Bypass or sleeve?

[Letsgetfit 3]

I'm completely lost and unsure about doing a sleeve or bypass. I am female 37 yes old, no kids in the future, 172cm and weigh 111 kilos. I have a small hernia and the surgeon recommends a bypass. I guess I'm apprehensive because I focused so much on doing a sleeve. I am an active individual who would like to add muscle while loosing fat. I'm afraid with a bypass I wont absorb necessary nutrients to achieve these goals. Anyone out there with similar situation? Is there a success bypass story where adding muscle mass wasnt a big challenge?

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[New&Improved 1,780]

You'll be taking plenty of Vitamins with bypass and generally weight loss is better... Muscle tone comes down to exercise...

They say there's more benefits from the bypass like if you have issues with gerd or reflux and it's the best for cure type 2 diabetes!

There's tons of pages on here about each surgery

[GreenTealael 25,609]

Listen to your Surgeon... If they are trying to give you the best outcome possible, consider it.

Good Luck 💜

Edited September 12, 2019 by GreenTealael

[catwoman7 11,284]

Vitamin deficiencies are uncommon as long as you keep on top of your Vitamins (you have to take vitamins with the sleeve, too). I can't imagine that adding muscle mass would be any different with sleeve vs bypass.

[AZhiker 2,253]

I am very happy with my bypass. My GERD is gone, which has relieved my asthma as well. I started exercising right away, gradually adding elements of cardio, weights, stretching. I have more muscle mass now than before surgery. I have also entered a triathon in Oct and a bicycle event in November. I have so much energy now and feel 20 years younger! My only issue with malabsorption is with fat. If I eat too much it will come out in my stools. All of my 6 month Vitamin levels were great, but I do take my Vitamins faithfully, which I think is a small price to pay in exchange for the life I have now. My only other issue is getting enough calories in now, to keep up with my training schedule. My pouch limits intake, so I am having to eat more frequently and starting to add more healthy carbs back into the menu.

All in all, I couldn't ask for a better outcome. I respect anyone's decision about which surgery to have, but it seems quite a few folks with the sleeve end up getting revised to bypass. I was also fixed on the sleeve until I understood the advantages of bypass with helping GERD and since that was an issue for me, it became a no brainer. I also like the fact that dumping can occur with sugar intake, when bypass is chosen. That is a great detriment for me to avoid sugar. Sugar is poison. I want no part of it, and my tummy agrees! No brainer there. I am also commited to taking care of my pouch and all the connections as well as possible. I work in the GI department of our hospital and I have seen firsthand the damage that can be done to WLS sites - ulcers and erosions beyond horror. So no alcohol, coffee, or NSAIDs for me. Those are my personal choices - again, a small price to pay for the life I have now.

Best wishes in your journey!

[RickM 1,753]

A few random thoughts, in no particular order -

You will likely lose some muscle mass as you lose weight irrespective which procedure you get; the main emphasis in general for WLS is to minimize muscle loss as we lose. Some maintain that it is impossible to build muscle mass while in a caloric deficit (needed to lose that fat) and while I never like to say "never" on such things, I would say that it would be exceptionally rare for it to happen, Typically, we lose what we need to lose to a healthy weight and body composition, and then work on building additional muscle mass if we so desire.

The bypass and VSG have very similar weight loss and regain characteristics - there isn't much to choose between them from that aspect. You may lose a bit quicker with the bypass owing to its malabsorption, but will ultimately end up in the same place. The caloric malabsorption of the bypass is a temporary thing - it dissipates after a year or two - so weight maintenance is similar for both; nutritional malabsorption is a long term affair, however.

As long as one stays on top of supplements and lab tests, both are good for long term health. The bypass, however, is somewhat fussier in its supplement requirements - minerals are malabsorbed, so one usually needs to supplement Iron and Calcium more than with a sleeve (and that may not be enough, as the need for iron infusions is usually greater with the bypass than with the sleeve. Iron and calcium is somewhat fussy as they need to be spaced out during the day. it's mostly a matter of establishing the habit, but this will bother some more than others.

The sleeve has a predisposition toward GERD or acid reflux, so if one already suffers from this, the bypass is often preferred unless there is a specific identifiable cause that can be corrected during surgery (such as a hiatal hernia.) In contrast, the bypass is predisposed to dumping, reactive hypoglycemia, and marginal ulcers (which precludes the use of NSAIDs such as ibuprofin or aspirin, which are better tolerated by the sleeve.)

The sleeve is conceptually a more straightforward, or simpler, procedure. However, it still takes some time and practice for a surgeon to master, so it is well to ensure that a prospective surgeon has performed several hundred of them. In the US, that isn't a big problem these days as most have been doing them for several years, but in other countries where they have been slower to adopt it, this may be a consideration. Owing to their national health policies, Canada is running about five years behind the US on their learning curve, and other countries seem to be similar. There is a recent poster (from AU, IIRC) here who went through a quick revision from an initial sleeve to a bypass within the first week or two, that is likely an example of this. So, if your surgeon is recommending one over the other, it is well to pay attention to them - their recommendation may (or may not) the absolute best thing for you, but it is likely to be the best that they can do for you, or are most comfortable performing on you.