I am curious that so many people are going from Sleeve to bypass. What is the reasoning behind this. Do you not have the option to go straight to the bypass. Can someone enlighten me.

Concerned it’s a just using us patients to make more money for the doctors by getting 2 operations from us?

First I don't know the answer but I will guess. It seems like Sleeve surgery is trending right now. But many who have the sleeve encounter problems with severe acid reflux (Gerd). Sleeve only makes this condition worse. So therefore they have a revision to gastric bypass.

Unless someone starts out with GERD, my surgeons office usually recommends sleeve unless the person is extremely obese. They consider it a safer, less invasive surgery.

I wish for once someone would describe it as dreamily obese,instead of extremely obese. I still hope to be the answer to someone's prayers, but I'm not certain Dr Needleman,my future Bariatric Surgeon has been praying for the,likes of me. I hope her regards me as the Once In A Lifetime Experience that I am!?&?&??

12 minutes ago, Frustr8 said:

I wish for once someone would describe it as dreamily obese,instead of extremely obese. I still hope to be the answer to someone's prayers, but I'm not certain Dr Needleman,my future Bariatric Surgeon has been praying for the,likes of me. I hope her regards me as the Once In A Lifetime Experience that I am!?&?&??

Sorry, Frustr8, you wouldn't make their cut for bypass based on your weight. You're too skinny!

And, before anyone asks. These are their recommendations. The patient does get a say.

Edited July 13, 20188 yr by Orchids&Dragons

My surgeon will work with the patient's preference. Both are safe, effective surgeries.

Statistically the average person loses 70% of their excess weight with bypass, and 60% with sleeve. But that's average...so with both surgeries you can also hit goal or screw it up.

Bypass is correlated to a few more nutrition absorption concerns, a few more post surgical problems, and of course...the dreaded dumping...which sleeve people don't generally get.

Doctors are not trying to screw you over....they're trying to give you options.

I have lost enough pre op that I have about 75 pounds left to loose but I’m having the bypass because of gerd and that my Metabolism level is so low that bypass helps with the malabsorption which can help me maintain my weight loss longer

3 hours ago, damonlg said:

I am curious that so many people are going from Sleeve to bypass. What is the reasoning behind this. Do you not have the option to go straight to the bypass. Can someone enlighten me.

Concerned it’s a just using us patients to make more money for the doctors by getting 2 operations from us?

Revisions from restriction only to restriction and malabsorption are common. I'm a Band to Bypass revision myself. Reasons will cover a wide range of situations. Maybe someone ended up with GERD after the sleeve, or they lost some weight but plateaued out and couldn't lose more (like with a lot of folks with the band did), maybe the sleeve didn't "work" (IE the person didn't change their habits enough or figured out how to eat around the sleeve), maybe they had complications that required the revision. There are quite a few reasons. But all of them fall into one big category "something didn't work right the first time"

I did a huge amount of research before making my decision and one of the main reasons I went for a gastric bypass is that if you get complications you can reverse the operation as nothing is taken away. With a sleeve you remove most of the stomach so once it’s done it’s done.

I found very few advantages to the sleeve and the Acid Reflux is a major reason why it soon became a no go for me.

Another big factor is if you have diabetes a sleeve doesn’t really change that much, where a bypass can reduce it hugely or in some cases eliminate it completely. That is a huge reason to seriously consider a bypass over a sleeve.

I am not trying to say that everyone should have a bypass, but every day I read more and more people who say Sleeve to bypass for me. Something seems wrong about that.

I think you are right James, it seems to be on trend right now, which is extremely worrying.

I get the feeling that most people get told what to have, rather than make there own decision based on evidence. I bet if the patients are told with a sleeve is final or with a bypass it’s reversible if you have complications, most would go for a bypass.

Anyway rant over ??

39 minutes ago, damonlg said:

I did a huge amount of research before making my decision and one of the main reasons I went for a gastric bypass is that if you get complications you can reverse the operation as nothing is taken away. With a sleeve you remove most of the stomach so once it’s done it’s done.

A surgeon discussed this at our last support group meeting. He said that while by-passes are "technically" reversible, it's still another major surgery, it can have complications just like any other, and there may be a lot of scar tissue on the portions of the stomach that you'd like to rejoin. It is a very major undertaking and really shouldn't be considered one of the "pros" of bypass.

41 minutes ago, damonlg said:

I did a huge amount of research before making my decision and one of the main reasons I went for a gastric bypass is that if you get complications you can reverse the operation as nothing is taken away. With a sleeve you remove most of the stomach so once it’s done it’s done.

I found very few advantages to the sleeve and the Acid Reflux is a major reason why it soon became a no go for me.

Another big factor is if you have diabetes a sleeve doesn’t really change that much, where a bypass can reduce it hugely or in some cases eliminate it completely. That is a huge reason to seriously consider a bypass over a sleeve.

I am not trying to say that everyone should have a bypass, but every day I read more and more people who say Sleeve to bypass for me. Something seems wrong about that.

I think you are right James, it seems to be on trend right now, which is extremely worrying.

I get the feeling that most people get told what to have, rather than make there own decision based on evidence. I bet if the patients are told with a sleeve is final or with a bypass it’s reversible if you have complications, most would go for a bypass.

Anyway rant over ??

Not sure where you saw that the bypass was reversible... but as per https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258

Roux-en-Y (roo-en-y). This is a type of gastric bypass surgery, and is the most common method of gastric bypass. This surgery is typically not reversible.

4 minutes ago, Matt Z said:

Not sure where you saw that the bypass was reversible... but as per https://www.mayoclinic.org/tests-procedures/bariatric-surgery/about/pac-20394258

Roux-en-Y (roo-en-y). This is a type of gastric bypass surgery, and is the most common method of gastric bypass. This surgery is typically not reversible.

Yeah, I don't know how it would be reversible, considering they remove the remaining part of your stomach. I had a larger incision from them pulling it through. The concept that people think it could be reversible is very confusing to me.

https://obesitynewstoday.com/bariatric-surgery-reversibility/

"In addition to reducing the size of the stomach, the gastric bypass also rearranges the digestive system, which is why it is usually not reversible."

https://www.realself.com/question/gastric-bypass-reversible

"Gastric Bypass surgery is considered a permanent operation but can be reversed for medical problems only. The risks of a reversal are extremely high."

So, "potentially" reversible, but reversing is almost never done due to complications. The band can be removed, the sleeve, your pouch can and will stretch out, but the bypass, the restriction plus the rerouting of your intestines, this surgery should not be considered "reversible" as a justification for getting it.

11 minutes ago, AshAsh1 said:

Yeah, I don't know how it would be reversible, considering they remove the remaining part of your stomach. I had a larger incision from them pulling it through. The concept that people think it could be reversible is very confusing to me.

All the illustrations I've seen for bypass show the stomach being separated into 2 parts, but both remain in the body and connect to the intestine. How did they do yours? This is interesting. I thought only the sleeve removed the "extra" stomach.

4 minutes ago, Orchids&Dragons said:

All the illustrations I've seen for bypass show the stomach being separated into 2 parts, but both remain in the body and connect to the intestine. How did they do yours? This is interesting. I thought only the sleeve removed the "extra" stomach.

Yes Matt just enlightened me. I thought it was pulled through because the incision was bigger there. The doctor had said something to me about it being more tender because that's where my stomach "was" (he probably meant, "was" as in, my working stomach is no longer there), and I just thought it was removed. The incision was larger though, maybe he needed more room to work, *shrugs*.

It actually is reversible. Not exactly sure how they do it though.

https://www.sciencedirect.com/science/article/pii/S1550728913002219