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.

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 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.

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.

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)

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.

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.

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.

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.

creepykbear wrote: »

My insurance will only pay for one WLS for life, so revision sleeve to RNY isn't really an option.

This is one reason I started thinking RNY before I ever saw a surgeon. I knew about this before my first consultation. It ended up with my other health issues that the RNY would be the outcome anyway, but I was leaning heavily towards already.

Amen!

If you go back to eating higher carbs it won't stick, with or without surgery.

creepykbear wrote: »

joysie1970 wrote: »

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!

The 103 pound loss has been on the pre-op diet (low carb, low fat). I've been working it since June. So no maintenance yet, still losing while waiting for insurance. My surgery goal weight for myself is 299. In the past I have lost weight time and time again, then gained it back plus more. I want the surgery to help this stick.

Sounds like you are on the right path and starting good habits now that will stick with you and serve you well! Kudos to you! Keep working it and maintain those habits after whichever surgery you chose - you are going to do great!