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!

Even though a "goal weight" for me would probably be losing 150 lbs, my surgeon *never* pushed bypass. He will do them for people who really want them, but his preference is for the sleeve. He makes it clear that he thinks it's the option with the best balance of risks and benefits. He's also really well known for his excellence in doing sleeves. I was sort of leaning towards the band at the beginning of the year, but my surgeon and his staff were pretty up front that they see better long term results from the sleeve.

AT least right now -- 3 days out from surgery -- I'm happy with my decision.

I have Vitamin deficiencies and I was steered away from RNY. I was told the band may be the only option unless I got my neuro to clear me. With the sleeve they meeting that you can not take pills bigger than can fit down a straw. A lot of meds would be stopped or changed

I was more interested in the bypass at first, got approved for it and everything but as I got closer to my date my surgeon ran a blood test to check my iron levels because I have chronic anemia. 1 week before my procedure I was told by my surgeon that I should consider the sleeve instead. Me being stubborn I was so stuck on getting the bypass because I thought it would be way more effective in weight loss than the sleeve until he revealed to me that I was at a much higher risk of complications because I'm extremely anemic. I agreed to the sleeve and they resubmitted my letter to my insurance company. Everything went smooth after.

The first seminar I went to was similar. The doctor was biased and pushing towards the gastric band. The entire seminar was structured around it, or so it seemed. After my initial consultation he also said the band was the perfect option for me, I am 5'10 307lbs. I was motivated but also felt uncomfortable that I didn't feel that I had enough information to make an informed decision. After researching I went to a second surgeons seminar and was positively surprised. He was very objective and was very helpful and letting patients decide what they feel is best for them. In the seminar I asked him what would be the motivation for other surgeons to be biased towards certain procedures and he said "Maybe it's their preference on which they like to perform, and have had less difficulties with". The surgeon I chose does over 400 WLS a year for over 25 yrs and just simply is used to do them all. I guess what I'm trying to say is that maybe your surgeon is an expert at RNY and just not comfortable with performing the sleeve. But I do have to say I don't think it was professional of her to give you false or misleading information. If you look into the research even in Europe the more widely adapted practice is the sleeve not making it better or worse but it is a form of medical advance that they came across to avoid rerouting your digestive system. Just something to think about I guess.

I opted for the sleeve and at the time I was told I would not likely lose as much weight and was asked to reconsider. I then received a phone call a week before surgery from the doc again urging me to consider the RNY because she saw a small hiatus hernia. She was worried I might have GERD post surgery. I stuck to my guns, they fixed the hernia at the time of sleeve surgery and everything has worked out great.

Mine made me watch videos about all three procedures and then asked me what I thought. I told him between them I was interested in the sleeve and the bypass, but was leaning towards the sleeve. He said good, because he thought that was best for me as well and we talked about why. My only hesitation was the staples, because of mma and kick boxing. I told him if I couldn't do those things post surgery, I didn't want it at all. He assured me barring any complications I'd be back in the cage in 6 weeks. I was pretty much sold after that.

I didn't feel he pushed me in either direction and really felt like he let me lead the way. I'm very happy with that.

my surgeon prefers to do rny but he is compatent doing sleeve as well he doesnt do the band any more. when i went into my appointment we talked about my goal weight which is 140 pounds to lose and i chose sleeve and he agreed to that so maybe you should seek a second opinion

It's interesting how different surgeons are! My surgeon checks for hiatal hernias, but if he sees evidence of one, he just makes plans to repair it -- he has no problems doing a sleeve with a hernia repair at all. On the other hand, I think if I had more history of GERD or reflux, that would have affected his opinion. In my case, I haven't had much reflux in years and years, though I did as a child. Also, he expected a hernia repair, but when he did the surgery, one wasn't needed. OH, and my surgeon said that a lot of older surgeons prefer RNY, because that's what they were trained doing and have been doing for years, but the next generation tends to be more likely to suggest the sleeve.

I have had lap band (would never reccomend), and now have the sleeve. 5 years post op, wishing I had malabsorption. I have regained 25-30 pounds. Don't think you will never be hungry from the sleeve. I am always hungry! Even when I drop my carbs very low, I will lose about 4 pounds and then nothing for weeks. Very frustrating!! Looking into revision, yet again. I think the sleeve is 100 times better than the band, but it's not easy after the first year.