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Gastric Bypass vs. Gastric Sleeve



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For meFor, I had severe herd (acid

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I always find it interesting that people find rny more extreme when it is actually reversible and the sleeve is not. I was not a sleeve candidate because I had bad acid reflux and as others have said, the sleeve makes it worse. Also, people lose more weight with rny statistically.Ultimately though, they are both just tools. I have never dumped but if I eat something unhealthy like ice cream, I feel queasy. My pouch protests, but I don't dump. My nutritionist said there is a correlation between the amount of intestines removed and the likelihood of dumping. I had a bmi of 40, on the "lower" end for rny, so I had less intestines removed Of course your surgeon can provide the best advice but these were my factors in my decision making process.

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I went with the sleeve. It was recommended over RNY unless you had acid reflux (which I didn't). I also think that RNY results in a quicker weight loss thanks to malabsorption.

The pluses of the sleeve are:

1. It's less likely to stretch because the stretchy part of the stomach is removed. Since an RNY pouch is constructed from the esophagus, it can stretch.

2. My surgeon told us no alcohol or NSAID'S with an RNY for life. I'm a weekend social drinker with arthritis, so this was my primary reason for going VSG.

3. I love the simplicity of the sleeve. Once I healed, I'm basically "normal" with an itty bitty stomach. Who doesn't love that. Yes, they say that that RNY is reversible, but I've never heard of anyone doing it and why would you?

4. I have also heard that the malabsorption factor goes away down the road and your left with just the restriction of the pouch, which can stretch (at least a little).

5. Finally, remember that VSG was first developed as stage one of a DS surgery, so I suspect you could always go back to get the malabsorption part done later if needed (at least I think this is true).

Btw, there is nothing I can't eat - no hint of dumping whatsoever!

Edited by Cape Crooner

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I went with the sleeve. It was recommended over RNY unless you had acid reflux (which I didn't). I also think that RNY results in a quicker weight loss thanks to malabsorption.

The pluses of the sleeve are:

1. It's less likely to stretch because the stretchy part of the stomach is removed. Since an RNY pouch is constructed from the esophagus, it can stretch.

2. My surgeon told us no alcohol or NSAID'S with an RNY for life. I'm a weekend social drinker with arthritis, so this was my primary reason for going VSG.

3. I love the simplicity of the sleeve. Once I healed, I'm basically "normal" with an itty bitty stomach. Who doesn't love that. Yes, they say that that RNY is reversible, but I've never heard of anyone doing it and why would you?

4. I have also heard that the malabsorption factor goes away down the road and your left with just the restriction of the pouch, which can stretch (at least a little).

5. Finally, remember that VSG was first developed as stage one of a DS surgery, so I suspect you could always go back to get the malabsorption part done later if needed (at least I think this is true).

Btw, there is nothing I can't eat - no hint of dumping whatsoever!

There is a huge difference in what doctors recommend. My surgeon was a top European specialist who trains many American docs. Did y'all realize there are many US docs who fly to Europe for bypass procedure training? He also spends one week per month in the Middle East, doing surgeries for the wealthy there. He commented to me that all his Middle Eastern patients want the sleeve and he tries to talk them out of it for a number of reasons (I wasn't paying a lot of attention to them because I never considered the sleeve). In my case, and there are multiple general ways of performing RNY surgery, I essentially have a sleeve but the bulk of my stomach is sutured closed and food passes through a small sleeve. You say you love the simplicity of the sleeve but in most cases the RNY is more simple.

As for your question about why someone would have this reversed, there are multiple reasons. My neighbor had been obese for years and after a broken bone and hospitalization suddenly developed malabsorbtion syndrome in which food just passed through him without being absorbed. In short order he became scarily malnourished and emaciated. I have known folks with cancer who have also gone through serious weight loss, and a couple of people I know were told by their docs at the time of diagnosis to gain weight and stop trying to take it off. These were people who were already obese.

I have the RNY, my stomach is just smaller than it was before, and my doc said drinking is fine. Only 6 weeks out and I've been indulging in a couple of drinks per week for 3 weeks now. It is inaccurate to generalize that RNY patients can't drink.

Yes, I have a lot of dumping 6 weeks out, but I think my situation is unique. First, since I am a 'low BMI' patient, my surgeon removed almost no intestine, less than 2 inches. There is likely no correlation between the amount of intestine removed and dumping in my case. For years I had bad stomach pain, at times so awful that I was incapacitated. After 3 years of trying to find a solution I found an expert who solved my problem. In short, the source of my pain was that my intestines are sluggish and don't work well, and my stomach was contracting harder and harder to push food through, I suspect that my frequent dumping is caused by my stomach still contracting super hard - it's been doing that for years so I doubt it will change very quickly. Also (apologies if this is TMI), for years I had pellet BMs and frequent constipation, and suddenly post surgery my BMs are soft and normal. I am so happy about that and about not having to daily think about pills or supplements.

There is no single 'best surgery' or guaranteed avoidance of particular issues which should make the selection of surgery simple or generic. Do good research of RECENT studies. Look for a doc who does a LOT of GBs and listen to his/her advice.

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I went with the sleeve. It was recommended over RNY unless you had acid reflux (which I didn't). I also think that RNY results in a quicker weight loss thanks to malabsorption.

The pluses of the sleeve are:

1. It's less likely to stretch because the stretchy part of the stomach is removed. Since an RNY pouch is constructed from the esophagus, it can stretch.

2. My surgeon told us no alcohol or NSAID'S with an RNY for life. I'm a weekend social drinker with arthritis, so this was my primary reason for going VSG.

3. I love the simplicity of the sleeve. Once I healed, I'm basically "normal" with an itty bitty stomach. Who doesn't love that. Yes, they say that that RNY is reversible, but I've never heard of anyone doing it and why would you?

4. I have also heard that the malabsorption factor goes away down the road and your left with just the restriction of the pouch, which can stretch (at least a little).

5. Finally, remember that VSG was first developed as stage one of a DS surgery, so I suspect you could always go back to get the malabsorption part done later if needed (at least I think this is true).

Btw, there is nothing I can't eat - no hint of dumping whatsoever!

There is a huge difference in what doctors recommend. My surgeon was a top European specialist who trains many American docs. Did y'all realize there are many US docs who fly to Europe for bypass procedure training? He also spends one week per month in the Middle East, doing surgeries for the wealthy there. He commented to me that all his Middle Eastern patients want the sleeve and he tries to talk them out of it for a number of reasons (I wasn't paying a lot of attention to them because I never considered the sleeve). In my case, and there are multiple general ways of performing RNY surgery, I essentially have a sleeve but the bulk of my stomach is sutured closed and food passes through a small sleeve. You say you love the simplicity of the sleeve but in most cases the RNY is more simple.

As for your question about why someone would have this reversed, there are multiple reasons. My neighbor had been obese for years and after a broken bone and hospitalization suddenly developed malabsorbtion syndrome in which food just passed through him without being absorbed. In short order he became scarily malnourished and emaciated. I have known folks with cancer who have also gone through serious weight loss, and a couple of people I know were told by their docs at the time of diagnosis to gain weight and stop trying to take it off. These were people who were already obese.

I have the RNY, my stomach is just smaller than it was before, and my doc said drinking is fine. Only 6 weeks out and I've been indulging in a couple of drinks per week for 3 weeks now. It is inaccurate to generalize that RNY patients can't drink.

Yes, I have a lot of dumping 6 weeks out, but I think my situation is unique. First, since I am a 'low BMI' patient, my surgeon removed almost no intestine, less than 2 inches. There is likely no correlation between the amount of intestine removed and dumping in my case. For years I had bad stomach pain, at times so awful that I was incapacitated. After 3 years of trying to find a solution I found an expert who solved my problem. In short, the source of my pain was that my intestines are sluggish and don't work well, and my stomach was contracting harder and harder to push food through, I suspect that my frequent dumping is caused by my stomach still contracting super hard - it's been doing that for years so I doubt it will change very quickly. Also (apologies if this is TMI), for years I had pellet BMs and frequent constipation, and suddenly post surgery my BMs are soft and normal. I am so happy about that and about not having to daily think about pills or supplements.

There is no single 'best surgery' or guaranteed avoidance of particular issues which should make the selection of surgery simple or generic. Do good research of RECENT studies. Look for a doc who does a LOT of GBs and listen to his/her advice.

I didn't generalize, I simply reported what my surgeon told us. I did leave out one other issue with RNY (as reported by my surgeon) and that's "dead stomach syndrome". Once the top of the stomach I'd severed from the esophagus, it is no longer possible to view it by placing a camera tube down the throat. Apparently, this can lead to issues.

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