Hi all!! (SLEEVE OR BYPASS).... running out of time!
I am scheduled to go in for my sleeve this Weds. I have been learning and reading so much and now I feel that perhaps a bypass might be a better choice for me. My fear is that I might develop bad reflux in the future and would need a revision to a gastric bypass. I don’t have any symptoms of that now, however I have read so many posts from people that have had this happen. My Dr is basically saying it’s my decision. I have fears that I will make the wrong choice..... Any advice would b much appreciated!!!

Any of these procedures may predispose you to some kind of problem as a result of the anatomical changes that the surgery makes; this doesn't mean that you will have such a problem, just that the problem shows up in more often than in the general population.

With the sleeve, the main predisposition is for GERD, as a result of cutting back the stomach volume more than its' acid producing potential - usually the body adapts and adjust things over time, but sometimes it doesn't. I have mild GERD which is well controlled with mild OTC medication; a few get it so severe that no med controls it and they have to get their sleeve revised to correct it, while others - most people - have no problem with it at all. GERD problems may also result from poor surgical technique, and was more common when the sleeve was new to the WLS world 8-10 years ago and most surgeons were still figuring it out (this is why I traveled to a practice that had already been doing them for some twenty years, so avoid this kind of "learning curve" problem. Most surgeons in the US today are experienced enough with it that this isn't much of a problem anymore, but it does seem to show up more in countries that are farther down that learning curve, such as Canada and Australia.

People with the bypass will also sometimes develop GERD, though usually more in line with general population numbers, and seems to often be associated with chronic over eating, volumetrically if not calorically.. This may also be why some with the sleeve also develop GERD after some years.

The bypass is predisposed to dumping and its close cousin, reactive hypoglycemia, as a result of rapid stomach emptying from the lack of the pyloric valve in the active GI system metering the stomach contents into the intestines. Some people with the sleeve, or even no stomach surgery at all, may dump as well, but it is rare. It is generally controlled with additional dietary restrictions.

The bypass is also predisposed to marginal ulcers, typically around the anastomosis between the stomach pouch and intestine. This is a result of the section of intestine being used not being resistant to stomach acid like the duodenum is (the part of intestine immediately downstream of the stomach in the natural anatomy, which is bypassed along with the remnant stomach in the RNY), leaving a very sensitive suture line that is easily irritated. This is why NSAID pain relievers and other similar medications are a big NO-NO with the RNY, but are better tolerated with the sleeve based procedures; one still needs to be cautious with them, but they are more usable with a sleeve than a bypass.

For the benefit of the OP, with no prior GERD history, but a history of orthopedic problems, I would be inclined to go with the sleeve, owing to its better tolerance for the various pain relievers that you are inclined to need at different times.

Good luck - none of this is easy, as it is often a matter of trade offs, and sometimes it's less a matter of good vs. bad as it is bad vs. less bad, or bad vs. not-great.

Thank u so much.
Have a speedy recovery!!!?

3 hours ago, RickM said:

This is why NSAID pain relievers and other similar medications are a big NO-NO with the RNY, but are better tolerated with the sleeve based procedures; one still needs to be cautious with them, but they are more usable with a sleeve than a bypass.

great feedback overall - although one thing I wanted to comment on: a lot of surgeons are now advising their sleeve patients to avoid NSAIDs, too, so this may or may not be a factor anymore...(back when I had my surgery, it WAS, but now - not as much. Some (medical) opinions have changed on this...)

3 hours ago, catwoman7 said:

great feedback overall - although one thing I wanted to comment on: a lot of surgeons are now advising their sleeve patients to avoid NSAIDs, too, so this may or may not be a factor anymore...(back when I had my surgery, it WAS, but now - not as much. Some (medical) opinions have changed on this...)

Yeah, the recommendations vary from doc to doc. Early on, most surgeons simply copied their RNY protocols for their sleeve patients - diet, supplements, drug interactions, etc. Those who had been doing sleeves for a long time - primarily the DS crowd - had lots of experience indicating that NSAID use was fairly benign (indeed, that was one of the selling points for the DS or VSG over the RNY.) As more got familiar with the sleeve, they often loosened up on their restrictions. At the same time, the medical world in general has become more cautious about NSAID use in general - for everyone - so we have two conflicting trends. The main point is that there is a physiological difference between the two procedures that influence their relative tolerances for these meds, and that is something that should be considered in these decisions. Ideally, none of us will need to take these meds, but the world isn't ideal, and that's where these compromises come into play.

I personally chose the sleeve. It matched the excess weight I wanted to lose, seemed to be the less invasive surgery and according to my EDG I've never had GERD or issues with that. I also wasn't interested in dumping or anything so I wanted sleeve from the start.