Sleeve vs Bypass

[Ready4aNewLife 1]

I have had my heart set on getting the vertical sleeve for sometime now. Now that I am actually in the process of making my dream happen, my doctor is trying to convince me to think about getting gastric bypass instead. Can all of you tell me why you chose the surgery you did? I also want to know all of the differences between them that I might not be able to find on the internet!

[TijuanaPlication 87]

I wouldn't go for RNY as you only malabsorb calories with that for 2 years but you malabsorb nutrients forever!! Also many people don't like the idea of having a blind stomach that can't be scoped (ie no endoscope possible on the sectioned off part if you get an ulcer or cancer... I know this is an issue with plication too, but that isn't the question here).

If you're super morbidly obese and are happy to have your bowels re-routed then you can convert to duodenal switch (or have it one stage). Converting from from RNY to DS can be very difficult (which some people convert to when they start to gain back, see here for info http://www.obesityhe...-DS-you-should/).

With bowel re-routing you can end up with end up with complications too, see here for an example

If you get your bowels operated on you've got to be extra diligent with your Vitamins and Protein (I know 100grams is the minimum for women with DS and I imagine it's the same with RNY).

I'm more versed with DS and I know they malabsorb 80% of the fat consumed and a certain amount of protein (I don't know the actual figure), so it's less like being on a diet. I imagine this is the same with RNY but only for the first 2 years (you still have to be carefulish with carbs with any WLS). Incidentally I've seen one DSer in her signature say she has 3,000 calories a day (a lot must come from protein and fat and very few from carbs for her to be able to maintain goal that way).

Research, research, research, as revisions can be difficult. All the best with whatever you decide!

[Rootman 1,101]

TP pretty much covered it.

I'll put it more simply. I didn't want a plastic gizmo floating around in my gut for the rest of my life - so no band. I didn't want my plumbing rearranged so no bypass. I wanted the sleeve because it is a simple removal of a majority of the stomach and doesn't introduce anything or rearrange anything.

[TijuanaPlication 87]

BTW stats for Excessive Weight Loss (EWL) is 70% with VSG and 80% with DS. I'm guessing with RNY the stats may be all over the place as you've got to factor in malabsorbtion for only for 2 years and then you've got to change your diet and go low fat.

Remember Carnie Wilson when she was looking fab and posed for Playboy and now she's back over 200lbs (better than the >300lbs she started at, but she's pretty short I think). BTW that wasn't a dis to Carnie, with RNY you just get the tables turned on you around 2 years out.

[1-4-Many 2]

I wanted the chance to be "normal" for the first time in my life and the sleeve was my path there.

I wanted a stomach that could tolerate foods, serve my body, but work with me instead of against me to support my body.

And I wanted, unlike many, for some of the responsibility to be mine. And that circles back around to wanting to be just a regular person. Not skinny, but a regular size. Not re-routed, just smaller.

My perception, for better or worse, is that this surgery gets you the closest to simply having been born with a smaller stomach than I actually came equipped with. (And I accept I pushed the limit.)

And I"m only a short window out but it seems to me I got exactly what I wanted and now I'm very excited about how different my life will be in 6 months once I've gotten a big chunk of this extra weight off and can move again. It's very exciting.

[shannoninathens 0]

I chose sleeve because my surgeon said that they are getting the same success rates with both sleeve and bypass patients at their practice. You can always switch to bypass later on if you find that the sleeve surgery did not help you achieve the results you wanted. Also, I have irritable bowel syndrome, so I was afraid to do anything that affected my ability to digest food properly. From everything I've read, sleeve seems to be as good as bypass in results, with fewer side effects and nutritional issues. The few people I know who've been banded haven't had good, long-lasting results.

[Rainydayz 27]

I have decided on the sleeve for all the reasons listed above plus the fact that the part of the stomach that produces the most ghrelin (the hunger chemical) is removed. Not disconnected and set aside or folded in on itself, but actually removed. I have read that the body being what it is (incredibly adaptive) that ghrelin will be produced in other areas but probably not as much.

I like the idea of having a smaller stomach that is happy with less food. I like the idea that I will be able to eat healthy foods, like meat and raw vegetables, unlike many band patients I have read about that never are able to tolerate meat or salads. I like that there will be no malabsorption so deficiencies are much less likely than with RNY or DS. I will have to eat healthy and lead a healthy life to make this work for me. That is what I want to do.

Oh and my surgeon said too that he is seeing the same results with the sleeve as with the RNY.

[juliarh 35]

I was pretty much on the same plane as everyone above -- I wanted the most 'normal' life that I could have -- so that meant no plastic (lap band) and no re-routing of intestines which causes malabsorption -- I really just wanted my life back and didn't want to trade the indignities of being morbidly obese with the indignities of dumping, pb'ing, etc. I am super happy with my decision.

[samantha209 19]

i was very anti-rerouting my intestines, and the whole thing with the dumping, and malabsorption of nutrients

[1-4-Many 2]

I was pretty much on the same plane as everyone above -- I wanted the most 'normal' life that I could have -- so that meant no plastic (lap band) and no re-routing of intestines which causes malabsorption -- I really just wanted my life back and didn't want to trade the indignities of being morbidly obese with the indignities of dumping, pb'ing, etc. I am super happy with my decision.

Very good way to word this.

I actually started out thinking band. That lasted until I met two women who were banded.

Then I went straight to sleeve and waited for it to catch up with me. I never stopped at RNY but I certainly had to explain myself a lot as to why I didn't. I don't think that will be the case in 5 years.

[TijuanaPlication 87]

Yeah, RNY is pretty much the only surgery you dump with (look up 'dumping' on youtube and you'll see people looking like they're having a heart attack). In theory it doesn't happen at all with DS or VSG, although there are people that say they get it a bit. To be honest I'd say I used to get a little pre-op, but not so much now I don't eat as much. I guess some people are pre-disposed to it (I have IBS, so I'd say that's part of my prob).

[Tiffykins 673]

This is my standard reply when this question pops up every couple of days. I won't try to sway anyone one way or another, but I'll give you my reasons for choosing VSG over RNY for my revision from the band. You can also check out the revision, failure, and food issue forums on here to get an idea of some long term RNY patients. For me, it was never an option. The cons outweighed the pros.

The VSG was my 2nd, and final WLS. I could have easily had RNY, but I fought to have VSG as my revision from the band. Some factors I considered in deciding on VSG. The pouch that RNY offers is similar to the pouch with the band. Least to say, a pouch sucks, I love having a normal tummy, just less capacity and still fully functioning.

1) No blind stomach left behind that can be difficult to scope yet can still get ulcers and cancer.

2) 2 years max on calorie/carb/sugar malabsorption, but a lifetime of vitamin/nutrient malabsorption. This process is called adaptation, and it happens with intestinal bypass surgeries. After adaptation occurs, I would be left with just the restriction of a pouch. I figured if malabsorption of fats/carb/calories was temporary, just go restrictive from the beginning and skip all the rerouting issues with RNY.

3) I had a pouch with the band, and it sucked. I'm pretty fond of my pyloric valve and the sleeve let me keep it. I love having a normal functioning stomach, just smaller in capacity.

4) Regain stats and #of RNY patients seeking revision truly scared the poop out of me. Check out the revision board here for an idea on how many RNY patients are now trying to get revisions to either ERNY or DS.

5) I have too many friends in real life that struggle with Vitamin deficiencies post-RNY, and most of them either never got to goal, or have gained back a significant amount of their weight.

6) The long term complications with RNY were too numerous for my comfort level. Pouch or stoma dilation, strictures, vitamin/nutrient deficiencies, ulcers,

7) I researched gastrectomies that had been performed for stomach cancer and ulcer patients, and found comfort in the long term results and minimal complications of patients that had lost most or all of their stomachs had dealt with over several years. Plus, the sleeve is the first stage of the DS that has been performed for 20 years.

8) I was a volume eater, and knew a restrictive only procedure would work for me. That was my thought process when I got the band, and I thought I could beat the odds on complications. Sadly, the band only lasted 8 months before I had to revise.

9) I did not want to have food or medication restrictions. I chose WLS to have a "normal" life, and I think it's normal to eat a couple of Cookies. With RNY, I wasn't willing to go through the possibility of dumping if I wanted to have a couple of Cookies, or a slice of cake on occasion. The big scare for me is medication restrictions for life. NSAIDS and steroids are a NO GO for life with a RNY pouch. I realize that I may never be diagnosed with a condition or disease that requires steroid use, but it is possible. I want the best long term results with the least amount of complications. Malabsorption is not anything to play with in my mind, and I was not willing to take that risk.

I lost all my weight in my ticker with the exception of 7lbs with the sleeve, and I did it in 10.5 months. The 115lbs fell off the first 6.5 months, and then the rest I lost as I was getting into maintenance over another 4 months.. It's been a fabulous journey, and I'm easily maintaining with zero issues for nearly a year at this point. I want to add that every WLS regardless of your choice will require discipline. Only a percentage of RNY patients dump on sugar/fat, pouches and stomas stretch, then you have the medication restrictions. I'm not trying to convince you, but these were my concerns when I knew I had to revise from the band. I started at 263 the day of my revision and today I weigh 127lbs. I bounce on the scale 125-130lbs any given week, and I couldn't be more ecstatic!

Best wishes in your research!

Edit to add: I wrote that long before the pregnancy. Since then, I've been diagnosed with a genetic disorder that causes a slow, blood clotting issue, and I have to take an aspirin a day for the rest of my life. With the pregnancy, myself and Sprout are both thriving. I have gained 8-10lbs in 16 weeks, and have not had any issues with my sleeve and the pregnancy. My labs are stellar, I feel great, and life is good.