Bypass vs. Sleeve

[HopeBar 0]

Which is more common - bypass or sleeve? I assume the surgeon's recommendation is according to what kind of surgery he does best...

Edited January 5 by HopeBar

[NickelChip 1,358]

My understanding is sleeve is more prevalent as a first time surgery, but a not-insignificant number of people have revision from sleeve to bypass down the road because of GERD or insufficient weight loss. There are reasons you may choose one over the other, and you want a surgeon who is just as comfortable with either. If he is suggesting one because he's better at it (sleeve is a much easier surgery to perform) then he is not the surgeon for you!

This video has some good information on both surgeries from a doctor who does both:

[Arabesque 7,590]

Dr Matthew Weiner is a great resource so am glad @NickelChip recommended his video. Another is Dr John Pilcher also a great source of information.

It’s not really about popularity or the most performed but about which surgery is best for you. Your surgeon should really take into consideration your current health status and history, your weight loss and gain history, your current weight and how much would be beneficial for you to lose, etc. Also discuss the possibility of side effects like malabsorption, dumping, reflux, regain with the surgeries and what you might be willing or not to live with or manage.

Do your research, watch these videos and others they may have and prepare questions to ask your surgeon. If you don’t think they’re as comfortable doing one surgery over another or you don’t feel comfortable with their responses, seek a second opinion or a referral to another surgeon. And remember there are other surgeries beside sleeve and bypass so look into them as well (Sadi, duodenal switch,, RNY, or a mini bypass). I would avoid a gastric balloon or gastric banding but that’s my opinion only.

[HopeBar 0]

Thank both you. The problem is that all surgeons claim they do both, but some recommend one over the other possibly because they feel more comfortable with one of the two. And wierd as it is, I could find any good surgeon around San Francisco for the mini bypass. How come people on this forum from the U.S. don't tend to do the mini by pass?

[The Greater Fool 2,071]

The MGB just has not been widely adopted in the USA. Back when I was more involved in the WLS world the MGB also had a bad reputation the cause of which I don't even remember now, which may have contributed to the lack of uptake. Europe had more MGBs.

Like other humans, surgeons have their ideas why one surgery is better or preferable over another. Like other humans, those reasons aren't necessarly rationational or based on tested evidence. This is why it's important to do your research and understand why you want the surgery YOU want, not what some human suggests for gawd knows what reason.

Good luck,

Tek

Edited January 6 by The Greater Fool

[NickelChip 1,358]

Another factor is insurance. For example, I know my insurance would happily (as happily as they do anything) cover sleeve or bypass. Meet the requirements and you could have either one of those, no questions asked. Everything else was considered "experimental" and was not covered. Based on my brother's experience of significant regain after sleeve, plus not wanting to risk GERD and the possibility of a revision, I opted for bypass right out of the gate. I felt like that would be a one-and-done surgery, and I have zero regrets.

A few key differences to consider are bypass is a stronger metabolic surgery, so you tend to get more durable weight loss if you look at 5-10 years post-op. But weight regain after sleeve can be managed with GLP-1 meds (if you have coverage or can pay out of pocket). If you have reflux or diabetes/pre-diabetes, seriously consider a bypass as this surgery is great for reducing or eliminating these conditions. If you smoke or require a lot of pain meds, seriously consider sleeve because your risk of ulcers with bypass is elevated by smoking and NSAID use, and the ulcers are very hard to cure.

Dumping can be unpleasant but managed through dietary choices. I have had a couple very minor instances of dumping. Once after eating too much sugar (I absolutely knew better when I did it), and once after a few bites of a very rich, very fat-filled Thanksgiving side dish (this one surprised me). In both cases, my heart raced for about 15 minutes to the point my Fitbit thought I was exercising and awarded me "zone minutes." For me, that was the extent of it and nothing I couldn't handle. I'll just avoid that green bean dish next time. Some people do get worse responses. A lot of people never dump at all.

One thing to consider if choosing a less-known surgery in the US is your doctors outside the surgeon who performs it may not be very familiar with it. Everyone should know what a bypass or a sleeve is. Hospitals or EMTs might not know much about your anatomy with a MGB or a DS, and that could cause delays in treatment, which in an emergency might become an issue. Not to say don't get those if they're right for you, but you may have to spend more time educating yourself and your healthcare team if you do.

[RickM 1,753]

11 hours ago, The Greater Fool said:

The MGB just has not been widely adopted in the USA. Back when I was more involved in the WLS world the MGB also had a bad reputation the cause of which I don't even remember now, which may have contributed to the lack of uptake. Europe had more MGBs.

Like other humans, surgeons have their ideas why one surgery is better or preferable over another. Like other humans, those reasons aren't necessarly rationational or based on tested evidence. This is why it's important to do your research and understand why you want the surgery YOU want, not what some human suggests for gawd knows what reason.

Good luck,

Tek

Bile reflux tended to be the biggie problem with the MGB back in the day. When my wife and I first started looking into WLS almost 25 years ago, the MGB was a proposed alternate to the incumbent bands and RNY but it never gained traction with the ASBS (precursor to today's ASMBS). In the meantime, both the BPD/DS and the VSG (and more recently the SIPS/SADI) have gained acceptance in the US bariatric (and insurance) industry. There are reportedly some techniques that have been developed to mitigate the bile problem, and there may be something to that, and why it may have been accepted elsewhere; but in the US, it's time has passed.

[RickM 1,753]

17 hours ago, HopeBar said:

Thank both you. The problem is that all surgeons claim they do both, but some recommend one over the other possibly because they feel more comfortable with one of the two. And wierd as it is, I could find any good surgeon around San Francisco for the mini bypass. How come people on this forum from the U.S. don't tend to do the mini by pass?

Surgeons will have their preferences based upon their experience and background. When I had my VSG around 14 years ago, the sleeve was fairly new, but most surgeons included it in their practice, though most were not that experienced with it yet (and it often showed in the outcomes, with quite a few rapid revisions needed.) I travelled to SF to have my sleeve done as there wasn't anyone in the LA area where we lived that was very experience with them, but there were several good BPD/DS surgeons in the Bay area, and as the DS uses the sleeve as its basis, those are the guys most experienced with it - my surgeon had been doing them for around 20 years at the time.

Note another difference is that we do see more revisions of the sleeve, in part because of that "infant mortality" problem of when most surgeons were still working up the learning curve on it, but also because it CAN be readily revised, whereas the RNY is difficult to revise, so it, or reversals, are not done commonly owing to the complexity. So, if one does wind up with, say, a GERD problem, which does happen occasionally with the RNY, too, then one is stuck with medicating it, or reversing it if things are that serious.

[Bypass2Freedom 999]

Definitely based on what is best for you. When I had my consultation with my surgeon, I was pretty sure I wanted the sleeve as I thought it would be 'easier' (I was thoroughly misinformed haha), but when I spoke with my surgeon, ran through my medical history (which included a high BMI, an underactive thyroid & PCOS), he advised that the bypass would probably be more effective for me.

BUT, at the end of the day, it is your decision

[NeonRaven8919 584]

I went with the sleeve because my surgeon recommended this based on my age and general health (35, no comorbidities, no history of GERD) I went on the NHS here in the UK so as it was covered by public funds, I only got the choice of sleeve or bypass. I was also hesitant to choose the bypass because my mother had it, had insufficient weight loss and because her operation went wrong and the had to fix something years ago, they couldn't fix a bowel perforation that she had which she died of. So because of her history with that, I wasn't sure that I wanted to go that route. If my surgeon had recommended bypass, I would have chosen that.

[YellowRose71 1]

I had a pre-existing problem with acid reflux. The gastric sleeve has a tendency to cause or worsen reflux, so my surgeon said he never does the sleeve on people like me. I have been more than happy with my results from the gastric bypass and NO acid reflux. It just disappeared, as my surgeon said it would. And I've changed my whole way of looking at food. It's been a wonderful experience.

Edited January 17 by YellowRose71