sleeve vs bypass

[bandproblems 10]

Hi everyone,

I had lap band surgery in 2010 and went from 330 lbs to about 215 in 2016, however, I started having some problems with the band where I could barely eat or drink anything and kept loosing weight rapidly. Went to the doctor and they did an upright xray with contrast and you could see that everything was stuck in the esophagus. The doctor said the band had to come out. Obviously I didn't want that and begged them to remove all Fluid from the band and wait another week but that did not help. It turned out that there was a lot of scar tissue from the band around where it was installed. The doctor wanted to do a conversion during the band removal but the insurance did not approve since I was 'too skinny' and did not qualify. I asked the hospital if I could pay the difference between removal and doing the sleeve since they already had me there and all the staff, etc. but was told it was not possible and it would be $24,000 which I could not afford.

After the removal I gained all the weight back and now I am between 320-325 lbs again.

I had been with two employers since then but like most of them they specifically exclude bariatric surgery nowadays. Now I am with a new employer and they will apparently pay for it.

[sorry for the long background story]

I am consider whether to get a sleeve or bypass. After doing a lot of research I think a sleeve would be better since it is less intrusive and the stomach function pretty much remains intact and you don't have to take medication for the rest of your life.

What do you all suggest?

[lizonaplane 1,613]

You still have to take Vitamins with sleeve, but the risk of Vitamin deficiency is lower, because sleeve allows you to absorb all the nutrients you are able to eat - the issue is if you are focusing only on Protein and can't eat too much, you are not getting enough nutrients.

Sleeve does have slightly lower rate of complications, but both are pretty safe. With sleeve, you have to worry about GERD, so if you have GERD now, it's probably better to do bypass. However, certain medications have absorption issues with bypass, so depending on what medications you take, it might be better to do sleeve.

I think you need to talk with your surgeon and see what they recommend, and get a second opinion if you still aren't sure. I wasn't sure, and after two surgeons suggested sleeve, I went with it. I think that was the right decision for me.

[I♡BypassedMyPhatAss♡ 808]

[mrs.melmcc 18]

I am speaking from my personal experience and would recommend the bypass. I got my sleeve 8 years ago and have had GERD since (was not an issue prior). It has progressively gotten worse and I now have a hiatal hernia as well. My doctor is considering a revision to bypass to address the issue. I also have issues with Vitamin and Protein deficiencies. I have been on Prevacid for the entire 8 years since my surgery. I realize everyone is different but research some of the risks of GERD after sleeve. It is not fun.

[catwoman7 11,285]

if you have GERD, go with bypass. Sleeve can make that worse about 30% of the time (and some people who've never had reflux issues end up developing them after sleeve). If you don't have GERD, then it pretty much comes down to personal preference.

you don't have to take meds the rest of your life with bypass - but you do have to take Vitamins for the rest of your life - but you'll likely have to do that with sleeve, too (there's one person on here I know of who doesn't have to take Vitamin supplements with her sleeve surgery, but most sleeve patients do). The difference, as someone else pointed out, is that slacking off on your vitamins has worse consequences for bypassers than it does for sleevers.

I love my bypass and would choose it again if I had to make that decision today. But some people want to go with sleeve, for one of the reasons you mentioned (they feel it will be less invasive - although cutting out most of your stomach and throwing it out also seems invasive to me, so....???). Check with the surgeon and see if he/she feels one would be more appropriate for you than the other - but they're both good surgeries and you'll find people on here who've had great success with both.

[gaddbaby 4]

Hello! I recently had band to bypass conversion. My surgeon explained the benefits and success rates of both and suggested the bypass. At 2 weeks post-op, I'm happy with my decision. Best of luck to you on your journey.

[ChubRub 1,709]

I went with the bypass because I had GERD, and I didn't want it to get worse with the sleeve. A bonus was that the GERD actually went away after my bypass. It's strange not to carry TUMS in my purse anymore!

If you have GERD, definitely get the bypass. If not, then it just comes down to your personal choice. Watch the youtube videos, do your research, and see if your surgeon leans one way or the other. Good luck!!

[SleeverSk 635]

17 hours ago, lizonaplane said:

You still have to take Vitamins with sleeve, but the risk of Vitamin deficiency is lower, because sleeve allows you to absorb all the n enough nutrients.utrients you are able to eat - the issue is if you are focusing only on Protein and can't eat too much, you are not getting

Sleeve does have slightly lower rate of complications, but both are pretty safe. With sleeve, you have to worry about GERD, so if you have GERD now, it's probably better to do bypass. However, certain medications have absorption issues with bypass, so depending on what medications you take, it might be better to do sleeve.

I think you need to talk with your surgeon and see what they recommend, and get a second opinion if you still aren't sure. I wasn't sure, and after two surgeons suggested sleeve, I went with it. I think that was the right decision for me.

You still have to take Vitamins with sleeve,

sorry but I disagree with that statement, I barely took my Vitamins directly post op because they made me sick etc and haven't taken any at all since about the 4 month mark, now at 10 months post op my bloods come back fine.

I also had gerd before the op and now it has improved dramatically still on 20mg on nexium though. Everyone is different though.

I totally agree talk to your surgeon and get a second opinion as Liz has suggested

[I♡BypassedMyPhatAss♡ 808]

I'm also band to bypass. Bypass revision is next month. I got GERD with my band... and GERD after wls sucks. You have wls thinking you're going to improve your quality of life, only to develop GERD... then you get placed on PPI's to prevent the acid issues... and the PPI's come with side effects, and now it's recommended to not take them long term. I got a kidney stone due to overuse of PPI's... so I would say if you have wls and are dependent on the use of PPI's longer than the normal post op period, it's a crutch. How can you say your GERD that you had previous to wls is gone if you're still taking an acid reducer? It's probably just masking the GERD that's still there. Come off the PPI and see if the GERD is there or not, then you'll know if it's really gone.

Why have wls if you have to stay on a PPI?

[SleeverSk 635]

3 minutes ago, BypassingMyPhatAss♡ said:

I'm also band to bypass. Bypass revision is next month. I got GERD with my band... and GERD after wls sucks. You have wls thinking you're going to improve your quality of life, only to develop GERD... then you get placed on PPI's to prevent the acid issues... and the PPI's come with side effects, and now it's recommended to not take them long term. I got a kidney stone due to overuse of PPI's... so I would say if you have wls and are dependent on the use of PPI's longer than the normal post op period, it's a crutch. How can you say your GERD that you had previous to wls is gone if you're still taking an acid reducer? It's probably just masking the GERD that's still there. Come off the PPI and see if the GERD is there or not, then you'll know if it's really gone.

Why have wls if you have to stay on a PPI?

I never said it was gone, it has improved dramatically. Prior to surgery I was on 40 mg Nexium and eating Gaviscon dual action tablets almost after every meal as well as the liquid Gaviscon so yes it has improved as my surgeon said it would as he believed my weight was a big factor in my reflux. I am yet to try to come of the nexium although I have been advised to but I remember how awful re-bound reflux is and I am happy with just taking 20 mg. Prior to surgery I had that big side effects fear and wanted to get off them right or wrong but I am comfortable where I am now in regards to my reflux.

I didn't want the risk of possible complications that come with a by-pass which is why I opted for a sleeve. Don't worry I had a melt down just before being wheeled into surgery because of my post op Gerd fears ( that I had read about on the internet ). My surgeon reassured me I would be fine and so far I have been.

[RickM 1,753]

On 6/1/2022 at 5:44 AM, SleeverSk said:

You still have to take Vitamins with sleeve,

sorry but I disagree with that statement, I barely took my Vitamins directly post op because they made me sick etc and haven't taken any at all since about the 4 month mark, now at 10 months post op my bloods come back fine.

I also had gerd before the op and now it has improved dramatically still on 20mg on nexium though. Everyone is different though.

I totally agree talk to your surgeon and get a second opinion as Liz has suggested

Generally, with the sleeve, we will have less need to supplement than with a bypass, all other things being equal; if one is inclined to try for the ideal of getting all nutrition from food, then the sleeve is the way to go - one may not quite make that ideal, but will be closer.

The first couple of years, our diets are Protein heavy and little else, so supplementing if a good idea, from a belt and suspenders perspective, if nothing else. Labs should be the determiner of how much supplementing is needed, and that takes some time to establish trends, rather than just a snapshot "my labs are fine." One of the problems that we have in going through this is that not everything shows conveniently in our lab tests. Some nutrients, Calcium being the most notorious, do not show as deficient until one is in deep trouble, as the body works to maintain serum levels at nominal levels at the expense of body reserves. The body will leach calcium form our bones to keep the serum levels "correct" until it can no longer do so - they you're falling apart. There are other tests that can be done that give us hints as to our status - is calcium depositing or leaching from bones? Talk you your doctor about these things if you are not supplementing as recommended

Many programs recommend the same supplements initially for both sleeve and bypass, primarily out of laziness, and then make adjustments over time as labs come in, and you can cut back as indicated. Again, trends over time tend to be more informative than simple "normal" levels.

On 6/1/2022 at 6:27 AM, BypassingMyPhatAss♡ said:

I'm also band to bypass. Bypass revision is next month. I got GERD with my band... and GERD after wls sucks. You have wls thinking you're going to improve your quality of life, only to develop GERD... then you get placed on PPI's to prevent the acid issues... and the PPI's come with side effects, and now it's recommended to not take them long term. I got a kidney stone due to overuse of PPI's... so I would say if you have wls and are dependent on the use of PPI's longer than the normal post op period, it's a crutch. How can you say your GERD that you had previous to wls is gone if you're still taking an acid reducer? It's probably just masking the GERD that's still there. Come off the PPI and see if the GERD is there or not, then you'll know if it's really gone.

Why have wls if you have to stay on a PPI?

Surgeries do not always correct the need for some medications; After WLS, one may still need meds for BP, cholesterol or diabetes as well, though usually at lower levels. Bypass patients often take PPIs either for GERD that they develop over time, or for the marginal ulcers that are endemic with the bypass (marginal ulcers are to the bypass, what GERD is to the sleeve - you may avoid one potential problem with your choice of surgery, but it is usually at the expense of risk of something else - that's life!)

[RickM 1,753]

Building on my comments above, if you got along well with your band - it seems like you did - but just had mechanical problems with it, then the sleeve is a good replacement as its' character is similar, being strictly restrictive, but without the foreign object problem potential of the bands.

The bypass is a good procedure that has been done for over forty years as a WLS, based upon procedures that are about 140 years old developed for gastric cancer, so it is a well established and understood procedure, both the good and bad. There has been a continuing effort in the industry to develop better procedures (as there should be) and a number have come along, with some remaining and becoming established as viable alternatives (such as the BPD/DS and VSG) and others falling by the wayside, never getting traction (such as the mini-bypass,) and others where the jury is still out (the SIPS/SADI/Loop DS.) The BPD/DS generally works better, being stronger metabolically, but is also technically more challenging to perform, so few surgeons have adopted it; the VSG came out of the DS (the DS is based upon the sleeve, and adds malabsorption) and has established itself as being comparable to the bypass in average performance - overall weight loss and regain resistance - in a more straightforward procedure that has fewer long term compromises for the patient.

GERD is the main potential bugaboo with the sleeve, which compares with the bypass's predisposition toward marginal ulcers, dumping and reactive hypoglycemia. The ulcer potential is what presents restrictions on some medications with the bypass, the biggest group being NSAIDs, but there may be others that one encounters in life that will also be off the table, or severely restricted, with a bypass. There is also the blind stomach and upper GI loop with the bypass, which makes those areas more difficult to monitor and evaluate through life (can't just stick an endoscope down there to take a look,) and there are an increasing number of endoscopic treatments for a variety of maladies available these days that would also be off the table. If one needs periodic monitoring in that region, for instance for a history of stomach polyps or family history of some cancers, the bypass becomes much less interesting.

Another factor to consider is what I call the "Plan B" case - what to do if things don't work out as expected and things need to be revised? While the bypass is technically reversible, that is rarely done as that in itself is another fairly complicated procedure. The bypass, overall, is something of a dead end procedure in that it is difficult to revise into something else is need be. As weight regain is similarly possible with either the sleeve or the bypass, there isn't much to be done to correct that with the bypass - installing a band over the pouch or tightening up the stoma are the most common revisions, and neither has a very good track record for resolving regain problems. The VSG, on the other hand, can be revised (some would say "completed" into a DS fairly easily as it is the first step in a DS, or it can be revised into an RNY if GERD problems can't be resolved with meds (the RNY is usually reversed if an ulcer problem can't be resolved with meds. So, more options are available with the sleeve should a "plan B' be necessary.

These are the reasons why the sleeve is building in popularity; there are good reasons to choose either, but one needs to take a close look at one's circumstances going into it to determine what is the best trade off for one's needs.