HOLY BANANAS!! Fast Track and I am still debating

[cmandrews13 8]

So I met with the surgeon's office today. Had the first meeting with the dietician, filled out the gigantic pile of paperwork and met with the doctor. Got some super amazing news from the coordinator of the program, which is not only does my insurance pay for the psych eval ($200), but also pays the program fees for the meetings and everything ($600). I was blown away. Then the super awesome amazing news - while my insurance carrier normally requires a documented 6 month dietitian/food class, my particular group does not. So that requirement is waived.

On top of all that, when I went to check out and make my psych eval appointment, the nurse said - "Can you do today? Like in 15 minutes? She has an opening and she is right across the street." I said "sure!" and off I went. So in one day, I got my first appointment, first dietitian meeting, most of the paperwork and the psych eval done. Basically, I just have to attend one informational class/workshop/meeting and I am good to go! I feel like I at the wheel of a speeding train!

As far as the debate, I had pretty much decided on Sleeve. I didn't like the idea of the bypass and I knew there were more complications with that procedure. But I do have Type 2 Diabetes and the RNY is this particular surgeon's gold standard for bariatric surgery. They said ultimately it is up to me, but now I am not sure. Anyone have any thoughts one way or the other? I am 44 years old, have approximately 150-170 lbs to lose and plan to live at least another 50 years. So for me it's mostly about the long term effects and while I know there is way more data about RNY, I just get skeeved out at the idea of re-routing my guts.

[gabybab 696]

My Dr recommends bypass, buy I chose sleeve. I have type 2 diabetes. Its veen 6 weeks and my bs are normalizing. I only take 10 units of lantus at night now. Hopefully I will be off that soon.

[elcee 3,340]

I had my guts rerouted because that scared me far less than the idea of most of my stomach being chopped off and thrown away! Plus I have a number of friends with sleeves with varying rates of success.

[Kristinqtpie 42]

@elcee, they didn’t cut your stomach for gastric bypass?

I think no matter your surgery the end result depends on you. If you get the sleeve you get restriction and RNY you get malabsorption as well to help with weight loss. I know the sleeve is not reversible but it’s not common to have RNY reversed (from what I’ve read) and it’s complicated. Do your research on both and (no pun intended) go with your gut! 😂♥️

[Matt Z 4,138]

6 hours ago, cmandrews13 said:

As far as the debate, I had pretty much decided on Sleeve. I didn't like the idea of the bypass and I knew there were more complications with that procedure. But I do have Type 2 Diabetes and the RNY is this particular surgeon's gold standard for bariatric surgery. They said ultimately it is up to me, but now I am not sure. Anyone have any thoughts one way or the other? I am 44 years old, have approximately 150-170 lbs to lose and plan to live at least another 50 years. So for me it's mostly about the long term effects and while I know there is way more data about RNY, I just get skeeved out at the idea of re-routing my guts.

There are actually not more compilations with the bypass than the sleeve, this is incorrect. Also, the sleeve is 100% non-reversible, because parts of your anatomy end up in the waste. The bypass is actually reversible in certain situations, the reversal is tough and has it's own complications, but it is possible and does happen.

Honestly, I'm really happy that I didn't go with the sleeve (I was a band revision and my surgeon *will not* do band to sleeve due to the increased staple line failure risk) I'm over a year with my bypass and I still am so very happy with it. To each their own, just, make sure you are basing your decision on facts, not feelings. Good luck!

The bypass will prevent GERD, the sleeve has a chance of causing it or making it much, much worse. Stick with the facts and figures over feelings... because feelings associated with things we don't know much about... are generally not accurate. I was afraid of the bypass too at one point, because I had the wrong information. I got the band. I really wish I had just gotten the bypass from the get go and not waste so much money on 2 surgeries only because I was afraid of something based on the wrong information.

My personal experience here. Good luck with whatever you chose to do!

[Danny Paul 761]

6 hours ago, cmandrews13 said:

But I do have Type 2 Diabetes

So do I. My A1c prior to surgery was 8.2 right now 18 months after surgery with no meds my A1c is 6.0. What would it have been with a by pass? No way for me to know. I will tell you that I have cut out 90% of processed sugar ( still in some foods that I eat) and cut cut my carb consumption tremendously. My endocrinologist says that everything combined is helping to control my diabetes.

It's always best to do your research so that you can make an informed decision.

[KCgirl061 1,529]

They are both good surgeries with pros and cons to both. Like you, I didn't like the idea of the rerouting of intestines but also the malabsorption scared me. Especially when it came to absorbing your Vitamin and minerals. I was on 2 support groups on Facebook - one a Bypass group and one a Sleeve group. When the question was asked on the Bypass group if anyone was having problems with their teeth a large majority was YES, with over a 100 responses. When I would look for the same question on the Sleeve group I could hardly find the question even asked. When I asked myself I got less than 20 responses and most were NO.

No offense to Elcee, but I work in surgery. Removing part of the stomach didn't phase me at all - I see body parts get removed all the time. Varying lengths of small bowel and colon are removed for cancer. Gallbladders are removed. Tonsils are removed. Uterus and fallopian tubes removed. Prostates removed. Bone joints are removed and replaced with metal versions. Vein is removed from the leg to bypass blood vessels in the heart. Even a small segment of the heart can be removed as a treatment for atrial fibrillation. So removing a large portion of the stomach didn't seem like a big deal.

Kristinqtpie is right. The surgery is just a tool to help facilitate weight loss but in the end your results depend on YOU and the choices you make. After spending well over a year in those Facebook support groups I came to the conclusion that regain doesn't just happen. People try to eat the same things they did preop and rely too much on their surgery to maintain the weight loss.

[KCgirl061 1,529]

22 minutes ago, Matt Z said:

There are actually not more compilations with the bypass than the sleeve, this is incorrect.

Uh no. Can you find a medical journal to back up that statement? Because all the ones I've seen say the opposite.

For example:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843041/

From the article:

"VSG is primarily a restrictive procedure for weight loss. The perioperative and postoperative mortality rates are 0.29% and 0.34%, respectively, with complication rates of 13%"

"RNYGBP has been the most common weight-loss procedure performed in the United States for the past several decades. Contemporary rates of perioperative and postoperative mortality are 0.38% and 0.72%, respectively.¹⁴ ..... In randomized controlled trials, the overall complication rate was 21%"

[FluffyChix 17,409]

26 minutes ago, KCgirl061 said:

They are both good surgeries with pros and cons to both. Like you, I didn't like the idea of the rerouting of intestines but also the malabsorption scared me. Especially when it came to absorbing your Vitamin and minerals. I was on 2 support groups on Facebook - one a Bypass group and one a Sleeve group. When the question was asked on the Bypass group if anyone was having problems with their teeth a large majority was YES, with over a 100 responses. When I would look for the same question on the Sleeve group I could hardly find the question even asked. When I asked myself I got less than 20 responses and most were NO.

No offense to Elcee, but I work in surgery. Removing part of the stomach didn't phase me at all - I see body parts get removed all the time. Varying lengths of small bowel and colon are removed for cancer. Gallbladders are removed. Tonsils are removed. Uterus and fallopian tubes removed. Prostates removed. Bone joints are removed and replaced with metal versions. Vein is removed from the leg to bypass blood vessels in the heart. Even a small segment of the heart can be removed as a treatment for atrial fibrillation. So removing a large portion of the stomach didn't seem like a big deal.

Kristinqtpie is right. The surgery is just a tool to help facilitate weight loss but in the end your results depend on YOU and the choices you make. After spending well over a year in those Facebook support groups I came to the conclusion that regain doesn't just happen. People try to eat the same things they did preop and rely too much on their surgery to maintain the weight loss.

Yes!!!! Sing it my sistah!!!! This surgery (both RNY and Sleeve) are largely what you make of them. But, the sleeve does carry a bigger risk of GERD and revision risks (IMHO). So if you have any reflux issues or asthma/upper respiratory issues, I'd sure choose RNY.

[SeattleLady 277]

Here the deal in my view. A person can sabotage either procedure. However, read the medical journals that deal with obesity and look up the psychological studies after wls.

You have to prepare your Mind and body for long-term success. It's not just about the weight. Your life is going to change in multiple ways. Counseling can help throughout this process.

Sent from my SM-J727T1 using BariatricPal mobile app

[Matt Z 4,138]

22 hours ago, KCgirl061 said:

Uh no. Can you find a medical journal to back up that statement? Because all the ones I've seen say the opposite.

For example:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843041/

From the article:

"VSG is primarily a restrictive procedure for weight loss. The perioperative and postoperative mortality rates are 0.29% and 0.34%, respectively, with complication rates of 13%"

"RNYGBP has been the most common weight-loss procedure performed in the United States for the past several decades. Contemporary rates of perioperative and postoperative mortality are 0.38% and 0.72%, respectively.¹⁴ ..... In randomized controlled trials, the overall complication rate was 21%"

That's a fairly old report and does not include the rate of revision from Sleeve to Bypass in the "complications" It also seems to include the dumping in the Bypass but not for the Sleeve as far as "complications". The rate of Sleeve to Bypass revision is fairly high. This also doesn't include or account for the medical advancements that have become common practice over the past several years AND seems to include older post op issues from older forms of the surgery. And, lets talk about the fact that Gastric Bypass happens more often than the Sleeve, thus again skewing the real numbers.

Case by case. They would come out about even. Except with the looming revision for the sleeve.

I had the band. I needed revision. So I had to have 2 surgeries thus increasing my overall risk as opposed to getting the bypass first which would have lowered my overall risk.

Any information, when taken without all facts can seem scary. But you need to look at the entire picture.

273 SGs were performed of which 6.6% (n = 18) were converted to RYGB most commonly due to inadequate weight loss (65.3%) and severe reflux (26.1%).
https://www.ncbi.nlm.nih.gov/pubmed/28416180



https://www.ncbi.nlm.nih.gov/pubmed/29496440
You've got approx. a 10% chance that you'll need revision to another surgery.

So, maybe 1 surgery vs 1 surgery without factoring in revision increasing the risks because now you've had 2 surgeries instead of 1, leaving out dumping for the sleeve but adding it in for the bypass, sure, it looks like the bypass is a much more dangerous surgery. When you factor EVERYTHING in... pretty sure they break even if not a little in favor of the bypass.

You still can't undo the sleeve though, no matter what happens. 70-90% of your stomach is gone. Nothing usually gets removed in the bypass, just moved around.

Again, either way. Good luck with your choice.