Gastric sleeve or bypass??

[Dani64519 27]

Hi all, I'm new here and have found this forum to be so very helpful! I had my initial consultation last week and the surgeon said I meet criteria for either the gastric sleeve or the bypass. Assuming I am medically cleared, I am leaning towards the sleeve since it seems a little less invasive. Although, I'm not really sure if I am taking all of the right factors into consideration. Any recommendations on other things I should take into account? (I have a BMI of 46 and am a type 2 diabetic). Greatly appreciate any suggestions!

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[james2021 160]

I'm opting for the sleeve for the same reason + less issues with Vitamin absorption, apparently. I think people sometimes opt for bypass if they have GERD and also because you usually lose slightly more weight.

[Creekimp13 5,838]

If sugar is a huge problem for you, consider bypass.

Sleeve people generally tolerate sugar more, and if it's your particular addiction, bypass can do more to put that fire out because it can have more physical consequences for overindulging in sugar.

Not to say you can't "dump" to some degree with a sleeve, but it doesn't seem to compare to bypass. I can eat about 200 calories of refined sugary stuff with no issues, but will feel pretty gross if I go over that. But not like a bypass where you get severely ill and sweaty and feel god awful. (on the other hand, if you WANT to be able to eat small portions of sugary stuff someday and don't want more severe limitations on sugar...sleeve might be better)

If you have a personal or family history of anemia or Iron deficiency, sleeve might be a better choice. It is less corelated with nutrient absorption issues than bypass.

Acid reflux is more of a risk with sleeve, but I feel like this could have something to do with the skill of the surgeon. I had a hiatal hernia repair with my sleeve that actually corrected my acid reflux completely. I think this is due to my surgeon being truly excellent and up to date on good technique for preventing these issues. But yes, statistically, sleeve carries significantly more risk for acid reflux issues...and they are no fun.

Best wishes whatever you decide!

[Dani64519 27]

1 hour ago, OAGBPal said:

Hi there! I came across a bunch of articles on diabetes remission while I was evaluating procedures. Would love to share, but can I first ask which procedures are available to you? RNY and Sleeve or also, say, Duodenal Switch or the Mini Gastric Bypass?

I know - due to my own procedure - the MGB has a very high remission rate compared to the sleeve, but not sure about RNY.

Thanks so much. My surgeon only presented the RNY or sleeve. I don't think they perform the mini by pass and the duodenal switch wasn't mentioned. I will have another face to face with the surgeon after my medical clearances are completed to discuss final options, etc. I appreciate any article info you can share on diabetes remission. While I am certainly looking forward to the weight loss, my priority is getting my diabetes under control.

[Dani64519 27]

57 minutes ago, Creekimp13 said:

If sugar is a huge problem for you, consider bypass.

Sleeve people generally tolerate sugar more, and if it's your particular addiction, bypass can do more to put that fire out because it can have more physical consequences for overindulging in sugar.

Not to say you can't "dump" to some degree with a sleeve, but it doesn't seem to compare to bypass. I can eat about 200 calories of refined sugary stuff with no issues, but will feel pretty gross if I go over that. But not like a bypass where you get severely ill and sweaty and feel god awful. (on the other hand, if you WANT to be able to eat small portions of sugary stuff someday and don't want more severe limitations on sugar...sleeve might be better)

If you have a personal or family history of anemia or Iron deficiency, sleeve might be a better choice. It is less corelated with nutrient absorption issues than bypass.

Acid reflux is more of a risk with sleeve, but I feel like this could have something to do with the skill of the surgeon. I had a hiatal hernia repair with my sleeve that actually corrected my acid reflux completely. I think this is due to my surgeon being truly excellent and up to date on good technique for preventing these issues. But yes, statistically, sleeve carries significantly more risk for acid reflux issues...and they are no fun.

Best wishes whatever you decide!

Thanks so much for the feedback. Sugar is a problem but not a huge one. Ugh, such a complicated, life altering decision!

[catwoman7 10,922]

if you have issues with acid reflux, they usually recommend you go with bypass. Sleeve makes that worse (or can cause it) in about 30% of patients. Otherwise, it's personal preference. I had GERD prior to surgery, so it was a no brainer for me. 30% isn't everyone, but it was enough of a risk for me that I didn't want to take the chance. GERD is awful.

RNY "dumping" is also a 30% risk. I've never dumped and know lots of others who never have, but it does happen to about 30% of RNY patients. But it can be controlled by limiting or avoiding sugar. Some dumpers can eat SOME sugar without setting it off - others have to avoid it altogether.

there's a better chance of putting diabetes into remission with bypass, although it can go into remission with sleeve as well - but the percentage isn't as high.

also, statistically people lose a little more weight with bypass because of the malabsorption, but that's just a statistic. Your success is really more dependent on your level of commitment and following the rules rather than which surgery you go with. You'll find lots of examples on here of people who've been very successful regardless of which surgery they had.

P.S. I've been super happy with my bypass and would choose it again if I had to make that decision today.

Edited March 22, 2021 by catwoman7

[ChubRub 1,700]

I also chose RNY b/c I had GERD in the past. Since surgery, I haven't had any heartburn, which feels amazing. I used to always carry tums in my purse, but not any more!

Very pleased with my RNY!!

[SummerTimeGirl 580]

At first I was going back and forth between the two but more leaning towards the sleeve. But after the first consult with my surgeon, he said he would do the sleeve since 1. I am currently taking Diclofenac for my lower back pain and if I even THINK I'm gonna continue to need it then he would do the sleeve and 2. because I'm anemic. So that made up my mind. LOL So the sleeve is what I'll have done when I get my date.

[Dani64519 27]

31 minutes ago, SummerTimeGirl said:

At first I was going back and forth between the two but more leaning towards the sleeve. But after the first consult with my surgeon, he said he would do the sleeve since 1. I am currently taking Diclofenac for my lower back pain and if I even THINK I'm gonna continue to need it then he would do the sleeve and 2. because I'm anemic. So that made up my mind. LOL So the sleeve is what I'll have done when I get my date.

I was almost wishing the surgeon would have only presented one option. I think I am leaning towards the sleeve but want to do as much research as possible before I commit. Do you you know when you will be having your surgery? I am hoping to line mine up for July'ish if all goes well.

[SummerTimeGirl 580]

17 minutes ago, Danielle6402 said:

I was almost wishing the surgeon would have only presented one option. I think I am leaning towards the sleeve but want to do as much research as possible before I commit. Do you you know when you will be having your surgery? I am hoping to line mine up for July'ish if all goes well.

Well my surgeon said when he has a patient with diabetes he almost always likes to do the bypass because it supposedly has quicker, more immediate results for people who have that and high BP. But with me, like I said, I have a history of being anemic and also take the NSAID's every day which is a no-go for bypass pts. So, that made the decision even easier. PLUS I was only borderline Type 2 at the time. It wasn't until I did my blood work a few weeks later that we realized I was now Type 2.

As for my date, we haven't even discussed it yet but I have an appointment on April 2nd with Mental Health then on April 5th I meet with the Pulmonologist. Providing neither of them need anything further from me, I will have completed everything and then it's just a matter of the office submitting it all to my insurance and waiting for an answer from them as to whether or not they will cover it and then I guess I get a date. I'm hoping for a May date the latest but I know they are backed up due to Covid so it may be later. I really don't know.

[Dani64519 27]

3 hours ago, OAGBPal said:

Alright, thanks for replying. The reason I ask is that the longer bypass options seem to be extremely efficient in diabetes resolution.

I found this study that compares diabetes resolution in Roux-en-Y Gastric Bypass (they refer to that as RYGB) vs Sleeve Gastrectomy (they refer to that as SG). From the abstract:

https://pubmed.ncbi.nlm.nih.gov/32355816/

In a way, I think you can read this in one of two ways:

- Either you read it as 'hey, even with the sleeve, there's a 2-in-3 chance my need for diabetes meds goes away'

- Or you can read it as 'alright, almost 9 out of 10 bypass patients go off their meds, and they're able to control their diabetes and blood sugar better in the longer term'

Whichever way you read it will guide you Other studies show similar results.

Thanks so much! Greatly appreciated.

[JMcRae 0]

Undecided between Sleeve and MGB
BMI is 31.5
So afraid of weight regain....
For this reason thinking MGB.....
Any advice would be appreciated....