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Told today No Bypass must be sleeve



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Back story is that 2 years ago, I started the process for weight loss surgery and the Dr. I saw told me that he believed that my best option was bypass because it doesn't allow me to cheat as easily and so I got it in my head that anything else would be a failure for me. Due to life situations, I was not able to take the time out to focus on surgery and recovery so I had to put it all off.

Now 2 years later I am starting the process again and with a new Dr. I have also developed stomach ulcers in the past two years so he told me today that he does not feel good doing the bypass when I already have ulcers and feels that the sleeve is the safest bet. In my head, it is still stuck that I am going to fail if I don't have the bypass. I don't want to go in feeling like a failure already and since most of my research over the years has been on the bypass, I am looking for real life experience.

So I guess what I need to know is did any of you feel this way going in and if so, have you been successful? Without the dumping, how do you Detour your thought process to not eat certain foods. I guess I was relying on feeling bad enough eating certain foods that I would never want to touch them again. I want this so bad but I don't want to fail and I need a mind reset.

Thanks for any advise

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if you end up having to do the sleeve, keep in mind that lots of people have been very successful with it! In both cases, it's really more your level of commitment than the type of surgery.

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Not everyone dumps with bypass....I have yet to and trust me I have tried. Meaning, i have tried things that SHOULD make me dump and do not. A few things make me nauseous which as close as I have gotten....but I would only tell you to NOT rely on dumping as the thing that is going to help you lose weight. You have to do it for yourself and be ready mentally and just stick to it. Whichever surgery you get, you can be successful, just have to put the work in.

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Your assumptions (and the surgeon's) are incorrect. :( But that's the good news! Do your full research. You may be surprised. Alternately if sleeve does not work for you, then there are other options about revisions. Whereas, unless you go in with the take-no-prisoners philosophy for RNY where you have 1 chance and 1 chance only...the chances of revisions and second surgeries carry a huge risk/reward scenario and are very limited in scope.

Also, welcome and please fill out your profile so we can actually speak to you intelligently. We don't know how much you weigh, your age, how tall you are, your goal, etc. :) Makes it a lot easier.

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As with another poster above, I have a bypass but do not dump. Ever. So, you were counting on something that may or may not happen. You can be very successful with either procedure. The most important factor for success after wls is your brain, not your stomach.

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I was told that I would be getting a bypass unless my surgeon felt it was safer to do the sleeve. Luckily I got the bypass. I wish you luck.

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I was convinced I wanted a bypass to get the "best results possible" based on percentages and lose the most weight, but after talking to my therapist and another one of my doctors, they both recommended the sleeve instead and I had it, no complications, it worked, and I'm very pleased with it.

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When things are questionable, second opinions are a useful thing. But, I can understand the surgeon's concerns from a couple of different perspectives.

One is that the bypass is predisposed to ulcers (typically marginal ulcers which would be of a different cause of what you have,) so as with the VSG which is predisposed to GERD and they often shy away from doing them with patients that already have GERD, I can see the reason to be apprehensive about doing a bypass on you.

The second is that the bypass leaves the bulk of your stomach in a blind limb that can't easily be inspected by endoscopy, and as ulcers can be a pre-cancerous condition if left unchecked, it is something that you want to monitor; waiting until obvious symptoms such as pain or bleeding occur is seriously bad news. The marginal ulcers that are common with the RNY are typically at the anastomosis between the pouch and intestine, so is in a place that can be monitored; anything happening within the remnant stomach that has been bypassed is out of reach.

As others have noted, not all bypass patients dump (maybe 30% or so?) so according to Murphy's Law (if something can go wrong, it will....) those who are looking for dumping as a form of aversion therapy will be amongst those who don't dump.

As FluffyChix, the bypass is something of a one shot deal - it is difficult to revise to something else if it doesn't work for you, either on weightloss or regain or due to medical problems (such as your ulcer problem) and even a reversal is no walk in the park (we have seen a couple go through here the past few months due to intransigent ulcers) while the sleeve is more readily revised if necessary. So there is some additional "margin of safety" or "plan B" available with the sleeve when things are questionable.

Overall, the results of the bypass and sleeve are very similar - whatever difference there may be in the intrinsic "strength" of each procedure is overshadowed by the initiative and habits of the patient - there are many successes with the sleeve (8+ years out here) just as there are those who fail to do well with the bypass, including going back to junk foods because they never dumped. There is plenty of work on your part whichever procedure you get.

good luck....

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I just posted this below on another post discussing VSG revisions and thought it was appropriate here as well. I am a VSG to RnY revision but not because my VSG failed me, because of GERD. I didn’t hit my weight goal but I lost 47% of my excessive weight and maintained until my revision. I do know I learned a lot between surgery 1 & 2 and my biggest take away is my surgery didn’t fail me but I definitely failed my surgery. Your tool, or whatever you call it, doesn’t decide what you eat or when you eat. It doesn’t choose to drink while eating or to graze. You get out of it what you put into it. I know people that have the VSG and have been wildly successful, I know people with the VSG who have lost and gained. I know people with the RnY who have been wildly successful and I know people with RnY who have lost and gained.

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Thank you all so much for the information. I don't disagree with my new DR. on what he has told me at all. I believe if he says it is safer to do it this way, than it is. He is highly recommended in my area and carries several awards and 16 years experience so who am I to doubt him. My issue is with myself. My previous Dr., is not as recommended and in all honesty, he planted the seed that I would fail with any other surgery and now I have to find a way to get that out of my head so that I can go into this strong and believing in myself. I know that if I can get this weight off, the fear of being trapped in this prison others call a body will help me to not regain weight, I am just terrified that I will fail myself getting to that point. You all have made me feel better about it reading these replies and reading others comments and replies so I am going to be here often in hopes that this support will help me get through it.

Also,

8 hours ago, FluffyChix said:

Your assumptions (and the surgeon's) are incorrect. :( But that's the good news! Do your full research. You may be surprised. Alternately if sleeve does not work for you, then there are other options about revisions. Whereas, unless you go in with the take-no-prisoners philosophy for RNY where you have 1 chance and 1 chance only...the chances of revisions and second surgeries carry a huge risk/reward scenario and are very limited in scope.

Also, welcome and please fill out your profile so we can actually speak to you intelligently. We don't know how much you weigh, your age, how tall you are, your goal, etc. :) Makes it a lot easier.

I updated everything, I think. Let me know if it shows up now lol

Thank you again for the info and encouragement. It is much appreciated.

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I saw a highly recommended surgeon and he talked at me, making many assumptions about me without asking questions. He automatically said sleeve was the only option. For the fact that I have metabolic disorders, and cannot use exercise to burn calories to compensate for extremely slow metabolism I felt like pursuing surgery was not an option without RNY benefits of absorbing less calories. I was there for a surgical consult for my gallbladder as well and he also assumed my gallbladder was not inflamed. (My gallbladder was low functioning with severe symptoms) I didn’t feel comfortable and decided I was not going to pursue it with that doctor. It was crushing, I was getting exhausted trying to fight my weight alone, my own fight with low carb low calories wasn’t getting me anywhere.

it wasn’t until I saw a endocrinologist and discussed my metabolic disorders and the fact that I couldn’t take the medications and that despite my efforts my weight kept climbing, that I got referral to Cleveland clinic.

the doctor there knew right away based on my history of severe GERD/acid reflux that the best option was RNY. And I also had ulcers but that was not a factor for the doctor. If you have any kind of acid reflux the sleeve can make it worse. Many people get sleeve and then end up revising to RNY due to GERD.

for me the possibility of dumping wasn’t an issue. One being that the gallbladder surgery also had similar dumping syndrome risk and I didn’t think It would be a big issue since I avoid the causes ie. Eat as little sugar as possible. And I’ve dealt with worse in my life. It was just something id deal with if it happened and not really think about.

im glad I went with Cleveland clinic, they made the process much easier. And since I had record for months (actually longer) of my diet efforts. It was approved quickly. Also it turned out that I had chronic gallbladder inflammation despite what the highly acclaimed doctor had said to me ...

but that’s just my personal experience. Some people do very well with sleeve.

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Thank you @Darktowerdream I think I am going to schedule another appointment with him and push the issue. I just sat there like a lump when he told me because I felt like I hit a wall and couldn't get my thoughts straight when he said it. Maybe he will reconsider and I wont have to go through finding another doctor and starting over again.

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38 minutes ago, Draven298 said:

Thank you @Darktowerdream I think I am going to schedule another appointment with him and push the issue. I just sat there like a lump when he told me because I felt like I hit a wall and couldn't get my thoughts straight when he said it. Maybe he will reconsider and I wont have to go through finding another doctor and starting over again.

@Draven298 don’t feel bad about your reaction. I was utterly speechless when the first doctor I saw said the things he did. He started off saying something like people seeing a buffet of food and eating everything in sight. My brain shut down. I barely remember anything that he said. I tried to maintain composure but was having a meltdown. I barely made it out of the office and not without being an embarrassment.

I tried to email the office about it and they told me I wasn’t a good fit for the doctor and turned me away. Maybe it was for the best, he would only do sleeve, and the insurance process was way too complicated with his office. Thankfully the endocrinologist recommendation that Cleveland clinic was an easier process turned out to be true.

I’m on the Autism spectrum and doctors treat me differently and don’t take my physical conditions seriously.

I’m not trying to scare you, just expect the possibility that the surgeon won’t listen. I didn’t even know if I’d have to give up on the idea of bariatric surgery. But I kept pushing my primary care and pushing to try to figure out why nothing I was doing was helping me lose weight and made sure my doctor had record of this for months.

Write down what you need to say to the doctor and bring it with you. I hope that the doctor listens to you and your needs. But if you feel uncomfortable than Finding another doctor might be necessary. There are risks with any surgery. So that should not be what makes your choice.

It’s not easy, dealing with difficult doctors, and I have for much of my life and it’s hard trying to fight for the right thing. especially when a doctor won’t listen to what you need.

I just know for me personally I knew the sleeve would not be enough. I had to listen to my gut instinct. Which can be hard to do. I wish I had better advice.

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