I'm going crazy deciding which surgery to choose!

[Shimmy 27]

I've read probably 100 posts...which have all been amazingly helpful here. Every time I tell myself I'm going with the sleeve, I read the next post and believe full heartedly I should go with the bypass??? I know this is an ever-popular question but I am feeling so confused. I don't currently have GERD but is sounds horrible. I also don't like the idea of "dumping". I want to lose 150 pounds. I am 100% committed and ready for surgery which will probably be this November or early December. I want to make the best, most informed decision for myself. I don't want a revision down the line...not that anyone does. One question I have is does artificial sugar/sweeteners cause dumping with the bypass? I'm 45, 298.6 pounds today. Just got approved yesterday and am super excited---------just confused LOL. Wishing all the PALS here the best!

[GreenTealael 24,852]

Bypass

[Bryn910 519]

If I were you and had to lose 150 lbs I would go with bypass.

I have bypass and do not dump. Not everyone with bypass experiences dumping. I actually had a revision of sleeve to bypass due to not losing weight and having GERD. Trust me, GERD is not in any way fun. I was miserable with anything I ate.

If you experience dumping, it could be a blessing; it’s your body’s way of letting you know “oh no, don’t put that in your mouth again.” Some people experience different food likes/dislikes post op; it may last forever, it may be temporary. Dairy may not agree with you a few months post op, but you may eventually tolerate it.

These surgeries aren’t cookie cutter by any means so to say that you WILL or WILL NOT experience a certain thing isn’t always the case.

good luck with whatever you choose

[catwoman7 10,845]

not everyone dumps. I never have - and most people I know who've had bypass don't. I don't know what the statistics on this are. I see 30% thrown around on here and on other boards sometimes, but I don't know if there's any hard core research behind that. It can be prevented, though, by limiting your sugar intake (many dumpers can eat *some* sugar - just not a lot of it)

Artificial sweeteners don't cause dumping that I'm aware of, but some people are really sensitive to them (especially sugar alcohols - the ones whose names end in -itol). GI distress, diarrhea, etc - but this can happen to anyone, bypass or not.

[mousecat88 2,279]

Did your surgeon not make any recommendations? My surgeon advised against the sleeve because it can exacerbate or cause acid reflux. I already have some, so I certainly don't want to make it worse. And I wouldn't want to cause it - knowing myself how bad it can be sometimes. I'm pre-op, too, but I've talked to a LOOTTTTTT of patients and families of patients and it is SO variable who has dumping and who doesn't. And everyone has said, it only happens if they do not stick to their diet. Bypass was a no-brainer for me.

[KimTriesRNY 1,853]

I agree with what others have stated, if your profile is correct and your BMI is 50 opt for bypass.

Gastric bypass is a great option if you have been obese for most of your life, including childhood. Having well over 100 pounds to lose makes it a great choice for you, even with no other comorbidities.

I have never dumped after my surgery and tolerate small portions of anything. Whether that is good or bad is an individual thing. If you need dumping to keep your eating in check you may not be successful in the long run anyways.

None of this is to say that you could not accomplish this with a sleeve, but your chances of success may be greater with gastric bypass.

Congrats on your approval and do let us know what you decide and how it goes!

[S@ssen@ch 745]

Not to make your decision any more confusing, but there are actually recent studies (I saw it posted on BariatricPal, but can't find it now) that say there is no direct correlation between sleeve and increased incidence of GERD.

Whether or not someone develops or experienced increased GERD from sleeve seems entirely on a case by case basis. Example: My friend who encouraged me to have sleeve had GERD so bad she developed Barrett's esophagus. Hasn't had one instance of GERD since sleeve surgery. Me, I had what my doctor felt was "situational" GERD, which means that I had it because of my diet and overall obesity. I had sleeve, but about 3 weeks in I started getting heartburn and nighttime reflux. It is managed now, but I suppose it could easily be a problem if I wasn't pretty diligent with management and prevention (medications and lifestyle).

In terms of dumping, not all bypass patients experience dumping AND there are some recent mentions of dumping in a sleeved patient. I've had dumping because I ate something very out of the norm for my diet and my body just decided it didn't like the extreme. That can happen to ANYONE, regardless of whether they're a bariatric patient or not. Plus, while we like to tout dumping syndrome as a deterrent to specific behaviors, I'm not sure I'd agree that it will stop you from eating things you shouldn't. That's entirely up to you.

Then, there are the statistics with how much weight you can expect to lose. On average a bypass patient can expect to lose about 70% of their excess weight, whereas a sleeved patient will lose about 60% of their excess weight.

For me, the primary determinant was that I absolutely did not want to deal with the malabsorption of the bypass procedure. I did not feel that the additional weight loss I could expect with bypass was worth the malabsorption, so I went with the sleeve. While the possibility of intractable GERD was considered, I truly felt that my risk was low. In all honesty, even though I developed GERD, it's not worse than any exacerbation of the condition that I experienced before surgery. In fact, I'd say I feel better than I did before surgery all around and specifically in terms of the GERD. I would do sleeve again, no hesitation.

Advice: have a heart to heart with your doctor, consider the risks and benefits, and make the best decision for YOU

[Matt Z 4,138]

17 hours ago, Shimmy said:

I've read probably 100 posts...which have all been amazingly helpful here. Every time I tell myself I'm going with the sleeve, I read the next post and believe full heartedly I should go with the bypass??? I know this is an ever-popular question but I am feeling so confused. I don't currently have GERD but is sounds horrible. I also don't like the idea of "dumping". I want to lose 150 pounds. I am 100% committed and ready for surgery which will probably be this November or early December. I want to make the best, most informed decision for myself. I don't want a revision down the line...not that anyone does. One question I have is does artificial sugar/sweeteners cause dumping with the bypass? I'm 45, 298.6 pounds today. Just got approved yesterday and am super excited---------just confused LOL. Wishing all the PALS here the best!

Everyone is going to have a different experience. But looking at the "averages", it seems a decent number of people develop GERD from the sleeve. And quite a few people don't get any dumping at all.

I've had exactly 1 incident of dumping, in over 6 months. And that was with Tomato Soup. I can eat pretty much anything I want at this point with zero dumping. I do get crampy here and there if I eat something I know I shouldn't, but I don't have any issues with any sweeteners. I went with the band back in 2011... and was revised to RNY this past March. Honestly the best thing I've done. I have a friend that was sleeved and he also had to get revised to the bypass due to complication with the sleeve. Also, the sleeve is 100% non-reversible. The Bypass is reversible under certain conditions, it's a risky reversal, but it does happen, you cannot undo the sleeve since 90% of your stomach ends up in the trash.

Also, long term research keeps showing that the bypass out performs the sleeve in all metrics. Patients lose more, keep it off longer, have lower rebounding weight gain.

It is 100% your decision, but my 2 cents, go with the bypass.

[KimTriesRNY 1,853]

https://web.duke.edu/surgery/2015bariatricmasters/session6_gerd_after_sleeve_torquati.pdf

https://www.journalacs.org/article/S1072-7515(16)30941-3/fulltext

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579881/

Regarding Gerd and VSG.

Being morbidly obese itself is a huge risk factor in itself as well.

Edited October 5, 2018 by KimTriesRNY

[harmony love 22]

Hi everyone

Its my first post and would like to let everyone know how appreciative I am that this community is out there. Im writing also because I'm conflicted on which surgery is best for me and I know its ultimately my surgeon and my decision but still very scared. Just a little history of me I'm a working mom of almost 3 year old twins, I work at a fast pace medical office so Im pretty much on my feet 8-12 hours a day. I've been overweight all my life but since my pregnancy I have not been able to loose weight and have high blood pressure with high cholesterol levels. My father had passed away from a massive heart attack at 43 yrs old and I just turned 40. My BMI is between 36-37. My first initial visit 6 months ago was to get gastric sleeve but since I've been feeling in my heart I want bypass. On my endoscopy it shown some inflammation due to acid reflux and I've suffered most of my pregnancy with it and definitely do not want GERD. I know theres more Vitamin deficiencies and more complications but I feel like theres more long term benefits with bypass. Again I really can't thank you all Ive been reading most of your posts and I feel so much more informed then I was when I started this journey.

BTW my pre-op appointment with my surgeon is this week and Im a ball of nerves

[Mhy12784 423]

Based on on your profile/stats, I don't think the sleeve or bypass is clear cut the better option. I would probably lean towards the bypass because you're a little on the higher BMI side but I think both are good options for you.

I didn't see your age, but that's typically a factor too in what my doctor recommends (age is a factor for women not really men)

But one thing I think that has to be a huge factor that is often overlooked is how many bypasses does your surgeon do? There are some surgeons who quite frankly do very few bypasses, and I would never go to one of them. The bypass is a fairly complex procedure, so do yourself a favor and ask them how many they do in a year!

I have surgeons at my hospital who might do several hundred sleeves a year, but do less than 20 bypasses a year. I would absolutely not get a bypass from a surgeon like that, even though the odds are it'll still be fine. It's just unnecessary risk in my opinion

[Shimmy 27]

Thank you all for taking time out to give advice/share your stories! Right this second I want to go with the Bypass. I think I'm going to stop talking with everyone at work (even my family) because everyone has an opinion based on one person they know or have heard about.... I think I'll just let my friends and family know what I've chosen when I wake up from surgery LOL. Happy Monday

[Midwest Girl 29]

I just had the bypass on 9/18 and I’m glad I did. The weight loss is steady but still takes effort. I don’t think the sleeve would have been enough for me.

[Shimmy 27]

Hey Midwest Girl! How are you doing post-op? I hope you're starting to get into the new groove and not having any complications. Keep me posted, I've decided to go with the bypass and my with my surgeon November 8th to schedule my surgery!!! I'm so happy.