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Sleeve vs Bypass concerns



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I’m having a consultation with the surgeon tomorrow and have lots of questions, but following a telephone consultation with a clinic admin/advisor with the provider a few days ago, they have said I’m not suitable for a bypass as my BMI is too low at 37.7. I wanted a bypass and concerned a sleeve won’t be effective.

Three things I’m concerned about are:
1. I’m honestly not a big eater. I eat two meals a day and glass of orange for Breakfast. My two meals are a single sandwich (usually cheese) for lunch and then a dinner. Dinner is typically a portion of tortellini and baked courgette with a couple of slices of garlic bread. Not huge portions. I do drink alcohol most evenings…3 glasses of wine as average. Some evenings I’ll have a bag of crisps (26g) too. My kids, friends etc comment on the amount I eat being so little. I don’t eat any sweet things. I sit at a desk at least 10 hours a day as I own my own business. I go home and sort my kids then work more. Very sedentary lifestyle. Will a sleeve be effective?

2. The admin asked if I suffered acid reflux, to which I said no, but since looking into a sleeve I’ve learnt that this includes indigestion…which I do get, especially at dinner with my kids (the arguing, bickering usually accentuates it!). Will the consultant think I’m making this up as I was so set on bypass?

3. I’ve read the sleeve isn’t as effective as bypass and it concerns me that I may only reach part way to an ideal bmi. I think if I’m doing this, and self funded, that I want to go all the way with it. It’s disappointing that I may not reach the best outcome with a sleeve.

Can anyone weigh in on this (excuse the pun!).

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I had a vertical sleeve gastrectomy. No post op complications for me, no reflux (although a certain percentage of sleevers do get this). I surpassed my goal weight. I started at 286, today 135. I was 49 when I had my surgery, I’m a 5’3.5” female. I followed my plan, upped my exercise, and found every bit of success that I was hoping for.

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I was exactly in your shoes two and a half years ago. I researched both surgeries and I had decided on the bypass because I read that bypass patients tend to lose more of their excess weight. But the bypass turned out to be medically contraindicated for me and I had to have the sleeve. Like you, I was never one to eat large volumes of food, so I wasn't sure the sleeve would be effective. But it was. I was one of the lucky ones who completely lost my appetite for the first year so it was possible for me to eat 600-800 calories a day for months. As my appetite slowly returned in year 2, my calories increased to 800-900. My weight loss slowed down but it continued and almost two years from my surgery date, I hit my goal of 130 pounds for a normal BMI. I continued losing and at this point my weight stays between 120 and 125. When I see it creep up to 127, I find myself immediately cutting back until I get it back down to under 122.

It wasn't just the restriction of the sleeve that helped me lose. The surgery changed my relationship with food (I'm guessing due to the hormonal changes from having most of your stomach removed). Even today, my appetite is about 65% of what it was presurgery and I don't have unmanageable cravings. I still like sweets but I eat mostly sugar-free things like popsicles and pudding, yogurt, etc. Once in a while I'll have a treat of some kind, like cake or pie or Bailey's Irish Cream, but it's rare and it's always one treat and then back on plan. I feel like I still have the capacity to be a sugar/carb addict, so I'm careful with those foods. I also keep my carbs relatively low (although not keto-low) because that helps me maintain.

So, statistically, bypassers do lose more on average. But your individual results can vary a lot.

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I had a sleeve gastrectomy too & had some reflux before surgery. I was also a lot like you in that I spent years not eating & skipping meals so my metabolism was pretty shot & I enjoyed a large glass of wine or two at night.

I eat more now than I did before surgery (smaller portions but more frequently) & I’m making better food choices. My metabolism is much faster - I feed it all day long. Only have a drink about once a month, occasionally more often or an extra glass & I don’t really miss it or look for it. I still have reflux but it manifests differently but is generally managed by 20mg esomeprazole everyday.

The average weight loss across sleeve & bypass is about the same at around 65% at the five year point. That is 65% of the weight you need to lose to put you at a healthy bmi. This takes in bounce back regain, complacency weight gain, lifestyle choices, medical conditions, etc. As with all statistical data some stabilise at a higher point others at a lower point. The surgery will get you so far. There may be physiological & psychological factors which influence your success but ultimately it is up to you.

I lost all the weight I wanted to lose plus more - 137% loss. Wasn’t intending to lose more but it took me while to sort out my maintenance. Been stable for a year now. I made sustainable changes to what I eat & when I eat & came to terms with why I ate. I still have odd days or times I’m not hungry but I still try to eat because I recognise I need to eat for my body to function. Eating because I need to not because I want to was an important realisation & contributing factor to my weight loss & now in maintaining my weight. Not perfect about this though because I do enjoy the odd treat but I’m careful about what the treat is, the portion size & why I’m eating it.

Good luck with whichever surgery you have.

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statistically, people tend to lose more weight with the bypass, but then, a statistic is a statistic. With either surgery, you'll find people who lose more or less than the statistical average. You'll find plenty of sleevers who do better than average - losing 80%, 90%, or even 100% of their excess weight. It really depends on the individual. By working at it hard and following the rules, you'll likely do much better than average - and do just as well as you would have had you had the bypass.

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I had made up my mind that I wanted bypass to because some things I read said you lose more weight with bypass. The doctor told me that he would do either one if I really wanted it but he suggested I go with sleeve because I have bipolar disorder and there can be medication absorption issues after the bypass that are more common than they are with sleeve. So I went with the sleeve and I was 35 BMI pre-surgery. I am almost 8 months out now I am 13 pounds from a normal BMI (177 pounds and still losing). Part of me still thinks this process may have been a little easier had I gone with bypass but at the same time I am glad I went with the sleeve because it is working. I am glad that I had to the sleeve because I am OK so far on just one Multivitamin and Calcium. My doctor explained it to me like using a power tool for something that you can get away with just using a hammer that the bypass was just overkill for me. The only thing would be your indigestion I would bring that up and I would like to think no they won’t think you’re lying if they do I would see a different doctor because you need to have trust going both ways

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I started wanting the sleeve, then went to bypass, and am back to the sleeve (my doctor thinks that is the best option for me). At this point, I'm actually kind of terrified of bypass -- I just don't want it. I don't want a revision or anything, I want to steer clear of it. I'm not saying it isn't fantastic for others, not at all. So I worry (maybe weirdly) that having sleeve is opening me up to that possibility in the future.

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