I have a question that's been haunting me for a while.

Why would anyone pick the least effective surgery for their particular needs (obesity level, food addiction, prior health issues, other mental health concerns,etc)?

Is it lack of research or self sabotage?

Edited August 20, 20188 yr by GreenTealael

I wish there was a way to know what is best for each individual. My choice on the sleeve was because of iron deficiency, vitamin D deficiency and heavy cycles. I was worried the bypass would make these things much worse and cause other problems for me. I would have loved to do the bypass because it comes with more weight lost. My surgeon and I both agreed on the sleeve. However I’m not sure ? it was the right choice. I started out at 280 lost 37 before surgery and would like to be 170. I’m currently 8 days out and worried because I havent lost a pound. Spoke with my doctor yesterday who says I may not be getting in enough liquids and calories to lose anything. So I am praying that I made right decision. I don’t want to be one of those people that needs a revision.

On 08/20/2018 at 12:23, summerset said:

Or availability? Or insurance coverage? Or wanting the least invasive procedure?

Some people don’t qualify for RNY. With my doctor it depends on your BMI.

One more thing. My doctor said that since I had so much weight to lose he actually thought it would be best to do the sleeve and then do a revision so I could get to my goal weight. Of course I said no, RNY please, one surgery. Because I’m trying to get pregnant after and can’t have two surgery’s to wait four years to have kids! I’m 31

Hmmn I want to help you lose weight, is it okay if I put you through 2 surgeries, all the pain and recovery from each? Good that way I can double-bill your insurance and take Mrs Surgeon on the Caribbean cruise she' s been nagging me about! Not too concerned about,your pain and suffering, twice the money for a little more of my time ,, Sounds like a win-win for ME, what's a little inconvenience and more time lost for you? Oh you don't think it sounds that good? Well maybe the next patient will! Got to make a financial quota so I can keep my malpractice insurance current and paid-up! Have a good day! See you in surgery!

This was not the old "RNY is superior to VSG" debate.

To clarify I have a VSG is a fine tool 

This was a question about the need/desire for revisions based on failed expectation on weight loss alone (not post WLS medical issues or malfunctions)

I see a ton of post (sadly mostly VSG based) where people are very freshly out of surgery wondering when they can cheat, or 2 years out of surgery wondering why they never made it to goal , or going for revisions to RNY to finally make to goal after regain

My questions was are people going for VSG to avoid dumping to cheat (vs malabsorption for medical valid reasons) OR were they not advised that the best surgeries for their particular cases would have been the more aggressive surgery
OR did they have no honest clue about the statistical weightloss/ regain rates ?

 I see a lot of good complex answers, thank you. I also see that a lot of Doctors are promoting VSG as their first choice surgery. Now I know. There are complex reasons why revisions are seemingly on the rise. Thanks everyone!!!!

I chose a sleeve because I am still in my 30s and malabsorption seemed like a really bad idea to me. Thought I would just be upping my chance for a barrage of health issues down the road. Add the fact that I have lost large amounts of weight in the past all on my own and a husband who only reluctantly supported the sleeve and was down right opposed to a bypass, and sleeve it was. Also, I don't want to be "skinny." I don't have the face for it--the thought of looking bony (for myself--not others) repulses me.

Now I am one of the lucky ones that is dealing with GERD from their sleeve. Medications do very little for me and are not a long term solution. I may be forced to get a revision and it still terrifies me. I do not want my intestines messed with. but it is what it is.

Should I have gone with the bypass to begin with? Maybe. I might have not had GERD but my mother has numerous GERD related issues--so I could have seen it coming. Not to mention I am only 3.5 months out and back to my creamer in my coffee ways. Plus, I did purge in my 20s. And the 100s of pounds I have lost on my own--I've gained them back, Time will tell--but to answer your question. FEAR. I was educated on the outcomes but I am afraid of a bypass.

On 08/21/2018 at 07:31, Missouri-Lee's Summit said:

The suggestion of self-sabotage doesn't make sense for me when considering one weight-loss surgery over another. Real self-sabotage is doing nothing, taking no steps toward reclaiming one's life via the tools of WLS.

I often wonder why some people have opted into a revision (from sleeve to bypass). Did they make a mistake in choosing the sleeve in the first place? I have no regrets in selecting the bypass. None. I think I'd be upset if I'd had ended up with the sleeve, though.

The RN at my Bariatric Center stated that many times people seek revision after the sleeve due to GERD. This isn’t an issue for me.

30 minutes ago, Gundy said:

On August 21, 2018 at 7:31 AM, Missouri-Lee's Summit said:

The suggestion of self-sabotage doesn't make sense for me when considering one weight-loss surgery over another. Real self-sabotage is doing nothing, taking no steps toward reclaiming one's life via the tools of WLS.

I often wonder why some people have opted into a revision (from sleeve to bypass). Did they make a mistake in choosing the sleeve in the first place? I have no regrets in selecting the bypass. None. I think I'd be upset if I'd had ended up with the sleeve, though.

The RN at my Bariatric Center stated that many times people seek revision after the sleeve due to GERD. This isn’t an issue for me.

When both options (sleeve and bypass) were presented to me, and I was told that I could develop GERD even without a history of it if I had the sleeve, I was convinced that I wanted nothing to do with the sleeve. Taking vitamins is no hardship, but having to contend with something like GERD was a dealbreaker. And sleeve people have to take vitamins, too, so why not go with he bypass.

Edited August 22, 20188 yr by Missouri-Lee's Summit

On 08/20/2018 at 16:16, GreenTealael said:

Would you ever consider revisions (based on weight issues alone) vs continuing to work with your current surgery?

Honestly I don’t know because I’m not there. I don’t think anyone can predict accurately what choices they would make in circumstances they aren’t in.

But based on my avoidance of other forms of surgery for decades when I was obese, probably not. But maybe now that I know what it’s like to live life at a normal weight that would motivate me. But I think there are far more people who don’t regain large amounts of weight with the sleeve than there are those who do. These boards see more of those who regain for obvious reasons.

I also have developed new ideas since my weight loss. Most of us had surgery for our health. The first pounds we lost were Health pounds. Then many of us go on to lose more weight and that I call vanity pounds. Usually the regain is of those vanity pounds and we tend to forget how many of the health pounds are still gone and beat ourselves up over the vanity pounds.

I honestly don’t think people should fret too much about the regain of vanity pounds. That’s pretty much... normal. All people do it as they age, whether they have a history of obesity or not. So I believe I would consider that normal and work to lose it as any normal person does.

On 08/21/2018 at 08:40, GreenTealael said:

This was not the old "RNY is superior to VSG" debate.

To clarify I have a VSG is a fine tool 

This was a question about the need/desire for revisions based on failed expectation on weight loss alone (not post WLS medical issues or malfunctions)

I see a ton of post (sadly mostly VSG based) where people are very freshly out of surgery wondering when they can cheat, or 2 years out of surgery wondering why they never made it to goal , or going for revisions to RNY to finally make to goal after regain

My questions was are people going for VSG to avoid dumping to cheat (vs malabsorption for medical valid reasons) OR were they not advised that the best surgeries for their particular cases would have been the more aggressive surgery
OR did they have no honest clue about the statistical weightloss/ regain rates ?

 I see a lot of good complex answers, thank you. I also see that a lot of Doctors are promoting VSG as their first choice surgery. Now I know. There are complex reasons why revisions are seemingly on the rise. Thanks everyone!!!!

Do you really think people have VSG so that they won’t dump so that they can cheat? Why would they even have WLS. I honestly don’t think that is anyone’s motivation.

What revision statistics are you looking at? I hope you’re not basing it on board postings because that is self selection and not population based.

And I say again, we can’t predict yet for whom which surgery will work. For many the sleeve creates a new set point and the reduction in grehlin eliminates the desire to binge—long term. I don’t understand the people on this thread who say the sleeve is temporary or short term.

1 hour ago, jess9395 said:

Do you really think people have VSG so that they won’t dump so that they can cheat? Why would they even have WLS. I honestly don’t think that is anyone’s motivation.

What revision statistics are you looking at? I hope you’re not basing it on board postings because that is self selection and not population based.

And I say again, we can’t predict yet for whom which surgery will work. For many the sleeve creates a new set point and the reduction in grehlin eliminates the desire to binge—long term. I don’t understand the people on this thread who say the sleeve is temporary or short term.

This comment, especially from someone with several years experience and AMAZING stats, makes me hopeful. I am pre-op and have chosen the sleeve because I am hoping it will prevent overeating binges. I am not under the impression that I will never have carbs again...in fact, I have always had more success on diets that incorporate carbs. and restrict portion sizes My problem is that I will do well for a while, and then have a binge, and that binge will set off more. I am hoping that the sleeve will be a tool to prevent those overeating episodes. I am not a grazer, so I am hoping this will work. I am hearing so much about the reduction in gherlin being BS and the sleeve only working for a few months. Seeing your success with it makes me hopeful, thank you.

Who do you hear that from? Medical studies show the gherlin reduction is real and the restriction is permanent.

That said, there are people whose appetite is not controlled by the reduction in gherlin. Responses to the surgery varies and sadly we can’t tell who will respond which way. Hopefully one day Science will advance to the point where we can better tailor surgery choice to the individual.

And I will say, I am very careful with my carbs. Carbs can trigger appetite and binge-y feelings for me and a lot of carbs upset my stomach—I can’t eat bread or rice especially—and sugar makes me feel ill (not full on dumping but icky).

I chose the sleeve because my doctor recommended it after reviewing my medical history and because it seemed less invasive than the bypass. I was familiar with RNY since this surgery is also done on babies with liver disease to allow them to grow big enough for a liver transplant. It seemed a little extreme to my nurse's brain to have all that done to lose weight. I have never had signficant GERD issues or I might have considered the bypass.

Approaching 4 months out next week and I do feel I made the right decision. I still have a ways to go but if I do not lose another pound I will still be ecstatic since I feel a million times better than I did before surgery, have no back pain and have been able to stop 3 asthma/COPD medications. I have great energy and feel happy most of the time. My life has done a 180 degree turnaround since April 18 and I am very grateful for that.

For me, the sleeve (so far) was the right choice since it is working well and I feel more comfortable with it than the other options.

I have never had signficant GERD issues or I might have considered the bypass.

But one can develop GERD (with the sleeve) even without a history of it. I don't think there's any way to predict who will develop GERD and who won't. I didn't want to take that chance.

....this was one of the things that steered me toward a sleeve - to preserve as much of my digestive system as possible and still lose enough weight to make me healthier.

But with a sleeve, a part of your body is removed permanently. How does that compare with a bypass in which nothing is removed? With a bypass, one's digestive system is rejiggered, nothing is removed. Do surgeon's tell their patients how much stomach they intend to remove? What if they inadvertently remove too of your stomach? How would you even know? It's not likely that they'll mention it.