Sleeve vs. Bypass

[RSM 69]

6 minutes ago, Mhy12784 said:

Of course, I agree completely. I think both procedures have their advantages and are both terrific procedures and everybody's circumstances are different . And thats why its important to remain open minded going into the process. I had originally gone to my surgeon wanting a sleeve because of my lower BMI and risk aversion, but my surgeon convinced me that the bypass was a better option. That was kind of the only point I was really attempting to make.

My BMI is 41 and I have diabetes 2. Since diabetes is rampant in my family, I'm geared more to the bypass. My grandmother lost a leg to diabetes,,,,,,, naturally I want to keep both of mine! My understanding is the bypass can cure diabetes if you lose weight with of course sticking and staying to the plan. I am sure the sleeve has good results as well, but there is not enough long standing data as there is with the bypass. But, the meeting with my Dr. this Friday will be fruitful I am sure.

Edited August 29, 2017 by RSM

[FlyFatA$$Fly 155]

My BMI is 41 and I have diabetes 2. Since diabetes is rampant in my family, I'm geared more to the bypass. My grandmother lost a leg to diabetes,,,,,,, naturally I want to keep both of mine! My understanding is the bypass can cure diabetes if you lose weight with of course sticking and staying to the plan. I am sure the sleeve has good results as well, but there is not enough long standing data as there is with the bypass.

There is no cure for diabetes, but both the RNY and sleeve stand a good chance of reversing it. RNY has a higher rate, but sleeve is still 60%-70% remission rate.

http://www.webmd.com/diabetes/type-2-diabetes-guide/weight-loss-surgery-and-type-2-diabetes

[Mhy12784 423]

Just now, RSM said:

My BMI is 41 and I have diabetes 2. Since diabetes is rampant in my family, I'm geared more to the bypass. My grandmother lost a leg to diabetes,,,,,,, naturally I want to keep both of mine! My understanding is the bypass can cure diabetes if you lose weight with of course sticking and staying to the plan. I am sure the sleeve has good results as well, but there is not enough long standing data as there is with the bypass.

I 100% agree with you there. I think if youre diabetic, have GERD, or are more than 100 pounds overweight the bypass is very highly probably the best option, and I would personally want a bypass if I had diabetes

[Berry78 4,261]

If you only have 75 pounds to lose and don't currently suffer from GERD, you are likely an excellent candidate for a sleeve.

Both sleeve and bypass are good surgeries, but like others have mentioned before, the bypass can have long term complications that are less likely with the sleeve (intestinal problems and malnutrition).

Unfortunately there is no perfect bariatric procedure. They all have pros and cons. We each have to weigh those things that are important to US, and in that, there is huge variation.

I don't care that a portion of my stomach landed in the trash. If it keeps me from developing diabetes or having a stroke from high blood pressure.. all to the good.

Sleeves ARE frequently revised. Partly because they CAN be. RNY are almost never revised, and it would be an especially rare case where it would actually be reversed. (It CAN happen, just almost never does).

Regain can and does happen post RNY. I think that "malabsorption" component allows people to feel relatively safe in eating a smidge more than they need. Then after a couple years, the intestines adapt, and suddenly they begin gaining.

The sleeve requires the patient learns good habits during the first year. Regain is always a threat, so they must learn new eating habits, right out of the gate. And lots of people just. don't.

Initially, post surgery weight loss is combined physical and mental effort. After the honeymoon period ends, it becomes all mental, no matter which procedure you have.

[Berry78 4,261]

Ok, when I started typing, I didn't see you mentioned diabetes. There is a bit more remission for diabetes with the bypass.

Ultimately, how long you have had diabetes, and whether you are insulin dependent makes a difference too. If you are newly diagnosed and don't take insulin, I still think the sleeve should be in the running. If you've been diabetic for years, and especially if you are on insulin.. then the bypass would be better.

[Mhy12784 423]

8 minutes ago, Berry78 said:

If you only have 75 pounds to lose and don't currently suffer from GERD, you are likely an excellent candidate for a sleeve.

Both sleeve and bypass are good surgeries, but like others have mentioned before, the bypass can have long term complications that are less likely with the sleeve (intestinal problems and malnutrition).

Unfortunately there is no perfect bariatric procedure. They all have pros and cons. We each have to weigh those things that are important to US, and in that, there is huge variation.

I don't care that a portion of my stomach landed in the trash. If it keeps me from developing diabetes or having a stroke from high blood pressure.. all to the good.

Sleeves ARE frequently revised. Partly because they CAN be. RNY are almost never revised, and it would be an especially rare case where it would actually be reversed. (It CAN happen, just almost never does).

Regain can and does happen post RNY. I think that "malabsorption" component allows people to feel relatively safe in eating a smidge more than they need. Then after a couple years, the intestines adapt, and suddenly they begin gaining.

The sleeve requires the patient learns good habits during the first year. Regain is always a threat, so they must learn new eating habits, right out of the gate. And lots of people just. don't.

Initially, post surgery weight loss is combined physical and mental effort. After the honeymoon period ends, it becomes all mental, no matter which procedure you have.

I will add that with the bypass you can always get a band over a bypass down the road as an option, though I dont know if I would classify that as a revision or not.

But i probably see more band over bypasses done than I do lap bands for people who have never had surgery before.

Edited August 29, 2017 by Mhy12784

[RSM 69]

OK, maybe using "curing" was the wrong word. Remission is what I should have said, in that saying if the person who has diabetes 2 sustains their life with the right eating habits combined with good exercise, then remission can and probably will occur. Which can lead one to think it can be cured,,,,,,,,,,,,,,you know what I mean. I personally don't take insulin, but I am on 2 medications for diabetes.

http://www.barixclinics.com/bariatric-surgery-type-2-diabetes

Edited August 29, 2017 by RSM

[JohnnyCakes 593]

45 minutes ago, Berry78 said:

RNY are almost never revised, and it would be an especially rare case where it would actually be reversed. (It CAN happen, just almost never does).

right.... that's the whole point! the sleeve constantly needs to be revised because it either causes unbearable GERD, or did not provide enough weight loss. so they are revised to - guess what - RNY.

RNY is virtually never revised or reversed because it works so well in the first place and doesn't need to be. i don't understand why this is so hard to understand. best weight loss, best diabetes outcomes, no GERD. and if you aren't an idiot and have the ability to follow basic instructions (take a Vitamin every day... oh god, the HORROR), the chances of you experiencing "complications" is extremely low.

RSM - the only real alternative to RNY is the mini-gastric bypass. but most dr's still don't provide it - it's still considered "experimental" for some reason. and it has a higher rate of reflux than the RNY. not nearly as high as the sleeve, but higher.

Edited August 29, 2017 by JohnnyCakes

[JohnnyCakes 593]

right on cue -- i just headed over to the "Your Story" section and this poor woman just posted this a few hours ago. one of many thousands who come to regret getting the sleeve due to dibilitating GERD.

but Mhy12784 wants to sit there and harp about osteoporosis as a "major risk" of RNY...

[Mhy12784 423]

38 minutes ago, JohnnyCakes said:

right on cue -- i just headed over to the "Your Story" section and this poor woman just posted this a few hours ago. one of many thousands who come to regret getting the sleeve due to dibilitating GERD.

but Mhy12784 wants to sit there and harp about osteoporosis as a "major risk" of RNY...

https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers

Sleeves just the fastest growing bariatric procedure by far, and outnumbers bypasses by at least 2:1

But I guess you know better than all the bariatric surgeons in the United States.

[JohnnyCakes 593]

49 minutes ago, Mhy12784 said:

https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers

Sleeves just the fastest growing bariatric procedure by far, and outnumbers bypasses by at least 2:1

But I guess you know better than all the bariatric surgeons in the United States.

riiiiiight.... because bariatric surgeons NEVER recommend ineffective surgeries (see: lap-band) in order to make a lot of money. no, never. you are so, so wise.

and I never said the sleeve was unpopular. when did I say that? it's getting very popular indeed! I'm sure all of obese America wants all the benefits of RNY without having to restrict their eating as much! the fantasy is very appealing!!!

and since when does popularity = efficacy? in that same graph, it shows lap-band was as popular as RNY in 2011. are you implying that that means lap-band is as good as RNY?

what's amazing to me is not so much how dumb your arguments are, but that you keep coming back again and again no matter how embarrassingly wrong you are proven to be... only to make more dumb arguments. fascinating...

Edited August 29, 2017 by JohnnyCakes

[Mhy12784 423]

3 minutes ago, JohnnyCakes said:

riiiiiight.... because bariatric surgeons NEVER recommend ineffective surgeries (see: lap-band) in order to make a lot of money. no, never. you are so, so wise.

and I never said the sleeve was unpopular. when did I say that? it's getting very popular indeed! I'm sure all of obese USA wants all the benefits of RNY without having to eat less! the fantasy is very appealing!!!

btw - I see you posting support for your claim. too bad it's completely obvious and no one argued any differently. but hey, you're learning. baby steps for you.

Surgeons get paid more for the bypass than a sleeve. So you're suggesting that they're doing something immoral that's not in the best interest of the patient, so that they can make less money?

I'm sorry but now you're in ridiculous conspiracy theory territory.

And the lap band was innovative and important in its time, but now there's better options.

[jess9395 5,450]

Some of us who get the sleeve fully expect to eat less. In fact I always thought you could eat more with RNY because the malabsorption would help ameliorate eating more (for want of a better word). So perception is important when making our choices, whether they are based in truth or not.

I'm sorry you think RNY is the "only" real option other than mini gastric bypass@JohnnyCakes but for some of us it works very well. I lost 100% of my excess weight and have kept it off for four years and counting. I have had no issues with GERD since about two months out and what I had early on was minor and well controlled with a PPI. My capacity for food is less than I see several of the bypass patients I know eating so there are few absolutes.

My big concern with the bypass was the potential for malabsorption causing Vitamin and other micronutrient deficiencies. I also was under the belief that by leaving the fundus intact, there was less reduction in ghrelin production for bypass patients and more possibility of stretching since the fundus is the stretchy part.

As for a longer recovery, my surgeon keeps bypass patients in the hospital 1-2 days longer so if that is not an accurate perception, I can at least see where that idea would come from. I believed it myself based on my surgeons protocol.

[JohnnyCakes 593]

2 minutes ago, Mhy12784 said:

Surgeons get paid more for the bypass than a sleeve. So you're suggesting that they're doing something immoral that's not in the best interest of the patient, so that they can make less money?

I'm sorry but now you're in ridiculous conspiracy theory territory.

And the lap band was innovative and important in its time, but now there's better options.

a little less in surgical cost waaay more than made up for in increased number of surgeries, as YOU JUST POINTED OUT.

dear god please don't make me explain economics to you...

if you are under the delusion that the medical industry, including *gasp* DOCTORS aren't in it for $$$, especially in America, then you will have topped yourself for most ignorant argument made today. which is saying something.

[JohnnyCakes 593]

1 minute ago, jess9395 said:

I'm sorry you think RNY is the "only" real option other than mini gastric bypass@JohnnyCakes but for some of us it works very well. I lost 100% of my excess weight and have kept it off for four years and counting. I have had no issues with GERD since about two months out and what I had early on was minor and well controlled with a PPI.

at no point in this maddening discussion did i ever claim that NO sleeve patients have success. nor did i ever claim that ALL sleeve patients get GERD.

i'm happy for your success.