I had my first surgical consultation last week and left feeling a bit upset. I had decided that I wanted to have the sleeve, but the surgeon said that he doesn't recommend it because I have GERD.

All of my research and reading that I have done over the course of the past year is out the window. RNY seems like a much more complex surgery. I am worried about the malabsorption aspect, as well as having my small intestines rerouted.

Did anyone else have similar concerns prior to surgery?

I thought I wanted the sleeve, as well, but ended up with bypass due to my GERD. I do not regret it at all. My GERD is gone, including the Barrett's esophagitis that had progressed to the point of a precancerous polyp. Malabsorption has not been a nutritional issue. All my vitamin and mineral labs are fine. Malabsorption actually starts to resolve after a couple of years, as the jejunum starts to take over the absorption role that the duodenum used to perform. Bypass surgery has been around for a long time. The procedure is just as safe as a sleeve and it works. I'm glad I had it. I lost weight quickly and have maintained easily.

When I went in for my first consult I had my heart set on VSG (gastric sleeve) because it was less invasive, you took less vitamins, etc. HOWEVER, I left upset because the surgeon told me it wasn't a good choice for me because it statistically has a lower AVERAGE weight loss percentage and my BMI was over 60. They told me my average weight loss for Sleeve would get me to settle at about 230 pounds, Gastic Bypass to 205, and DS would get me to 185. This is AVERAGE. By all means there are people who lose more and people who lose less. So I was very upset because I'm disabled and knew that average is the best I could hope for so I decided after a lot of soul searching and bouncing back and forth to settle on having the Loop DS. My goal is 180, but if I settle at 185 I'd still be insanely happy with that. Yes the malabsorbative aspect of my surgery scared me, but... that aspect in my surgery is reversible. So if it becomes necessary they'd reverse the intestinal bit and I'd be left with just the VSG stomach. It took a while to chose my surgery and I balanced all the pro's and cons. BUT in the end the surgery that you decide is your own. If you are willing to risk the chance of possible making your GERD worse then go for it. It doesn't make it worse for everyone, but there is a large amount of people that it does effect. If you are prepared to potentially have to get a revision down the line if it does happen then that's your choice. Just make a list of pro's and con's, that's my advice.

I had GERD, had the sleeve, and now I don't have GERD anymore.

I went into my initial consultation thinking that I wanted the sleeve because it seemed like a less extreme, less risky surgery, but the surgeon recommended gastric bypass because my BMI was over 60 and gastric bypass results in more weight loss on average (as NovaLuna said above, some lose more and some lose less than average, but gastric bypass gives you slightly better odds).

I did more research in the months before my surgery and by surgery day, I was confident that gastric bypass was the right surgery for me. I've never had GERD, but I've seen a lot of people who get the sleeve talk about developing it (or existing GERD worsening), and I've seen a lot of people who get revisions from sleeve to bypass, either because of GERD or because they didn't lose enough weight with the sleeve. I don't want to get another surgery, so it seemed like bypass was the way to go to minimize my chances of needing it.

I think I also had some misconceptions about the risks of gastric bypass. Nowadays, bypass and sleeve have very similar rates of complications, so neither is significantly safer than the other. The sleeve has a higher risk of GERD, and bypass has a higher risk of ulcers. Some doctors allow sleeve patients to take NSAIDs (although I believe it is still not recommended), while NSAIDs are not allowed for gastric bypass patients. You need to take supplements for both, but sleeve patients have a better chance of being able to stop taking them eventually. There is a higher chance of dumping syndrome with gastric bypass, but some people consider that a benefit because it stops them from eating things they shouldn't.

Remember that the decision is ultimately yours, and you have the right to go to another surgeon for a second opinion. It's a big decision, so do your research and make sure you can live with the decision you make. Keep in mind, though, that the surgeons are experts who have seen lots of patients and have a pretty good idea of what surgery would give you the best outcome.

It was the other way around for me. I really wanted to have the bypass because average weight loss is higher than for the sleeve. But it turned out to be medically contra-indicated for me and I had to have the sleeve instead. I was super-disappointed, but it has turned out well in the end. I got to my weight loss goal and a normal BMI and I didn't have any major complications or issues. I know it's frustrating not to be able to do the surgery you want, but it can still be a total success. The sleeve does exacerbate GERD for a lot of patients, so when you balance the risks/benefits, are you taking that into account as well? Are you willing to possibly have to do a revision surgery at some point down the road if you have the sleeve? I guess another option is not having the surgery at all but obesity carries its own serious risks. It can be hard evaluating all these trade-offs, so I wish you well in making the best decision. ?

bypass is usually recommended if you have GERD. There's a significant minority of people (I believe I've read 30%, but don't quote me on that) for whom the sleeve will make it worse. Note that means it does NOT make it worse for the rest, but 30% is still a fairly big risk - and you'll find several people on here who originally had the sleeve but were later revised to bypass because of it. I also had GERD and was advised to go with bypass, so I did. I wasn't willing to take that chance. The GERD went away (as it usually does with bypass), and I've been very happy with my decision.

malabsorption is rare as long as you keep on top of your vitamins.

I don't think bypass is really that much more complex - and it's been around for a long time (much longer than the standalone sleeve surgery). That part of it appealed to me as well.

the decision is ultimately up to you (or it SHOULD be, anyway), but there are some medical conditions for which one surgery is more appropriate than the other, and GERD is one of those conditions.

I went to my consultation hard headed and wanting the bypass and the surgeon was just as hard headed and wisely said the sleeve because of my previous bouts of diverticulitis and previous bowel resections. I wanted the "whole deal" I wanted to be all in and now I am super happy with the sleeve and realized I should have understood that the Dr probably has his reasons for his recommendations and I am just an armchair Dr.

Tell your Dr your reasonings for your choices and listen to his reasonings for his choices and spend some time researching both......remember that procedures are not what they used to be yesterday and both have really good results.

Thank you all so much! Your responses have been so helpful. Thanks for sharing your experiences.

Hi, Pookie! I'm in the same boat as you. I wanted to have the sleeve, but my surgeon recommended RNY due to my GERD. He said if the GERD had been caused by a hiatal hernia, he could have just repaired the hernia at the same time he did my sleeve. Unfortunately, I just have a weak valve, so my GERD is almost guaranteed to get worse with the sleeve. I wasn't too disappointed though...I know several people who've had RNY and none of them have any regrets. They look great and seem genuinely happy! After I left the surgeon's office I did my own research, and now I feel completely excited about the RNY. I have my surgery on 12/28. Bring it, I say! ?