Sleeve vs Gastric By Pass

ReginaKeat

I am under Dr care on pre-surgery for weight loss surgery. There is a 6 month consultation with a host of specialties. The Dr, a psychologist, a dietitian, and physical trainer. They have scheduled meetings every 2 months prior to surgery. There is a video conference with two social work (they have MA in psychology) for 8 weeks.

The two options I am looking at are the sleeve and Gastric By Pass. I discussed this with the Doctor who said both are good options. He said depending on who you talk to the recommendations could be either one. I mentioned that I am concerned about nutrients and heard the sleeve was the better option for this. He said I should do some research and we would talk further at the our nest bi monthly meeting. He as been doing the By Pass for a number of years and has a good success rate with it. He has just started with the sleeve a couple of years ago and does not have as long of a history but they appear to be as effective as the By Pass.
I got a lot of information from the following link https://www.realize.com/do-i-qualify/potential-results

This link tends to portray the sleeve as a better option. My Dr asked me to weigh the companies products to see if they were a sleeve or by pass supplier as this may have an influence in their presentations. Basically do a do diligence prior to relying on their material
I do not know if this subject has been discussed but I would appreciate any help on the matter.

judydixon98

I too am currently considering bariatric surgery and am trying to decide between the sleeve and RNY - ROUX EN Y. Any 'medically sound' info or 'personal experience' input on which is best I would greatly appreciate. Thank you.

bikrchk

I was weighing both options in the beginning as well. I chose the sleeve over the bypass for several reasons:
1. I was concerned about the long term ramifications of malabsorption present with R/Y.
2. I was a "lower bmi", (37) WLS patient and didn't feel like I needed the full R\Y with malabsorption to succeed.
3. It seemed "simpler" somehow? No re-routing, one longer staple line rather than several places where things can go wrong, etc.
4. I liked the idea that they'd "cut out my hungry" and the grehlin producing part of the stomach would be removed.

These were MY reasons. I have many friends on both sides with great success. Turned out to be a good one for me. At 5 months out I'm almost 70 lbs lighter, off all meds except a PPI, exercise regularly and LIKE it, (who knew?) and wear a size 8. I had no complications and healed quickly. I can eat small portions of pretty much what I want, (except Chinese fried rice which is no great loss). Still have 16 lbs to go to a healthy BMI, but I can see the light at the end of the tunnel and know I'll get there. Good luck with your decision.

csmccord

So, I choose the RNY over the sleeve.

1. My BMI (50.2) and my weight: 340. My surgical team presented the RNY to me as for those who want to lose more than 100 lbs. They recommended the band for those wanting to lose up to 50, the sleeve for those wanting to lose between 80 and 100 and the RNY for above that.
2. I actually wanted the RNY due to the poor reaction to fats/sugars. Sugary foods are my trigger food, especially candy. The RNY induces a symptom called dumping when too much sugar or fat is eaten. Dumping is the absolute worst thing I have ever felt and gone through. However, it does also let me know when I've over done it, and it makes me afraid to eat too much processed sugar or high fat foods.
3. The malabsorption properties of the surgery do concern me a bit for when I get older. I'm 32 now, and I'm taking an extra 6000 IU of vitamin D daily. It does make me wonder how many vitamins I'll have to take when I'm older. I was actually talking to my doctor about this last week at my 18 month post-op check up. He said that over time, your body will adjust to getting more macro nutrients (protein, carbs, fat) processed after surgery. However, it never adjusts to become better at getting micro nutrients. RNY patients will need to take a tremendous amount of vitamins for life. It's really not so bad, but this might be something to consider. Here is my vitamin regiment daily:

3x multi - due to the brand I selected. Some brands (Celebrate Vitamins) you only need to do 2.
1x iron - 36 mg
1x C - 1000 iu - helps with iron absorption
3x2000 iu D
1x B50 complex
3x calcium - 750 mg total



As you can see from my ticker, the RNY was successful for me. My medical team praises me every time I go in there, as I've lost more than they expect the average patient to lose. I attribute the extra to my change in lifestyle. And for those of you considering any weight loss surgery that is the most important thing to remember. This surgery may be a permanent thing, however it will NOT keep the weight off permanently. It is a tool to assist you in changing your lifestyle. For those of you that have read my other posts, I harp on this on the time, and probably sound like a broken record but I'll say it again.

50 percent of weight loss surgery patients gain all the weight back within 5 years.
50 percent of weight loss surgery patients gain all the weight back within 5 years.
50 percent of weight loss surgery patients gain all the weight back within 5 years.

So, use the surgery to your advantage. I won't lie, it's not easy. The weight loss will come easy at first - for maybe about the first 8 months or 1 year. After that you have to work at. I lost my first 100 lbs in the first 5 months. Since then, I've only lost another 44. I've had to work at that 44. So just keep that in mind. It's not a quick fix. You still have to put the work in. It's not something to be taken lightly.

amylb0822

I started my journey last June with Diet and exercise under a Dr.'s care with a goal of WLS. I met with the dietician, psych, and also an exercise consultant. Under just diet and moderate exercise I lost about 60 pounds through January. Originally I was planning on Lapband. It seemed the least invasive option and I was doing well on diet and exercise, so it would be a tool.

at the presurgery consultation(my surgery 2/20/14) my surgeon and I talked, and we changed to a Gastric Sleeve Surgery as my best option. IT is less upkeep, with no need for fills which can run $265 each. With the sleeve, the grehlin section is removed, and so hunger is no longer an issue ever. It has great success, and only a moderately higher risk than lapband.

I had surgery and have been incredibly happy so far.

THe trick is, you really have to follow the instructions. Eat what is recommended and I the limited quantities of 1/2 cup at a time. Chewing very thoroughly is key. I drink fluids all day, eat high protein foods in small amounts for my meals and so far I am happy as heck!

JenaOnTrack74

I have just finished my 12 week classes where they gave us tons of information and the information more or less was the same for both procedures.

I went in wanting Sleeve but RNY did sound appealing to me after a few weeks. However, I do not have the 100 pounds to lose that they want due to the fact your very likely to loseat least that much (this is what I was told forgive me if anyone has a different experience).

Secondly I Have had 3 C-sections and undoubtedly have a lot of abdominal scar tissue. Another reason they would more than likely opt for Sleeve.

I have not yet met with the surgeon to discuss all my options but I do know that with either surgery AND hard work and dedication we will have the chance to shed the pounds we have tried for so long to lose.

I hope you are both getting to attend classes and be informed of everything that goes with this weight loss option. You will feel better about your decision once you are better informed, keep going to your classes!

Through the classes and consults with your surgeon, it will start to become more obvious which procedure will be best for you.
BEST OF LUCK!!

annwyatt69

I had the option for all 3, and my head opted out of the band immediately. While I was torn between the sleeve and RNY, my surgeon, endocrinologist and I chose RNY. I am a type I diabetic who was dealing with multiple issues, such as sleep apnea, asthma, high blood pressure, high cholesterol, low thyroid, and poor kidney function. My highest weight at 5'5" was 246 pounds. My doctors wanted me to get "normal" quicker because I had been told I had "reached the point of no return." My surgery saved my life. I take my vitamins diligently and my blood work is perfect. I have gone down from 155+ units of insulin a day pre surgery to about 25 units (through the pump) a day. I hit normal BMI 8 months after surgery. I have had zero complications, I don't "dump" and have never thrown up and don't deal with nausea. I had a year pre surgery to get my head where it needed to be.
While I realize the sleeve would have accomplished what I needed, I am glad for the way I went. I had a hiatal hernia that was repaired also during surgery.
I had 3 c sections, gall bladder removal, a hysterectomy all before my bypass. There was never a mention of scar tissue being a problem. I think the issue between sleeve and RNY comes down to personal choice. You will require a life of vitamins either way.

JenaOnTrack74

Really Anne?! Well shoot now, once again, I want RNY!! :laugh:

Oh brother! Decisions decisions!

Losing_Sarah

The most recent evidence suggests that the sleeve is just as effective as the RNY no matter the circumstances. They are similar, but work differently. The RNY has malabsorption of your calories, and the sleeves main thing is restriction. A lot of people who had the lap band, then had a revision to the sleeve basically said it does what the lap band was supposed to do (there is a low success rate and a lot of problems associated with the lap band).

I am almost five months out from being sleeved. I had a BMI of 54 when I started. I've gone from 315 pounds down to 252 currently and still moving along nicely. It used to be thought that it was better for patients with a lower BMI, but I know plenty of sleevers who started out with BMI's of over 50 or even 60. One girl has lost 250 lbs (125 of it since her surgery in May 2013).

Here are my reasons for choosing the sleeve (I went back and forth between the two during the first four months of my 6 months pre-op classes, doc appts, etc)

- Strict vitamin regimen not required for life - I have to take vitamins, but the list is smaller than an RNY patient and likely will not be for life.

- I can still take Ibuprofen when I really need it. You aren't allowed to ever take it again with RNY.

- No re-arranging of my parts. I liked the idea of them just having 80+% of my tummy removed. (Before I educated myself on the types of surgery I honestly thought that WLS was exactly what the sleeve is.)

- Success stories - I am a member of OH (Obesity Helps website, too) and there is a large community of people who have had WLS. I participated and read the RNY, VSG, and General Forums on OH from the time I started the 6 month pre-op stuff and still do. Again, it took me four months to come to my decision, but by the time I first met with my surgeon I was certain that I wanted to be sleeved.

- My doctor was experienced in both surgeries and I felt very confident in his abilities. Even if he was newer to the sleeve I wouldn't have been nervous. The hospital system that I had my surgery is good at what they do and their WLS center is set up so their patients not only have their surgeon, but a team of people who specialize in various parts of the whole process.

Good luck making your decision.

garber6th

I chose to have sleeve surgery for similar reasons as others - no malabsorption issues, I felt it was less invasive, no parts to be rearranged, no dumping issues, and they do remove the part of your stomach that produces the hunger hormone which is a big help. Also, because my BMI was so high (my starting weight was 382, my weight at the time of surgery was 312), my surgeon chose the sleeve as it was a less risky procedure to perform. I am about 5-1/2 months out now and have lost over 70 lbs, and I feel amazing.

eric5150ii

One of the deciding factors I had discussed with my surgeon was acid reflux. I was beginning to show signs of this. Per Dr. C., the sleeve can contribute to this (i think he said along the lines of 27% chance or so) and the RnY eliminates this (99%). So that is what helped with my decision. He also said that he only took about 100cm of small intestine out of the loop, and with that, I should not see any mal-absorption issues. Yes, I need to take supplements, but that is what is.

DJRonnieLINY

As you can see the decisions are very individualized so you really need to have frank dicsussions with your Dr. on what is the right one for your specific situation.

For me; I quickly ruled out the LAP band as an option primarily due to the installation of a port. I wanted a one-and-done medical procedure not regular adjustments that my insurance will not cover.

RNY vs. Sleeve: for me the choice was easy - my Surgeon and GP agreed on the range of weight I should lose. My surgeon estimates that his Sleeve patients, on average, lose 85% of the weight after a Sleeve then they would have with a full RNY. 85% of my ideal weigh loss would still put me comfortably in the range both doctors reccomended. That coupled with the less invasive surgery, quicker recovery time, elimination of malabsorption and lack of scaring made a Sleeve the appropriate procedure for me. They also highly reccomended I engage in an exercise program to make sure I maintain my new body and get fitter.

Based on my highest weight, and "charted" ideal, my goal was a 123lb loss. In 4 pounds I will have reached 85% and I am now working with a PT.

Agate69

I had the RNY in 2010. It put my diabetes in total remission , cured my sleep apnea. Gastric sleeve was not widely used in 2010, and RNY was considered the gold standard. I do miss NASIDS and it is true you should never use them again. I have only one malabsorption issue, and that is calcium, and that is not necessarily caused by the surgery. It is a thyroid thing,

Either way it is just a tool and it still takes work to keep the weight off

spfldpam

I had the same issue pre op WLS. Which to choose. I asked my surgeon what he would recommend for me and he said sleeve and that was kinda the way I was leaning towards also.
No regrets. The sleeve has been done for years as part of two part surgery and super obese people. Many had the first part done and lost weight and continued to loose so didn't have the second part done (rny) so that is how the sleeve only surgery started my WLS program surgeon explained to me. Since then they have been tracking the data on this I think about 7 years.
Many say people don't loose as much with the sleeve but I disagree with that. I went from 223 (surgery date) down to 124 from June 2012 to April 2013. so 99 pounds in less than one year and that was after loosing 47 on my own from Feb 2012 to June 11, 2012 surgery day. I know people at my WLS program who have lost even more with sleeve too. I averaged about 10 pounds a month after that first month of loosing more post op.
I didn't want to worry about the malabsorption issue you have with RNY and the dumping either.
You have to do what is right for you though.

Tristaan

I had RNY after discussion with my surgeon. I had (have) half my body weight to lose, along with co-morbidities. So I took the most drastic route and I knew there was no going back. It is such a personal decision though, and after five months I am really seeing that everyone really has a different reaction to whichever surgery they choose. There are so many factors that determine success and/or complications - some can be controlled, others cannot. I will say that I do not seem to dump after eating sugar. As a self-diagnosed sugar/carb addict prior to starting my surgery prep, I was kind of looking forward to this "side effect" as kind of a positive. Unfortunately, not everyone dumps, in fact I have read as low as 30% of people dump after RNY. So it just re-enforces the fact that no matter what you choose, you'll still have to work for your long term goals. This is just a re-set, and the 60 lbs I've lost these first 5 months definitely make me feel more energetic and active. My food quantity is also quite limited, I'm usually around 1000 calories or less, but there have been a few days around 1300 (mainly those days I let chocolate creep back into my life). I've had no complications so far and my numbers are back to normal, BP meds are down to about 1/4 of what I was talking prior to surgery. You have to take a realistic inward look at yourself and be honest with yourself about your willpower and motivation., and your ability to follow the doctors orders. Also - are you organized enough to plan your protein and get your supplements and water every day. Those are non-negotiable if you want to be successful after RNY.