I have been doing some intensive research regarding the two different types of surgery - and i cannot make up my mind. On one hand i know the sleeve is "safer" and has less medical intervention as such (complex intervention i mean) and you don't need to have additional vitamins for life afterwards. However i have also read that the bypass gives a better weight loss that can stay off permanently whereas i read one article that said a sleeve has a 18 -24 month period to lose weight then you are likely to regain and plateau - i don't mind the plateau because i know it will eventually have to stop coming off but - the question is is 2 years long enough to lose everything.
For those of you who have had either of the above, would you say the medical assumption of weight loss between 30%-50% for sleeve and 40%-60% for bypass are accurate?
I received my letter the other day from the Bariatric Physician and with it came a questionnaire about the surgery, and the first question they ask is which surgery do i want... Ugh i don't know!!
oh Birdie - all excellent Qs, but they don't have quick answers. The key thing to remember about the bypass is that you no longer have a pyloric valve [which paces the rate at which food passes from your tiny tummy into the intestines], and you have a malabsorption component. For the sleeve, remember that you KEEP your pyloric valve and you also KEEP your normal intestinal process [there is no malabsorption.
Sleeve = restriction only; bypass =restriction plus malabsorption. And this is a great point to discuss with your surgeon [you can always put in something like 'considering XXX procedure, but need to discuss with surgeon].
For people who are extremely overweight, the bypass may be the best answer. for people who are 'only' 100 or so pounds overweight might be best served by the sleeve. But everything depends on your overall health, whether or not you have diabetes, and most important, how you're willing to live for the rest of your life.
Now about those numbers. No matter which form of surgery you choose, you'll generally have an 18-24 month 'honeymoon' during which you'll lose most of the weight you're going to lose. It's best to work your surgery during this time for best results. After that, the body adjusts, and it becomes the same battle.
People with bypass tend to lose faster than people with the sleeve, but it pretty much evens out at the end.
Those total weight loss numbers between 30%-50% for sleeve and 40%-60% for bypass are for EVERYONE, and includes people who have completely and utterly blown off the surgery and regained EVERYTHING plus some.
So, bottom line, barring problems with the surgery, the amount of excess weight you lose depends on YOU. I lost 86% of my excess weight at my lowest. I'm currently at about 65% of excess weight loss - after 12 years. and that's OK.
Thanks Jiffy, you make a lot of sense in what you are saying. I also read about the malabsorbtion and that does worry me, not becuase i have any issues but because i worry that it might cause issues, if for example i forget to take my pills or something. Not to mention the cost of them every month for the rest of your life. I have already decided I don't want a band, i think there is a lot of life maintenance involved in terms of fills etc at the Dr's for follow ups - at least it is one down!
I will definitely discuss both options with the surgeon and see what he thinks anyway, and take it from there... although i am sure you understand that me doing that will not stop the obsessive research anyway!
You have done a remarkable job on your journey, it seems you have got to a place where you are happy and that is the most important part of it all. Well done on losing the 86% that's awesome.
I know i am prepared in my head for this change, i have had a long time to think about it and get it sorted emotionally - so I think I should be okay afterwards.
The thing i keep thinking is that i want this to be a permanent change, i don't want to be sitting outside my house in 5 years time and wishing i had chosen a different op. I have in total about 120lbs to lose to get to my goal weight - and i know for sure i can do it.
I had a sleeve done and I'm on vitamins for the rest of my life-- the same one that gastric bypass patients take. I've heard that its not as critical as it is for gastric bypass patients, but if not taking vitamins is a factor in your choice...just an fyi.
A gastric sleeve can be turned into a gastric bypass, with an additional surgery later on. Not that its the right mindset to go into surgery with (oh, if this doesn't work, I'll just have another surgery later!) but its true.
Either surgery can help you take the weight off and keep it off. Talk it over with your surgeon-- they can look at your medical history and make a recommendation based on a lot of factors.
I had a consult with the surgeon last week. He said that I'm a good candidate for both the RNY (bypass) or the Sleeve. He said that for people that take NSAIDs (non-steroidal anti-inflammatory drugs like Advil, Aspirin, etc.) daily for pain relief, the sleeve is better because he said that NSAIDs can cause problems (ulcers) in the small bypass pouch. However, for patients who have heartburn or acid reflux, these conditions can frequently get MUCH worse if you have the Sleeve operation because it's just a straight shot from the new vertical sleeve stomach back up the esophagus. With the bypass the part of the stomach that produces acid is no longer attached to the esophagus.
I take a prescription NSAID once or twice daily for back pain, but I am on other non-narcotic, but non-NSAID meds for back pain. And I take a medicine for acid reflux.
So what I'm trying is to go without the NSAIDs for awhile to see if my back pain will be tolerable if I have the bypass surgery and have to give up the NSAIDs completely.
The surgeon said patients who have the sleeve operation get some relief by taking acid reflux meds or antacids. But if left untreated the heartburn/reflux can get REALLY bad.
So since my reflux is already bad at times, I'm 99% sure I'm going to have the bypass done as long as I can give up the NSAIDs. I just couldn't bear my reflux to get worse and be more frequent.
If you have any questions about this stuff....ask your surgeon or his staff. I don't have any medical background, I'm just repeating what my surgeon said.
Thanks Diyana and Ducky, you are both right, i need to talk it over with the surgeon when the time comes. Both operations will hopefully help me lose weight and keep it off.
On both accounts i have issues that i am worried about, the reflux on the sleeve side and the malnutrition on the bypass side - although having said that, I am certain if i skip one day's worth of vitamins it wouldn't actually kill me.. there is a lot to consider.
But as you rightly say, it's a personal decision and one that is individual to each person.
Just thought I would throw my 2 cents in here. I had the sleeve in 2011. I get migraines and have to be able to take Advil. I have not had any problems with heartburn or anything like that. I have not been as compliant with the way I should be eating as much as I could have been and as a result my weight loss has been slow. I still have at least half of the weight I wanted to lose to lose. Another woman who was about the same weight to start had RNY a few days before me and she has done much, much better and is close to her goal weight. I KNOW, I KNOW we should never compare ourselves to others but in this particular case it is difficult because I often wonder if I had the bypass would I have done better. I don't know. I really don't. Sometimes I think I would have been just as non compliant with the RNY as I have been with the sleeve and it wouldn't make a darned bit of difference then on the other hand I think to myself that bypass may be the gold standard for weight loss surgery for the reason that it works. In the end the surgery is only a tool and it is up to the individual to make it work.
On both accounts i have issues that i am worried about, the reflux on the sleeve side and the malnutrition on the bypass side - although having said that, I am certain if i skip one day's worth of vitamins it wouldn't actually kill me.. there is a lot to consider.
Birdie01, I am a little confused about this statement. Without proper monitoring and supplementation, you could be become malnourished, but that can happen even without rearranged guts (if you only ate spaghetti, you'd eventually become malnourished). Taking vitamins just becomes a part of your day; no big deal. Plus, as others have pointed out, most VSGers have to supplement as well. I wouldn't place malnutrition on the list of reasons to avoid RNY.
The big considerations are those already mentioned: VSG can really aggravate reflux. If you decide to go the VSG route, make sure you have an EGD done prior, so that your doctor knows the extent of damage already done by GERD. It just might rule out the VSG (as it did in my case. I have Barrett's Esophagus, which would never have been diagnosed without an EGD.)
There are some RNY patients that take NSAIDs occasionally under the care of their doctor, but most folks need to stay away from them. The problem is that ulcers can develop in the remnant pouch, which is pretty difficult to treat. I would seriously consider if you can give up NSAIDs, if you have a medical condition that requires their use. Let's be honest: Tylenol rarely helps with inflammation (and has its own set of worries, such as liver damage), which means that some RNY folks need to depend on prescription pain meds for relief.
Someone (can't recall who) in this thread stated that VSG could be converted to an RNY. This is not accurate. It can be done, but only by a few skilled surgeons, in extreme cases. The VSG is the first step for the DS, though. The DS reroutes past a greater portion of the intestines than the RNY and does require a lot more supplementation. So, there is another procedure out there (the DS), but fewer surgeons perform this WLS, as it requires more diligence from the patient, and is a more challenging surgery.
Just some feedback for you to consider. Good luck on whatever decision you make.
Birdie - doesn't it feel liberating once you make the decision? I know it did for me. Bravo on being down a few more pounds! I'm working on losing the required pre-surgery pounds set by my doctor. I weigh myself once or twice a week, but on different scales, so I'm not sure what's accurate. I'm trying to eat within the 1,200 calorie per day diet plan that my nutritionist gave me, and I'm exercising nearly every day. I wish you all the best pre-, during, and post-surgery.
Hi Michelle, yes indeed it feels great to know what path I'm going to take. I'm a lot more calm and relaxed about it all now and I can focus on losing my weight and having it stay off this time.
Good luck to you too.. I am certain you will reach your goal weigh pre and post surgery.
good luck with your decision...I had the sleeve a year ago and am very happy..when it's right ...it's right..but please remember NONE of this is permanent..even RNY - if you don't eat correctly and make the lifelong changes- you can gain your weight back..these are tools...not fixes.... Good luck! it's a great journey!!!
Indecision between a Sleeve or Bypass
checked my weight this morning and am down a few more pounds! 
I wish you all the best pre-, during, and post-surgery. 
