Hello,

I've just joined and I have a question I'm hoping someone can help me with. I am in a program for bariatric surgery to be scheduled later this year. I just met with the surgeon and was told she will only perform a sleeve, I would like a bypass. She says that she constantly has patients coming back from bypass needing iron infusions or having issues with ulcers and she thinks the sleeve gives the same benefit without the risks. Basically, she only does bypass on rare occasions, like with people who have acid reflux. Has anyone encountered this before? I thought I would be able to choose my surgery and after much debate I opted for the bypass.

I'm 53, post menopause, 5-4, and 260. I would like this to be a one time surgery and not have to go back for additional one if needed. I'm also a sugar junkie and like that bypass would eliminate or limit that consumption for me.

Thanks in advance for you responses.

Different surgeons have different preferences and recommendations. Some of them only perform one type of WLS. You have the right to get a second opinion from another surgeon, and go with a different surgeon who will perform a bypass.

Hi BigSue,

Thanks for responding. I actually started out at a different hospital and they seemed more likely to do both surgeries, the issue with them was that it took a long time to get them to give me their costs for the surgery and even with my insurance it was out of my price range. So I switched to another bariatric center that I could afford. the surgeon and the center have multiple awards for surgeries and she was voted best surgeon in my region, so I'm wondering is she just more experienced and knows its not worth the risks or too conservative?

In any case, at this point I feel tied to this center since I've already spent a lot of time/money and am reluctant to start again. I really wish everyone would just list the costs up front.

4 minutes ago, crpowers said:

Hi BigSue,

Thanks for responding. I actually started out at a different hospital and they seemed more likely to do both surgeries, the issue with them was that it took a long time to get them to give me their costs for the surgery and even with my insurance it was out of my price range. So I switched to another bariatric center that I could afford. the surgeon and the center have multiple awards for surgeries and she was voted best surgeon in my region, so I'm wondering is she just more experienced and knows its not worth the risks or too conservative?

In any case, at this point I feel tied to this center since I've already spent a lot of time/money and am reluctant to start again. I really wish everyone would just list the costs up front.

For what it's worth, I went into my consultation leaning toward the sleeve and my surgeon changed my mind to gastric bypass. He does perform both procedures but he recommended gastric bypass to me. I took his recommendation because he's an expert and he had good reasons for recommending gastric bypass, but if you feel strongly that you want the sleeve, consider getting a second opinion. It's a really big decision!

Yeah, I'm thinking about it. I just didn't expect such resistance. Opinion, recommendation-yes. Outright refusal-no.

If the bypass is what you want you’d be better off finding another surgeon instead of trying to force the issue. I know doctors are professionals but I wouldn’t get my car fixed by a mechanic who says “I don’t do many of those” let alone a surgical procedure. In my completely uneducated opinion that has zero value, your reasons for preferring bypass sound legitimate and worthy of pursuing further.

She may only be comfortable performing the sleeve. Every surgeon does the surgery a little different in terms of how big they leave the stomach, and in the bypass, exactly how much intestine they bypass. It could be that her method of doing the bypass led to more issues? I would at least talk to another doctor and see what their opinion is. It's pretty silly that they weren't upfront about this when you first started working with them.

I chose bypass for pretty much the same reasons you listed. My doctor performs more sleeves (I think there are more of those in the US overall) but didn't object, especially when I had reasonable thoughts about it. This is a big surgery! You shouldn't have to settle for something that isn't exactly what you want.

I’m 5’4..263lbs… getting sleeved 9/2!!

Thanks everyone.

Your comments have helped. I'm going to ask more questions and maybe contact the previous bariatric center I was working with before.

I was really curious to see if anyone else had received the same feedback from their surgeon, like, perhaps opinions on the bypass were changing among the bariatric community.

thanks again and have a great weekend everyone!

I would seek another surgeon. Her experience is probably lacking in the gastric bypass arena.

If I had my choice over again, I'd go bypass instead of sleeve. It would've saved me years of Gerd and sleep issues because of it. That is just my personal experience, of course. Many do not develop Gerd. I had my revision to bypass a little over 3 wks. ago, and I feel so much better now.

That's the weird thing, She has 23 years experience and is a surgeon of excellence in a MBSAQIP bariatric center.

I don't want GERD and I don't want to have another surgery down the road. It annoys me a bit that the surgeons are like if this doesn't work out we'll change to a bypass later. Not everyone has the funds to keep getting surgeries.

For what it’s worth, I was 49 when I had my surgery 5’3.5”, started at 286 and now 140. I had the sleeve and it worked well for me.

-It is not an unreasonable position for her to keep, as the bypass does indeed provide very similar weightloss and regain results to the sleeve but at a somewhat higher cost in potential problems, limitations in future medical care and increased fussiness on supplements. The bypass is overall a very good procedure that is mature technology - it has been around as a WLS for some 40+ years, and its basis dates back some 140 years, so it is a well known quantity, both good and bad.

Her concern about ulcers is well founded, and that is something that one lives with, or at least the threat of them, with the bypass as it is intrinsic to it. One may never experience one, and most don't, but everyone is living to avoid them - it is the basis of the "no NSAID" policy that is common in the bariatric world as one needs to avoid any medications that promote stomach irritation and NSAIDs are the most common class of drugs that we encounter (but there are others that one may encounter through life.) Occasionally someone will come through with an ulcer problem that defies resolution, and their main course of action it to reverse the bypass. This is rare, but it happens. Marginal ulcers are to the bypass what GERD is to the sleeve - you can't fool mother nature and there will always be potential consequences to fooling around with her. One needs to balance what one gets from a treatment against what might possibly occur on downside.

Iron infusions are also a fairly common need after bypass, as it malabsorbs minerals in particular, and while some can get away with simple oral iron supplements, many can't and need periodic infusions. This is rare with a sleeve as there is no particular malabsorption.

Another factor that weighs on some is the "plan B" factor - what does one do if things don't work as expected - complications, inadequate weight loss or regain? While we don't like to think in terms of getting revisions, they are sometimes necessary, and the bypass is difficult to revise if it doesn't work right; as noted above in the case of intransigent ulcers, the usual is to reverse the bypass and put you back where you started from, and likely still needing help in weight control. The sleeve, on the other hand, can readily be revised to the bypass if needed - typically for intransigent GERD problems - or to a duodenal switch for continuing weight problems. Again, not something we like to think about, but the options are there.

The bypass also presents some additional limitations in future medical treatment, as it leave one with a blind remnant stomach and upper intestine, which can't easily be scoped endoscopically as with the natural GI system or with a sleeve. Again, something that may never come up, but likely will sometime in your future life.

A further note, your surgeon is in good company, as my doc rarely does bypasses as well, though his preference leans toward the duodenal switch as his primary, with VSG as a second choice. He does, however, do a fair amount of business revising problematic bypasses to the duodenal switch, and will do the odd bypass when it is specifically indicated for a patient, but that is fairly rare.

I agree. This is a big life changing surgery and you should get the one you want. I have bipolar so meds absorption can be a bigger issue with bypass plus I had lower BMI so he thought bypass would be overkill, but even still my dr said he would do it if I really wanted it (but he also stressed the risks). I think you should consider looking to another doctor if that one refuses to do what you want.

the sleeve is an easier, less complicated surgery and some surgeons are more comfortable doing that one. If you want bypass and she won't do it, you can always go to another surgeon. Yes - there's a greater risk of complications with a bypass, but the risk of major complications with either surgery is pretty low.

I've been hanging around on bariatric surgery sites for around seven years, and yes - although some bypass patients need iron infusions because they don't absorb enough iron from oral tablets, I would say that's definitely not the majority.

I went with bypass because it has a longer history and I had GERD. I've had no issues with it and have been very happy with my decision.

I went with sleeve and I am very happy with my choice, but I don’t think I would have been happy if I hadn’t had a choice. This is your body, and if the surgeon doesn’t have a specific medical reason why you shouldn’t have the surgery, that seems odd. I’d probably just find another surgeon at this point. This is a huge deal and you deserve to get the surgery you want!