So my EGD found inflammation. I start a zole drug tomorrow for 8 weeks to see if that help, but since I’m not an optimist. I’m trying to figure out what my choices are if I have a stomach acid problem. I have been not interested in RYGB. But if I have an acid problem I thinks my surgeon won’t do SG. So I’m not sure if any thing is left if this doesn’t resolve.

Why are you against RYGB? If that's the best surgery for you, it seems like the logical choice?

From ACS I understand it has more complications. SG also is the most convertible procedure if I ever needed a revision. I’m also concerned about too much malabsorption. I’ll talk with my surgeon, but if RYGB is my only option I’ll need to reassess my personal risks.

Obviously you need to decide what's right for you.

I was in the same boat as you in that they discovered inflammation during my EGD. I had already been leaning toward RYGB anyway, but that sealed the deal as far as I was concerned. My doctor stressed that even though I wasn't having issues with GERD, there was a strong possibility I'd develop issues if I insisted on SG.

As far as risk is concerned, all surgeries carry some risk and since RYGB is a more complex surgery, you are correct that some studies show a marginally higher risk profile. Interestingly, other studies show no difference. Keep in mind that obese people are all going to have a higher surgical risk for ANY procedure than a normal sized person. Other factors that increase risk are things like heart disease, diabetes, smoking, etc. Also, surgical experience and the quality of the facilities play a huge role in overall risk. My point is that cross sectional studies showing risk are not equivalent to YOUR risks of surgery.

In terms of "convertability", I think my opinion is somewhat the opposite of yours. Technically, RYGB is completely reversible, since unlike SG, nothing is removed from your body. This to me was a huge plus in my decision making process. When we look at revisions, keep in mind that revision of SG due to GERD is pretty common and those revision surgeries basically revise the patient to gastric bypass to alleviate the GERD.

I can't speak to your malabsorption concerns since first of all, malabsorption in and of itself is potentially a good thing for weight loss. i can see a concern for malnutrition, but I was willing to commit to a lifetime of vitamin and calcium supplementation. I also try hard to eat a fairly healthy diet, thus also upping the chances that I have no issues with malnutrition. If you are not willing to commit you those things then yes, this may be an issue for you.

Keep in mind that while it's less common, SG patients can also suffer from malnutrition. It's actually recommended that all bariatric surgery patients use supplements and eat a healthy diet and I think as long as you do those things, neither surgery is going to be an issue.

Best of luck whatever you decide.