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I've had both. I had the sleeve for 5 years and revise to a bypass just recently. The urgent diarrhea happened with the sleeve too, and some of them dump. I dumped with it, unfortunately. This is just for me... But if I had to do it all over again, I would skip the gastric sleeve and go RNY. Post-op sleeved, I was hungry from the beginning and not too long after I develop Gerd. I'm post-op RNY now and I don't feel hungry at all. The VSG surgery and RNY was basically the same pain level. Having said that, they are both good choices. Not everyone develops Gerd from the sleeve.

Deciding which surgery to have is not straight forward & it’s a good idea to ask for real life experiences to help you decide. Some factors will direct you more to one or the other more easily. Like some surgeons recommend bypass over sleeve if you have a larger amount of weight to lose. If you have reflux/gerd already the sleeve really isn’t for you. Then it becomes lifestyle choices, existing medical conditions, weight loss history, etc. that will influence your decision. I had sleeve surgery even though I had occasional reflux. I experience it more now but it manifests differently. One of the reasons I chose the sleeve was because it would change my digestion the least but also because I could revise to a bypass if I needed in the future. My tummy has always been a sensitive (lactose, spice esp chilli, fatty or oily foods, etc.) because of the reflux, a parasite in my gut, an acid tummy & just me. Consequently, I thought I’d be more likely to end up with additional food limitations with a bypass. 27 months on & I’m happy with my sleeve. There are odd foods I’m not good with. Bread, pasta, rice, potatoes sit like a weight in my tummy. Dry meat & vegetables like char grilled ones cause the foamies & gagging. Oily fish upset me more now than before surgery. But this is very individual & you can’t predict it. Amusingly I’m way better with dairy than I was before - tossed that parasite with most of my tummy. I find it harder to find non spicy & non chilli food than foods I eat with my sleeve. Foods you struggle to eat in the first couple of months after surgery may be fine later on. Your tummy can be sensitive to begin & you might have episodes of diarrhoea, vomiting, dumping, foamies. It can help if you introduce foods back into your diet slowly. Most of this is temporary or only if you eat a specific food & I just try to avoid those I know upset me. Some people, though, seem to have no issues with food at all. These experiences seem to be similar across the surgeries. I remember my mother lamenting she didn’t know what food to buy when I visited her. The reality was she didn’t have to buy different foods or cook differently (mind you I’d always do the shopping & cooking when I’m there). I just bought my own yoghurt & protein bar snacks but otherwise we ate the same foods except she has dessert & slightly larger portions. You may choose to make a lot of changes to your long term maintenance diet (I have - rarely have sweet cakes, biscuits or desserts, no fast foods, etc.). You may chose to go the moderation path & still include the odd take away, sweet treat, etc. Doesn’t matter what form your maintenance diet takes it just has to be sustainable for you & how you want to live your life. Good luck with which ever surgery you choose.

I haven't had the enlarged fundus personally, but I have read about this happening to people after the sleeve. The "good" news about it is that it gives you additional options in how to treat the reflux. Most sleevers do not have enough fundus left for a fundoplication to control the acid to be an option, but since you have a larger fundus than normal, you probably can have at least a partial fundoplication (aka Toupet fundoplication). You may want to talk to a surgeon who does reflux surgery about that option if it is looking like they won't cover a revision to bypass.

I've been in this WLS world for close to twenty years, since the initial work up to my wife's DS and then my VSG some years later, and from what I have seen from many in our support groups, most everyone can lose up to around 30lb of regain - it takes some effort and a few months, but it comes off more or less like a "normal" person. 50lb or regain is more a a 50-50 proposition - some can lose it on their own, and some need a revision to help it along. My general feeling is that the revision should be your last step rather than your first. Go back to some basics and try to understand where your regain happened, as if it happened, once, it can happen again after a revision., so you need to get your head around the root of the problem. Is it a head problem, meaning that maybe some therapy is in order, or not really understanding the nutritional side of things and how to eat and live to maintain a healthy weight - an RD can be helpful for this. Or, maybe a bit of both. Unfortunately, our WLS, and by extension a revision for regain (rather than for complications) is really more of a "do over" rather than a cure for the problem Very commonly, before we had WLS, the most frequent reason for failure in dieting is that the diet will yield some weight loss, maybe even to normalish weight, but then the person declares success and goes back to their old habits, and diet, that helped to promote the weight gain in the first place - they never really learned how to live, and eat, to maintain that healthy weight. This is why we frequently see people regaining fairly rapidly after notionally successful dieting. The same basic profile often happens after WLS, only it takes a while longer to happen owing to the lower volume that we can eat, but that tendency is still there. Another consideration is that every time we go inside to do surgery, we back ourselves further into a corner, limiting our options for future treatment should that be necessary, whether for regain revision or for something completely unrelated; you have limited any future surgeon's options in what they can do to help you with some future problem. This is why I am very shy about "wasting" a surgery if I can possibly treat the problem some other way. Again, let it be your last choice, rather than your first.

Hi, I'm also 4 mos out with a stall between 192-195. I'm also became caretaker for my elderly Mom so lots of stress going on here. I know how that can impact a person's health but at least I'm not gaining. Still thrilled to be in "onederland" and really enjoying breaks I get from other fam members so I can do my. Reformer Pilates classes where my focus is now cardio/sculpt. I also hop on my treadmill at home buty water intake has really taken a dive. Need to work on that. The great news is that my A1c # for diabetes no longer requires meds. I'm so, so, happy about that🙂. Btw, my highest history of weight gain was 261, pre-op was 245 to 235 from the week fast, and now 192. Goal is 150 since I am 5'6". I had the revision from lap band to gastric sleeve. My niece had the bypass and she said that her stall required her to go back on protein shakes 3x a day un order to trigger more weight loss and so far she has lost 100 pounds. I think I will be trying that, too. Good luck to everyone and I love seeing the pics Mizzkay! You look awesome. Blueslily, thx for keeping this topic alive. I'm right there with you on the stall. We can do this! Sincerely, Trish

I did a revision and it's horrible 😫

I put on 40 lbs since my VSG in 2018. I filled out a health questionnaire for Mexico Bariatric Center. Just got approved from one of their Doctors. Not sure if I want to try and take this off traditionally or try the revision. I think it's 3 times the price here in the USA.

Did anyone purchase a secondary health insurance policy to help cover the cost of a revision?

SW 280, VSG DOS 263 LW 172 but weighed 177 for about 4years. Got GERD and went up to 233! Revision to Bypass 11/2/20 and today 165! Not even a year our yet. So yes you will lose. Not as much as the first time but I’m still working out a lot and I drop when I eat more calories. I’m at 1,000-1,200 a day right now and run 5x a week 2 miles a day and weights 2x a week. I wish I would have don’t this the first time around lol BUT the surg was so painful I was like omggg why lord. My doc said well you have to understand I had to make the stomach slim again since it was stretched , THEN do the bypass so it was a lot of work. Yikes! Lol so thankful. Anyways good luck! Now I get my plastic surgery so I can feel comfy and get rid of this old skin lol

4 years post-sleeve, yes, I do regret it. The sleeve has a pretty high rate of revisions to gastric bypass in the long run due to either really bad acid reflux or inadequate weight loss. It also makes you more likely to get a hiatal hernia post-operatively, which may not sound like a big deal, but it has had a real effect on my quality of life. I didn't have a hiatal hernia until after the sleeve. Knowing what I know now, I would have never had bariatric surgery in the first place, because I was quite healthy in spite of being fat and bariatric surgery made my quality of life worse instead of better. However, if I did want to go through bariatric surgery, I'd rather get the RNY. At least the RNY has stood the test of time over many decades and cures acid reflux instead of making it worse like the sleeve does. Personally, I would only recommend bariatric surgery to people who already have health issues from being fat. Then it is worth the risk that the surgery might create its own problems.

How many times did you guys and girls have to appeal an insurance denial before it went through (if it went through?) I have Harvard Pilgrim, and they have determined that my revision is not medically necessary despite reflux that wakes me up every night with imaging and an upper endo to prove this. I plan to call my surgeon's office and find the best way to appeal it, but I was just curious if anyone had successfully appealed before - particularly with Harvard Pilgrim. Thanks!

Follow up: I actually just got the denial from my insurance company about an hour ago. Even seeing this, they’ve deemed a revision “not medically necessary.” I’m gonna have a fight on my hands 😩

Hi! No, they didn't do a baseline swallow study, so I don't have anything to compare it to, unfortunately. Fingers crossed that insurance approves my revision and we can get that corrected intraoperatively, too. Thank you, and I hope you feel better soon too!

That is absolutely abnormal. Did your doctor say that it has been stretched over time? Did you get a barium swallow right after surgery to compare? I don't have a dilated fundus, my sleeve looks good but my esophagus is really dilated instead, so I think that is the cause of the really bad reflux, Gerd Etc. and why my doctor suggested I get a revision to bypass. I hope you feel better soon.

My surgery, revision from sleeve to RNY, is on 9/20 and pre-op diet begins 9/6. I’m feeling all sorts of feelings; excitement, anxiety and a little apprehension. Good luck everyone! I look forward to reading about your progress.

I am going on a year now trying to have a revision done due to GERD. Last August, I saw my old surgeon's nurse practitioner who told me that omeprazole daily was my only option. She ordered a swallow test which she reported looked "normal" and she could see no reason why I had GERD - so, again, continue with omeprazole. This past April, I finally had had enough and decided to advocate for myself a little more and saw a surgeon in another facility. He took one look at my swallow study and said it was far from normal - I have a huge dilated fundus and a hiatal hernia. He, too, tried to push the meds vs. a surgical intervention but I told him that I could not go on like this nor did I want to take yet another medication daily for the rest of my life for an issue that could be fixed with a revision. Fast forward to THIS August, I'm waiting on insurance approval with my fingers crossed. I'm frustrated that I was misdiagnosed, as this could've been taken care of almost a year ago... bottom line, push, advocate for yourself. You know your body best. The only trick is getting insurance to deem the revision medically necessary. Good luck!

I agree, the full liquid phase seems to be going very slowly. I had my sleeve the same day as your revision. I started full liquids on Thursday (29th) and don't move to soft stage until August 10th. Getting tired of broths & shakes, but knowing this is temporary makes it easier. Sometimes I even feel like I wouldn't want anything to eat anyway, those times makes it easier. Then other times I really want something other than what I can have. I am looking forward to that soft food stage! (No purée stage on my plan) Yesterday, I added Genepro to my Crystal Light and my soup (half serving of genepro in each), that way I only needed 1 protein shake. Do you, or anyone else have anything they did during full liquid that makes it easier or more interesting? We'll be on to a new phase before we know it, we just got to hang in there! Hoping everyone is doing well with their progress. 😊 (Scale isn't moving as much as I thought it would my first week🙄, but it's moving)

Ugh, I am sorry that you are dealing with this problem. Rick's advice is solid. I suspect that he is correct that this nasty reflux is probably happening because you ended up developing a hiatal hernia. Hiatal hernias seem to be a VERY common complication of the sleeve long-term sadly, and reflux is the number one symptom they cause. You will very likely be offered a revision to bypass, since that is the "tried and true" way of fixing this kind of problem. However, some people have had good results just repairing the hernia and not doing a whole revision. If it does turn out you have a hernia, check out these recent discussions we have had about the issue:

Hi I got my revision on July 26th and been on a liquid diet since. Some days are easy but some days are so hard especially when time is soooo slow and everyone munches around you!

When I first met up with a doctor for revision, I told him I couldn't sleep at night because food or acid would rush back up, and if I didn't take my PPI (which I've been on for quite a few years), my esophagus burned, and I didn't want to up my PPI and be on it for my entire life. He then said that I needed a revision to bypass to help with Gerd, and maybe it'll help me lose a little bit more weight.

It could be a number of things, most common this far out would be a hiatal hernia that could cause these problems. Is your protonix once a day, or split into two doses, morning and evening? If it is consistent with the labelling, try taking it in the evening, as that is where your biggest problem seems to be, or splitting it morning and evening (if it is two 40mg pills.) Short term to help with the overnight problem, try elevating the head of your bed 3-6", or elevate your head and torso with a wedge pillow, or sleep in a recliner if you have one - anything to get your upper body (not just your head) angled down toward your stomach. Avoid eating anything 2-3 hours before bedtime. These are classic DIY reflux mitigations that the gastro will probably also suggest. You can consider going to the ER and hopefully they can get some of the tests done necessary to diagnose your problem (likely an endoscopy and/or barium swallow imaging. The may also just send you home with a larger dose of protonix or maybe a switch to dexilant and possibly carafate. An urgent care clinic may be able to help, particularly if you have one affiliated with your hospital - they may be able to short cut getting the tests done that you can then take to the bariatric surgeon (who would likely order the tests anyway. Many hospitals run these clinics for just this purpose - not really an emergency, but too urgent to wait a week or two for an appointment. This may save you a couple of weeks. Don't worry about insurance coverage as if a revision is needed, it would not be considered a second WLS (which some insurance limits) but as corrective surgery for you complication. Good luck in getting some resolution soon (er, rather than later)

So I’m not there yet but today is my 5 month surgiversary!! Starting weight 273, surgery weight 260, today 192. My goal weight is 165 so more to go. I may revise my goal when I get there but I’ve never been that weight as an adult so not sure what I’ll look like when I get there lol. So happy I made the leap and thank you all for the support, tips and sharing. I don’t have a picture just before surgery as I hated photos of myself but here is one that a friend took when I wasn’t aware, at my biggest. The second one was taken yesterday.

It’s my 5 month surgiversary today!! Best decision I have ever made! I have lost 81 pounds in total, 68 post surgery. Not only do I feel so much healthier but there are so many non scale victories too. Only real downside has been losing so much hair but I would still have gone ahead with the surgery. I set my goal weight to 165 pounds because I actually don’t know how I would look at that weight as an adult. I may revise it when I get there, but it feels pretty good to be so much closer to that goal. I really hope you’re all doing well and are happy to have had the surgery. I’d love to hear about your journeys to date, the good and even the not so good 😊. Below is a before picture and one taken yesterday. I hated being in photos so I didn’t take one just before surgery but I now wish I had.

I had revision from VSG to Bypass October 2020 due to severe gastritis, esophagitis and Reflux. I'd been on PPI medication for GERD since well before my sleeve surgery, but it only got worse after. Drugs no longer had any impact and I couldn't sleep unless I was in a recliner. I saw my surgeon in August of 2020, had all the testing done to verify the diagnosis and my insurance approved within a month. I have Aetna insurance, but when the surgery is "medically necessary", it moves pretty quick. I was "overweight", but not obese at the time of the bypass, so weight gain was not a factor in the insurance approval. But I don't think it would have changed the medical necessity of the surgery. Good news - the surgery was a success, acid reflux is gone, I now sleep in a bed and I've lost almost 60 pounds since surgery. Recovery was rough - I'm a "dumper", so I still have to be careful what I eat, but I am so very happy that I made the decision to have the revision. Good luck with your surgery!

I have about the same problem you have!!Went in at 270 and only lose 70 pds with the sleeve .I'm doing my work on having the revision because of the GERD...it is bad, I didn't have any of this before the surgery. Sent from my SM-G960U using BariatricPal mobile app