Hi all. I've been lurking the past few weeks, researching heavily. My insurance has cleared me for sleeve but I'm not as sure now as I was when I chose that surgery. My last hurdle is labs and upper GI. I'm bouncing back and forth between sleeve and bypass. My doubts about the sleeve include the risk of developing GERD. I see a lot of revision stories and I don't want that.

My main reason for choosing the sleeve was to keep the pyloric valve intact and avoid dumping. It also seems to allow normal medication action - I take a number of meds. I'm creating a list of questions for my surgeon because I want to make the best choice but man, I must admit to feeling dizzy with all this information. It's a big step.

I'll save my dietary questions for another post. Thanks already for the great information I've gotten from reading through this forum!

Edited October 22, 20223 yr by David in Washington

Hi all. I've been lurking the past few weeks, researching heavily. My insurance has cleared me for sleeve but I'm not as sure now as I was when I chose that surgery. My last hurdle is labs and upper GI. I'm bouncing back and forth between sleeve and bypass. My doubts about the sleeve include the risk of developing GERD. I see a lot of revision stories and I don't want that.
My main reason for choosing the sleeve was to keep the pyloric valve intact and avoid dumping. It also seems to allow normal medication action - I take a number of meds. I'm creating a list of questions for my surgeon because I want to make the best choice but man, I must admit to feeling dizzy with all this information. It's a big step.
I'll save my dietary questions for another post. Thanks already for the great information I've gotten from reading through this forum!

My sure your labs are good presleeve. I was anemic and the doctors didn't notice but I did. I want all to make sure your labs are good prebypass.

A chose bypass due to GERD, but I also had some reservations around dumping and medications.

Medication-wise, the reality is over time, a lot of the medications you take may end up going away. Especially if they are for conditions like high blood pressure or diabetes that are often reversed with weight loss. Personally, I was really worried about NSAIDS, because I have a number of physical issues that have had me on prescription NSAIDS for over 35 years now. My surgeon agreed that even with bypass, I could keep taking them as long as I continued to take a PPI to limit the risk of ulcers. I'm also hopeful that as I get closer to goal, I may be able to give them up entirely. For the rest of my meds (if you include supplements, I take over 30 different pills a day), no mention has ever been made about me needing to adjust the dosage in any way. Honestly, I think the whole "malabsorption" thing for bypass may be a bit overblown? As far as I'm aware, the only ones where you might run into a problem are extended release versions of medications. For most of those, there are non extended release alternatives. If you have specific medication concerns, my suggestion would be to talk with your bariatric team. They can best advise you if bypass would be an issue for you with that medication.

As far as dumping is concerned, dumping is far from guaranteed with bypass. I have not experienced it and many others here have not either. Plus, we've had first hand reports that even some sleevers have end up with dumping syndrome. Certainly it's much more likely with bypass, but I'm not sure I'd worry about this too much. If you do end up with that issue, it can certainly help you stay on plan and may help you do better in the long run by controlling your intake of things you probably shouldn't be eating anyway.

only about 30% of bypassers dump, and for those who do, you can prevent it by avoiding or limiting sugar intake (or fat - some people dump on fat). I've never dumped - and I know lots of other bypassers who've never dumped, either.

Hi David, I'm in Washington also. I have just started my journey, spoke with the Dr. and am making sure I have everything done, my insurance requires 4 months of medically supervised weight loss so I'm starting that in November, and I need the Endoscopy so I'm thinking I won't be ready for surgery until Feb-March 2023. Who are you seeing for your procedure? I'm going through MultiCare.

RNY here. Revised over a year ago from VSG due to severe gerd. I don't dump, I believe most don't and can be avoided if you do, as@catwoman7 said. Maybe that's why I don't dump, I don't really have a sweet tooth. Not sure but it isn't as common as people think.

I can take any medication except NSAIDs (same with VSG, I believe). I really have no negative things to say about the RNY. It has been an extremely positive experience for me.

Both surgeries are excellent though and congrats on the beginning of your journey.

Lap Band to RNY for severe GERD. I haven't dumped yet and don't think I will be a dumper.

I gave up Celebrex seven months before revision surgery and have been fine. (RA patient here) I have virtually zero pain. Losing weight helps reduce inflammation and reduce the need for nsaids it seems.

And you're right, you don't want wls induced GERD. It sucks. Meds won't even help when you get this type of GERD.

All I can speak to is my personal experiences and comparing RNY to lap band, which I know is antiquated now but RNY feels completely natural to me and I'd do it again if I had to all over again and could choose from any wls.

Best wishes!

12 hours ago, David in Washington said:

My main reason for choosing the sleeve was to keep the pyloric valve intact and avoid dumping. It also seems to allow normal medication action 

these were my reasons for choosing sleeve as well.

BuT...i dump anyway. Excess sugar (especially on an empty stomach) is my downfall. Am 4 years out and am still susceptible to too much sugar.

As for NSAIDs, i seem to be ok taking them occasionally, but the daily one i used to take pre-surgery became unnecessary after surgery for some reason so I cant really comment on regular long term use.

12 hours ago, David in Washington said:

My main reason for choosing the sleeve was to keep the pyloric valve intact...

I forgot, I also wanted to comment on this.

I too thought that logically this made a lot of sense and thus sleeve must somehow be better because it kept the pylorus in the food canal. The more I thought about it, the more I realized I couldn't actually articulate why i was so worried about this? Millions of bypassers live normal lives, thus surely it can't be as big a deal as I thought?

What I always found odd is that most people feel the sleeve is "less invasive". In sleeve, part of your stomach is permanently removed from your body. In bypass, noting is removed, all the parts are still there, just rearranged a bit. Not sure about you, but permanently removing things sounds pretty invasive to me?

On 10/21/2022 at 6:34 PM, SpartanMaker said:

A chose bypass due to GERD, but I also had some reservations around dumping and medications.

Medication-wise, the reality is over time, a lot of the medications you take may end up going away. Especially if they are for conditions like high blood pressure or diabetes that are often reversed with weight loss. Personally, I was really worried about NSAIDS, because I have a number of physical issues that have had me on prescription NSAIDS for over 35 years now. My surgeon agreed that even with bypass, I could keep taking them as long as I continued to take a PPI to limit the risk of ulcers. I'm also hopeful that as I get closer to goal, I may be able to give them up entirely. For the rest of my meds (if you include supplements, I take over 30 different pills a day), no mention has ever been made about me needing to adjust the dosage in any way. Honestly, I think the whole "malabsorption" thing for bypass may be a bit overblown? As far as I'm aware, the only ones where you might run into a problem are extended release versions of medications. For most of those, there are non extended release alternatives. If you have specific medication concerns, my suggestion would be to talk with your bariatric team. They can best advise you if bypass would be an issue for you with that medication.

As far as dumping is concerned, dumping is far from guaranteed with bypass. I have not experienced it and many others here have not either. Plus, we've had first hand reports that even some sleevers have end up with dumping syndrome. Certainly it's much more likely with bypass, but I'm not sure I'd worry about this too much. If you do end up with that issue, it can certainly help you stay on plan and may help you do better in the long run by controlling your intake of things you probably shouldn't be eating anyway.

Wow, 30 pills! This does make me feel better. I'm still going to ask my surgeon and PCP, but I've been reading that Cox-1 specific NSAIDS liike Celebrex and Mobic are ok for regular use. I'm on Mobic (meloxicam) for osteoarthritus. I realize the need may be reduced after weight loss but age could bring it back and NSAIDS are about all there is for this.

On malabsorbtion, after looking at all the surgical schematics which distort the dimensions, I thought maybe it was only a foot bypassed. It's actually up to 5 feet which I guess could make some difference. Still, that's out of 26 feet of small intestines.

I think I'm going to stop worrying about dumping. It sounds like something that can be controlled and may happen with either surgery. GERD concerns me more. I was concerned about it because I have IBS and diarrhea with cramps has been a nemisis for a long time ?

On 10/21/2022 at 6:10 PM, SeattleLady said:

My sure your labs are good presleeve. I was anemic and the doctors didn't notice but I did. I want all to make sure your labs are good prebypass.

Thanks, I will.

On 10/21/2022 at 10:11 PM, Tomo said:

RNY here. Revised over a year ago from VSG due to severe gerd. I don't dump, I believe most don't and can be avoided if you do, as@catwoman7 said. Maybe that's why I don't dump, I don't really have a sweet tooth. Not sure but it isn't as common as people think.

I can take any medication except NSAIDs (same with VSG, I believe). I really have no negative things to say about the RNY. It has been an extremely positive experience for me.

Both surgeries are excellent though and congrats on the beginning of your journey.

Thanks for the advice and congrats. Your weight loss looks phenomenal!

20 hours ago, SpartanMaker said:

I forgot, I also wanted to comment on this.

I too thought that logically this made a lot of sense and thus sleeve must somehow be better because it kept the pylorus in the food canal. The more I thought about it, the more I realized I couldn't actually articulate why i was so worried about this? Millions of bypassers live normal lives, thus surely it can't be as big a deal as I thought?

What I always found odd is that most people feel the sleeve is "less invasive". In sleeve, part of your stomach is permanently removed from your body. In bypass, noting is removed, all the parts are still there, just rearranged a bit. Not sure about you, but permanently removing things sounds pretty invasive to me?

You are right about this. I've started thinking about the sleeve as more drastic.

7 minutes ago, David in Washington said:

I think I'm going to stop worrying about dumping. It sounds like something that can be controlled and may happen with either surgery. GERD concerns me more. I was concerned about it because I have IBS and diarrhea with cramps has been a nemisis for a long time ?

I don't seem to dump. Although I haven't really pushed my diet much since surgery.

You're right to be concerned about GERD, wls induced GERD is awful.

I have/had? IBS-D and Bypass seems to have normalized it. My surgeon said that it would improve my symptoms. I was skeptical. But she was right it seems.

On 10/21/2022 at 9:34 PM, MamiMB said:

Hi David, I'm in Washington also. I have just started my journey, spoke with the Dr. and am making sure I have everything done, my insurance requires 4 months of medically supervised weight loss so I'm starting that in November, and I need the Endoscopy so I'm thinking I won't be ready for surgery until Feb-March 2023. Who are you seeing for your procedure? I'm going through MultiCare.

I'm going through Franciscan Center for Weight Management, David Swedler, DO. I've made it through my insurance company requirements and was certified for sleeve, but I'm on the fence now between that and bypass. Do you have a preference yet?

Congrats on getting started!

17 minutes ago, I♡BypassedMyPhatAss♡ said:

I have/had? IBS-D and Bypass seems to have normalized it. My surgeon said that it would improve my symptoms. I was skeptical. But she was right it seems.

Wow, now that's worth considering. I've had IBS since my teens. Thanks.

I just noticed your weight loss - 180lbs in 3 months? Wow, just wow.

Edited October 23, 20223 yr by David in Washington