl I've met have told me that the surgeons have pushed bypass vs sleeve especially for the extremely overweight such as myself when I began this I was 462 I lost 60 lbs by surgery in late February this year today I'm 293 at 6'1 I hope to get to 180 so it can be done with sleeve or bypass just remember one thing it's your body your decision your life you must deal with any outcome so if you feel comfortable one way or the other then you get to decide no ones does and no one should pressure you into anything if that's what u feel is happening then do not use this surgeon as you said u have no co morbids so there's no reason for this to be pushed on you I had one dr who was not in this field but knew some who are tell me some of these Drs were very harsh about fat ppl in private he actually named one who I'd had a consult with seven months prior to meeting him and I disliked her immediately she didn't even pretend to be professional I never went back I didn't feel I should have to tolerate someone speaking to me as if I were the lowest form of life and justifying it by saying well your fat so don't let anyone bully you into anything just because they are trained to operate doesn't mean they know everything or are better than you you know your body better than anyone else let alone a surgeon u will see likely once for a consult once at endoscopy if they require that the day of your surgery and one follow up likely after that u will see a NP unless u have a surgical issue or complication

Yup.

I switched surgeons.

I think it depends on your height, weight, body mass, & etc.

Due to my height & weight, I should actually have the gastric bypass because I will lose more weight, but I want he sleeve b/c I don't want anything re-routed. I liked that they typed of my reason for why, I signed it, & they put it in my chart b/c they said if I ever regret my decision, they can pull that & show me.

Tell your Doctor how you feel. If she is as awesome as you said, then she will hear your thoughts & explain why she might be leaning towards one than the other.

But at the end of the day, unless health reasons are a concern, you should pick what surgery you want.

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.

My primary tried telling me that too I had to inform her that it wasn't true I may possibly have responded to the other post u made but I've been told by other bariatric patients that they were pressured too to do bypass instead of sleeve and I know a couple Drs who know a group of bariatric surgeons who speak terribly about the patients they operate on in private which really turns my stomach because they are supposed to be trying to help us and in private are ridiculing us while making money from us and the reason I believed him is because he named one dr who I had met with 7 months prior to ever meeting him he didn't know I'd seen her and when I was in her office she behaved exactly as he described and justified it by saying well your fat as if it had somehow escaped my notice ... I left and never went back I'd rather die then let someone treat or operate on me when they treat as if I'm less then human and not deserving of basic respect

I met with my surgeon last Monday. I had read so much, attended two different surgeon groups weightloss seminars at different hospitals, read posts here, and anywhere I could find info, etc. I need to have my lap band removed first. My heart/gut feeling is that I will be happy with the sleeve. My head and a few things I read made me question if I needed to go with the RYN. I was very happy my surgeon said he would do either, but agreed I should do fine with the sleeve. I am excited to get this process underway.

Usually a surgeon will pressure you into getting a bypass Don if you need to lose more than 100 pounds

I wasn't pressured. I initially wanted the sleeve, but I have been banded before and he took 45 minutes to discuss the sleeve with me and explained the risks because of my previous band. He told me that the sleeve would make my reflux and heartburn worse due to the high pressure it causes. I had been taking Zantac max strength and Prilosec both twice a day plus tums , milk and slept with 8 pillows at night for nearly 4 years so ....no thanks. I would rather not have any more heartburn or make it worse. I went back to him to discuss bypass after researching it on my own. He spent another 45 minutes talking with me about this and answered every question that I had. I have never once felt pressured. Bypass can be reversible, but if you are sleeved, your stomach is gone forever. If I hadn't had previous WLS, and if I was choosing for the first time, I would have chosen sleeve. But because of my weakened stomach from the previous band, and scar tissue, bypass is a better option, less chance for leaks and less complications for me. Research and gather as much info as you can to educate yourself. If you are new and not getting revision, go for the sleeve. But if you have had previous WLS before then consider bypass. Best of luck to you!

Edited September 2, 201510 yr by Dream4tc

When I went to my initial seminar, we were told that it was our option, but the sleeve was what was overwhelmingly being chosen and performed.