Sleeve or By-Pass?

I thought for sure I wanted sleeve but after meeting with the "team" I am now questioning whether I should go with by-pass. A few things I'm hung up on:

1. They say that if you get heartburn you should NOT get the sleeve. I don't have heartburn myself (2 times when I was pregnant 15 years ago), but everyone else in my family does to varying degrees. Does this mean I'm pre-disposed and will likely develop it? Anyone have that issue?

2. Leakage...my surgeon has never had a leak from the sleeve. However, she states statistically it can happen 1/1000. She indicated that if there is a leak, I would have to go to Minneapolis to have a stent put in because we are not equipped here. However, she indicated that if there is a leak with by-pass, they can go back in and restaple.

3. Dumping...this is something they say you have with the by-pass but not really with the sleeve. Is it something you get used to and can avoid easily? Does it fade over time? Do the foods that cause it change/decrease?

4. Percentage of loss...80% for by-pass and 65% for sleeve. What I've seen on line shows better percentages for sleeve and that they are similar in percentages.

I appreciate your help. I'm excited to take this step in my life, but still determining what is best for me. I understand this isn't a magic bean but just a tool to help me make life changes that I need.
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Replies

  • garber6th
    garber6th Posts: 1,894 Member
    In response to the points you posted -

    I thought for sure I wanted sleeve but after meeting with the "team" I am now questioning whether I should go with by-pass. A few things I'm hung up on:

    1. They say that if you get heartburn you should NOT get the sleeve. I don't have heartburn myself (2 times when I was pregnant 15 years ago), but everyone else in my family does to varying degrees. Does this mean I'm pre-disposed and will likely develop it? Anyone have that issue?

    I had heartburn before sleeve surgery, mainly from my poor eating habits/food choices. I have not had one single bout of heartburn in the two years since my surgery.

    2. Leakage...my surgeon has never had a leak from the sleeve. However, she states statistically it can happen 1/1000. She indicated that if there is a leak, I would have to go to Minneapolis to have a stent put in because we are not equipped here. However, she indicated that if there is a leak with by-pass, they can go back in and restaple.

    Since leaks are rare and your surgeon hasn't had one, maybe this is not a huge deciding factor?

    3. Dumping...this is something they say you have with the by-pass but not really with the sleeve. Is it something you get used to and can avoid easily? Does it fade over time? Do the foods that cause it change/decrease?

    I haven't had dumping with the sleeve but I know of people who have with bypass. That said, some things do upset my stomach more than other things, but for me those are cues that those foods should probably be avoided.

    4. Percentage of loss...80% for by-pass and 65% for sleeve. What I've seen on line shows better percentages for sleeve and that they are similar in percentages.

    I think I figured out that my loss was about 80% with the sleeve.


    I chose the sleeve surgery for several reasons. I felt that is was less invasive, less re-routing of the plumbing so to speak, and I felt that it kept my natural body functions a bit more intact. I also chose the sleeve because I didn't want the issues with malabsorption that can come with the bypass. I had heard there was more dumping with the bypass and I didn't want to have to deal with that either.

    If you do get the sleeve, you can always have a revision to bypass in the future, but if you get the bypass, that's what you will live with.

    All that said, you can be successful with either surgery, the main thing is maintaining the lifestyle changes after, which you will have to do with either surgery.


  • Gknee11
    Gknee11 Posts: 15 Member
    I opted for the full bypass because I wanted dumping!!! I knew that I shouldn't be eating fatty/sugary foods and the dumping was something that made sure I didn't eat those things.

    With the full bypass I am 8 months post op and am down 114lbs overall. I am only 12 pounds away from my goal weight of 125 and thrilled with the progress and support I've had from my surgery team.

    The decision should be based upon what you are hoping to get out of the surgery and how much you are willing to change your habits. I think I would have struggled with the sleeve because it takes more discipline from the person who gets it and although I think I could have succeeded with it, I know that I would have found ways to "cheat" the system. It is much more difficult to do that with the full bypass.

    Good luck to you! I know whatever you choose will be right for you!!!
  • joysie1970
    joysie1970 Posts: 415 Member
    I had the sleeve because I had suspicious areas in my stomach - RNY was not a option. Acid was an issue prior to surgery but not after (I had an esophageal hernia that was repaired - this is not the norm). Leaks are uncommon but a consideration only you can decide. My husband had RNY and does not experience dumping - I had the sleeve and dump (what a rip off - LOL) but honestly it keeps me on track, I rarely go off plan but when I do, I know it pretty immediately (Starbucks on our honeymoon two weeks ago got me pretty good - nausea and sweating). I hit the surgeons goal for me in less than 6 months - I am now 8months out and have lost an added 10lbs since I last saw the surgeon and still dropping - I think loss is an individual thing and dependent on you and your commitment to the program (will you be exercising will you eat clean) and your body - my start weight was 249 day of surgery. I agree with Beth - you can be successful with either surgery - my surgery was 4/7 my husband was 5/11 together we have lost 170 since surgery (two different options both successful). We follow the rules for the most part (Starbucks on our honeymoon was a cheat) and work our tool. Best wishes to you in whichever you decide.
  • anbrdr
    anbrdr Posts: 621 Member
    Many of these questions really vary from person too person, which makes it hard to give conclusive answers. I had/have reflux(regurgitation) issues pe-op. My surgeon also told me that the sleeve would increase the frequency of it, so I went RNY. I can say that my issues have lessened quite a bit, as long as I don't drink within 20 minutes of food (before/after).

    Leakage is the last thing I worried about. such a small chance of it happening.

    Dumping- Kind of miffed about this one. I am part of a subset who does not sugar dump. I apparently have fat dump. My best friend had the RNY years ago, and his dumping did eventually go away. But I don't think that's a good thing. You avoid it by sticking to your guidelines, and knowing what you can handle.

    Losing percentages, meh, the maths are close enough to each other. Plus that really comes down to your individual work. You could totally blow the diet, never exercise, and have thrown away your money.
  • garber6th
    garber6th Posts: 1,894 Member
    anbrdr wrote: »
    Dumping- You avoid it by sticking to your guidelines, and knowing what you can handle.

    Exactly. And you cannot count on the fact that you will have dumping and that you can use it as part of your checks and balances.



  • cabennett99
    cabennett99 Posts: 357 Member
    I opted for RNYGB; basically, if I was gonna do it I wanted to be "all in". That was 13 months ago, and I have no regrets. I've lost 147 pounds, (332 to 185), and while weight loss has slowed, and I'm lighter than I really believed would be possible, I think now I can get to 175. I had bad reflux prior to surgery, and I had been on medicine to treat it for over a decade, and since the first day after surgery I have been completely symptom free, I never have reflux. I have never experienced dumping either, and at this point I doubt that I will. While I eat less than I used to, and I eat better (mostly protein and produce), I don't feel like I'm depriving myself, and I don't have problematic cravings.
  • Tawnykakers1
    Tawnykakers1 Posts: 207 Member
    I think they are both great options with their positives and negatives. My question is why is your surgeon not equipped to handle a leak in a sleeve? I don't mean to sound pessimistic but that would put a seed of doubt in my mind that I could not let go of. Maybe your in an area that does not have many options. I went to three seminars and asked many questions and actually picked a surgeon that is an hour and a half away from the closest surgeon to my home. I not only researched the different types of surgeries but also researched the surgeons. It may just be me and the way I'm wired. Whatever you decide on the benefit of loosing weight and getting healthy is the main goal and they both offer an excellent tool for that.
  • garber6th
    garber6th Posts: 1,894 Member
    Does your surgeon have a recommendation? My surgeon actually told me that because of my starting weight that sleeve surgery would be the better option, and fortunately that's what I wanted to do anyway.
  • ThinGwen
    ThinGwen Posts: 174 Member
    I'm agreeing with Tawnykakers. This is major surgery, and some people have very scary complications. I'd recommend finding a doctor who has access to everything, and who had been doing these surgeries for forever, and does around 15/week (3 surgery days, 4-5 operations per day)
  • AngieViolet
    AngieViolet Posts: 232 Member
    I agree with Tawnykakers. I went to a surgeon a few hours from my house because the entire hospital was geared towards Bariatric surgery and even have a gastroenterologist on site. I'm paranoid about stuff due to an issue that occurred within my family, so I found a surgeon who actually works to certify other hospitals as centers of excellence in bariatric surgery.
  • I picked RNY Gastric Bypass because I wanted the dumping, the strictness, the full-in option. It's worked wonders for me. I would do it again in a heartbeat.
  • rpyle111
    rpyle111 Posts: 1,066 Member
    I went with the sleeve primarily because of the fact that it keeps the plumbing connections the same as pre-surgery. The malabsorbtion was a concern to me as well. While learning the program, it became clear to me that the post-surgery habits and behaviors were miles more important than the actual surgery chosen.

    I believe that patients can be successful with either surgery, and the percentage differences come from a more effective honeymoon period for the RnY due to the malabsorbtion 'bonus'. With hard work, the loss numbers can be similar with either procedure.

    14 months out and no regrets!

    As far as the ability to handle complications, I am a strong proponent of the Bariatric Center of Excellence and similar certifications. They are aimed at ensuring a whole bariatric program (versus just doing the surgery) that will give the best chance of success. My program was certified under the American College of Surgeons program, although there are others. Not sure if your surgeon is at a COE or equivalent, but I would check.

    Rob
  • cmchandler74
    cmchandler74 Posts: 510 Member
    It really is a personal decision as to which option is right for you, and it's good you're taking all of the options seriously. My surgeon, who does RNY, sleeve and lapband, requires all candidates to attend a weight loss surgery seminar where people are educated on all three options without prejudice so that they can make an educated choice. The reasons I chose sleeve were:
    • It's less invasive. It wasn't the biggest reason (surgery is surgery), but it was certainly in the mix.
    • Statistical data from our hospital's patients that the sleeve had better results for weight loss retention than RNY or lapband. This also bore out with people I know personally that have had both sleeve and RNY. Out of the three people I know that had lapband, only 1 lost any significant weight that she has kept off. The other two have actually gained weight. Plus, the maintenance requirements for lapband just would not have worked well at all with my work and home schedule. Out of the 5 people I know with RNY, only 1 has kept weight off and the other 4 have gained back and then some. This may be different in other places, but traditionally, here in the southern U.S., the people I know who have had RNY or lapband just don't make it stick.
    • The more gradual weight loss that comes with sleeve. This was important to me because I didn't want to get that gaunt look that a lot of WLS patients get, and I also wanted to minimize loose skin. It's also why I've been consistent with exercise. The same thing can happen with sleeve patients most certainly, but it does seem easier to minimize with sleeve.
    • No dumping syndrome. My friend's mother (RNY 10+ years ago) has severe dumping syndrome very often because her body does not stay consistent with what she is able to tolerate from day to day (one day she can eat a certain vegetable, and the next day it literally spirals her out). After watching her experience it, I don't EVER want it to happen to me.
    • Accountability. This, I think, is the flip side of the same coin with the people who do want dumping syndrome. I wanted to force myself to retrain my eating habits mentally, but I didn't want to have to depend on a physical reaction to make it happen. There's nothing wrong with the people who do need that physical reaction, but it wasn't a right choice for me. Everyone is different when it comes to personal motivation, and my personal fear was what if that physical reaction goes away someday and I haven't toughed my brain into different habits?

    As for the heartburn, one of the big issues that causes it is that 99 percent of patients who have WLS (at my hospital, anyway, according to the statistics I was given) also have a hiatal hernia that needs correcting. It's actually so prevalent at my hospital that they have you go ahead and sign a consent for that surgery prior to your procedure so they can just go ahead and take care of it while they're in there. That said, I did not experience issues with heartburn prior to surgery, and I have not had any afterward. One of my friends that had sleeve in October of 2013 started having heartburn afterward but his is managed effectively by taking a daily Prilosec tablet. (They also gave me a prescription for it, but I've never even filled it nine months post-op.)

    Anyway, only you and your physician can really decide what the right choice for you is. Whatever you decide, you will have support here from everyone - it's that awesome of a group. :smile:

  • ABETTERCADILLAC
    ABETTERCADILLAC Posts: 3 Member
    I think they are both great options with their positives and negatives. My question is why is your surgeon not equipped to handle a leak in a sleeve? I don't mean to sound pessimistic but that would put a seed of doubt in my mind that I could not let go of. Maybe your in an area that does not have many options. I went to three seminars and asked many questions and actually picked a surgeon that is an hour and a half away from the closest surgeon to my home. I not only researched the different types of surgeries but also researched the surgeons. It may just be me and the way I'm wired. Whatever you decide on the benefit of loosing weight and getting healthy is the main goal and they both offer an excellent tool for that.

    Nobody in my state has that capability. I've been looking at surgeons and she is highly recommended and great track records.

  • ABETTERCADILLAC
    ABETTERCADILLAC Posts: 3 Member
    rpyle111 wrote: »
    I went with the sleeve primarily because of the fact that it keeps the plumbing connections the same as pre-surgery. The malabsorbtion was a concern to me as well. While learning the program, it became clear to me that the post-surg
    As far as the ability to handle complications, I am a strong proponent of the Bariatric Center of Excellence and similar certifications. They are aimed at ensuring a whole bariatric program (versus just doing the surgery) that will give the best chance of success. My program was certified under the American College of Surgeons program, although there are others. Not sure if your surgeon is at a COE or equivalent, but I would check.

    Rob

    She is.

  • loveshoe
    loveshoe Posts: 365 Member
    Abetterca, It's not an easy decision between the full gastric bypass or sleeve. My doctor helped me to decide which was best for me based on my pre surgery weight and weight loss history. Together we decided the sleeve would be best for me.

    In answer to a couple of your questions. I'm 6 lbs away from my goal weight of 145, I've lost 90 lbs with the sleeve. My only exercise is walking daily. I do weigh and log every calorie that passes between my lips. I closely watch my protein and carbs. I don't bring home what I can't have to eliminate those temptations. I travel a lot and have successfully lost weight with restaurant eating. It isn't always easy but I've managed.

    I had only one experience with heartburn prior to surgery 10 - 15 years ago. Since surgery I've had a few issues with heartburn. I was disappointed but I've managed it by making sure I get all my water in. I can't explain it but if I drink my 64 ounces of water no heartburn. If I don't fully get my water in I can expect to wake up to heartburn in the middle of the night. I can then drink 3 - 4 ounces of water and it goes away. On the rare occasion that water doesn't work I take an over the counter medication. Heartburn has been the only side effect I've had that is unpleasant.

    Good luck and much success in your journey.
  • creepykbear
    creepykbear Posts: 69 Member
    Thanks for asking this - I'm having the same issue. I met with my surgeon yesterday. I've lost 103 lbs on the 6 month preop diet - Yep, this is awesome, but I still have so far to go (another 150+). At this amount to lose it seems that RNY would be the best for me, but yet, the surgeon thought I would want the sleeve and said he would be comfortable doing either on me. My insurance will only pay for one WLS for life, so revision sleeve to RNY isn't really an option.
    I think I'm leaning towards RNY because I do want the all in aspect, but yep, I'm scared of the malnutrition aspects. My biggest concern is keeping the weight off long term, as I've already shown myself I can lose but in the past I always regained what I lost plus some.
  • joysie1970
    joysie1970 Posts: 415 Member
    Thanks for asking this - I'm having the same issue. I met with my surgeon yesterday. I've lost 103 lbs on the 6 month preop diet - Yep, this is awesome, but I still have so far to go (another 150+). At this amount to lose it seems that RNY would be the best for me, but yet, the surgeon thought I would want the sleeve and said he would be comfortable doing either on me. My insurance will only pay for one WLS for life, so revision sleeve to RNY isn't really an option.
    I think I'm leaning towards RNY because I do want the all in aspect, but yep, I'm scared of the malnutrition aspects. My biggest concern is keeping the weight off long term, as I've already shown myself I can lose but in the past I always regained what I lost plus some.

    Have you been able to maintain the 103 lb? I was in your boat, lost 120+ preop but was able to maintain for five years before pursuing surgery and have lost another 90 - with a sleeve and still losing! I am happy with my decision but its a very individual choice - good luck with whatever you decide!
  • Ultima_Morpha
    Ultima_Morpha Posts: 895 Member
    I originally consulted for the sleeve but due to some advanced damage to my esophagus and stomach from some serious reflux issues I'd had in the past, my surgeon recommended the gastric bypass. I had shied away from this because of my belief that I would struggle with nutrient malabsorption. My surgeon had some good data showing that, assuming you follow the vitamin supplement protocol, that this isn't the concern that it was in the past. He said most cases that he had were when people already had problems with their levels.

    I've actually had a marked improvement in some of my levels despite having been on supplementation for years.
  • Lisa51Me
    Lisa51Me Posts: 12 Member
    I had my sleeve done on Tuesday, so I am very new to this. I chose the sleeve because it was less invasive and I've seen really good outcomes. My surgeon's practice sponsors a monthly support group for people pre and post surgery and that has been awesome. I started cutting out trigger foods, sugar and fast food 3 months before surgery and that was successful. I see a therapist and we have been working on strategies to avoid any resurgence of old, bad habits. My primary Doctor was very supportive of my decision. He said that surgery has the best long term outcomes for someone as morbidity obese as l am. I think each person has to weigh the pros and cons for themselves, but I knew it would be best for me.