Confused by Consult

[Imortalcandy 1]

I had my first consultation with my Bariatric surgeon today. I said I would prefer a sleeve but that maybe a bypass is better for me because it seems to have a better long term outcome with keeping the weight off. He said that both procedures have the same long term weight loss it’s just up to the patient to eat right. He also said that you cannot stretch out a sleeve. The one that really surprised me was when I said that I have reflux and I don’t want a sleeve to make it worse, we’ll he told me that both can give you reflux and that I’ll just be on Prilosec either until it resolves or forever because it’s perfectly safe.

What is everyone’s thoughts on all of this?
He did elude to the thought that he only does bypasses on extremely large unhealthy people.

[Tina 2.0 64]

Can you consult with anyone else? There are huge differences between the two procedures. I have read several posts on here about folk’s revising the sleeve. If you don’t stick to the guidelines you can just eat less crap and still regain the weight. Tmw my con worker is going from sleeve 8 yr ago to a RNY. The doctor should really be looking at all of your needs and concerns to help you decide what is best for you.

[SleeveToBypass2023 2,682]

4 hours ago, Imortalcandy said:

I had my first consultation with my Bariatric surgeon today. I said I would prefer a sleeve but that maybe a bypass is better for me because it seems to have a better long term outcome with keeping the weight off. He said that both procedures have the same long term weight loss it’s just up to the patient to eat right. He also said that you cannot stretch out a sleeve. The one that really surprised me was when I said that I have reflux and I don’t want a sleeve to make it worse, we’ll he told me that both can give you reflux and that I’ll just be on Prilosec either until it resolves or forever because it’s perfectly safe.

What is everyone’s thoughts on all of this?
He did elude to the thought that he only does bypasses on extremely large unhealthy people.

My thoughts are that you need a new surgeon. If you have reflux, DO NOT get the sleeve. It will likely make it a lot worse. I was able to choose between bypass and sleeve because my A1c was less than 7 and because I don't have any form of reflux, so I chose the sleeve. My husband has GERD and a higher A1c and was advised that bypass is really his only option. Sometimes those that never had reflux get it with the sleeve and have to revise to a bypass to resolve it. And while the sleeve has less risk, the bypass does give about an extra 10% of weight loss. So definitely find a new surgeon.

[GradyCat 3,697]

That all rings true with what my surgeon told me and what I've read on these forums as well.

[kcuster83 1,505]

Hmmm, that is completely opposite from what I learned from my surgeon and everyone in support groups and forums just by reading and listening to people's stories.

I would try to have a consult with another surgeon.

I had SEVERE GERD before surgery, so bad I have extensive damage to my esophagus that had to be repaired during surgery. I went into my first apt. with my surgeon with plans of getting sleeve. He explained both surgeries in depth and then explained why the sleeve was not a good choice for me. Mainly was because of the GERD and a high amount of patients end up with some to a ton of acid problems with the sleeve, secondly because I wanted to loose so much weight that the malabsorption would assist in that more so than just the restriction. he asko explained that the hatial hernia repair and the bypass would likely eliminate the GERD if not completely, very likely to get it under control. I was on 2 prescriptions meds and eating tums every day and still, vomiting fireballs half the time.

I am 4 weeks post op and I am now only taking a pepcid prescription which everyone takes for a while after surgery to lower the risk of ulcers, but better yet I have had ZERO acid problems. I mean NONE! I know it is still early, but I am starting to get back to a regular diet, even eating some hot sauces from time to time and still no issues. I have high hopes. Honestly, even if I have to take meds I would be completely satisfied as long as they completely controlled it with the meds.

This is just my experience and everyones is different. But I truely believe his information is incorrect based on years of research and what I have learned. But I am no professional.

[Queen ApisM 427]

I'd say he is partly right and partly wrong. The right part is that outcomes are not that vastly different between sleeve and bypass. You can have great success with both, and also completely regain weight with both. So, the fact that he's not bought into the higher weight loss with bypass rings true. It's about what you do with the tool. It isn't a magic bullet.

The acid reflux thing is just totally wrong, though... If you have GERD or severe reflux the bypass is definitely better. My practice required an endoscopy before doing a sleeve. If I had had it - even silent GERD - she wouldn't have done the surgery.

I'd consult with other surgeons if you have options where you live and see what they say. I spoke with 3 different practices when I was considering mine and I learned a lot at all the consults. It really helped me make the right choice (for me) in surgery type and also the surgeon.

[catwoman7 11,284]

like the above person said, the average weight loss difference between the two isn't that much, and it IS up to the patient to develop good, lifelong eating habits to prevent gaining the weight back - so I agree with that part. However, there's about a 30% chance of developing reflux with the sleeve (or if you already have it, of it getting worse), whereas the bypass usually improves - if not outright cures - GERD.

most of us are put on PPI's (like Prilosec) for the first 3-6 months after surgery, but after that, no. If you continue to have reflux issues after that, then yes - but continuing reflux problems are much more common with sleeve than with bypass.

I'd consult with another surgeon. Or if you don't have other options, then insist on bypass. You should be able to get the surgery that you want.

[catwoman7 11,284]

in addition, no, PPI's are NOT perfectly safe. There has been a LOT of publicity the last couple of years about the dangers of long-term use of PPIs. They're fine for the short term - maybe a few months - but not for long-term use. My clinic used to put patients on them for a year (like back when I had surgery in 2015). But no more. Most clinics limit them to 3-6 months now.

[Flab-U-Less Forever 140]

I went into this firmly believing I would be getting the sleeve but after my pre op testing and research I ended up getting the bypass. I discovered my frequent heartburn was actually GERD and a hiatal hernia. My surgeon had no problem with me switching to the bypass even though my BMI was exactly 40 (I am 5'-3" and my highest weight was 236). She did make the comment that I was on the low end of patients she would want to do a bypass on. I did not want my GERD/heartburn to worsen. I had bypass on March 3 and have been taking pepcid twice daily. I think this is for only the first 3-6 months. I have had NO heartburn since surgery. I would get a second opinion.

[SleeverSk 635]

18 hours ago, Imortalcandy said:

I had my first consultation with my Bariatric surgeon today. I said I would prefer a sleeve but that maybe a bypass is better for me because it seems to have a better long term outcome with keeping the weight off. He said that both procedures have the same long term weight loss it’s just up to the patient to eat right. He also said that you cannot stretch out a sleeve. The one that really surprised me was when I said that I have reflux and I don’t want a sleeve to make it worse, we’ll he told me that both can give you reflux and that I’ll just be on Prilosec either until it resolves or forever because it’s perfectly safe.

What is everyone’s thoughts on all of this?
He did elude to the thought that he only does bypasses on extremely large unhealthy people.

Sounds correct this is pretty much what my surgeon told me. My reflux has improved with the sleeve. Which my surgeon said it would as being overweight is the reason most people have reflux in the first place

[SleeverSk 635]

8 hours ago, catwoman7 said:

in addition, no, PPI's are NOT perfectly safe. There has been a LOT of publicity the last couple of years about the dangers of long-term use of PPIs. They're fine for the short term - maybe a few months - but not for long-term use. My clinic used to put patients on them for a year (like back when I had surgery in 2015). But no more. Most clinics limit them to 3-6 months now.

I have been using ppi's for 16 years with no issues what so ever other than the paranoia I get from reading stuff about them on the internet

Edited April 22, 2022 by SleeverSk

[SleeveToBypass2023 2,682]

46 minutes ago, SleeverSk said:

I have been using ppi's for 16 years with no issues what so ever other than the paranoia I get from reading stuff about them on the internet

My husband has been on PPI's for close to 20 years and he's been perfectly fine. If he misses even 1 day...oh boy....

[redhead_che 824]

I’m a revision from sleeve to bypass on 5/6. The sleeve gave me awful GERD and some regain. If you have GERD already I’d get a bypass to avoid the likelihood of having to revise.

[Crisscat 182]

I have never had GERD. I did question my surgeon about GERD and the probability of getting it after sleeve surgery. I also asked her what percent of her patients that had a sleeve came back to her with GERD (having no prior history of it). She looked pretty shocked when I asked her that but was able to provide a pretty detailed response. She did an EGD on me Feb 9th and said very thing looked normal and great. So hopefully I dont get GERD lol

[SleeverSk 635]

11 hours ago, Future Sleeve Diva said:

My husband has been on PPI's for close to 20 years and he's been perfectly fine. If he misses even 1 day...oh boy....

Since getting sleeved I have reduced to 20mg and no gaviscon needed. Before surgery I would alternate between 20 and 40 mg and always had a bottle of gaviscon dual action on hand.