Does anyone feel pressured by surgeon to have the bypass (instead of sleeve)

[Mayastone 6]

Does anyone feel pressured by their surgeon to do the RNY/bypass over the sleeve?

Like everyone else, I sat through the initial info session my surgeon offered and I felt like she was really selling the RNY. The whole session was about the RNY, in fact, and how it's the "gold standard" and best procedure.

Then, I met with her for my initial appointment. She predictably said I was a better candidate for the RNY. I am 5'2" and weigh 250. Fair enough. I went home and had my mind set on the bypass.

But then I started doing my homework and, after much thought, I decided the sleeve may be better for me for many of the same reasons as others who make this decision: I have no comorbidities, research seems to say it's less invasive, no rerouting, no dumping, no vitamin/medicine probs and it would cut out the hunger hormone grehlin. Equally as important it would restrict the amount I can eat and, according to the many pieces of research I read, offer practically the same amount of weight loss as the RNY over the long term, albeit at a slower rate.

I am also a cancer survivor and I had concerns about the malabsorption that comes with the RNY and whether or not I could effectively be treated in the future (if needed) if my body would no longer absorb medicines (including oral chemo).

That said, I did have a couple of concerns about the sleeve. One, I'm not a necessarily volume eater and this is obviously a purely restrictive procedure. And two, I have a career, a lot of business travel, and a toddler, so I can't commit to constantly exercising like others do. I wondered if I wouldn't lose enough and then regain what I do lose because I won't have that malabsorption so many people benefit from with the RNY.

So, I made a second appointment with my surgeon to discuss all of the above and she was still all about the RNY -- which is totally fine. She is the expert and I am turning to her to help me make an informed decision. However, she mentioned several things that were contrary to everything I've read. She said...

--Malabsorption only lasts six months at the most for both calories and nutrients/medicine (yet, her required nutrition classes talk about the life long Vitamins, etc???)

--People don't lose weight from the RNY because of the malabsorption or restriction; they lose weight because they're bypassing all the hormones in the first part of the small intestine, something you don't get with the sleeve (so malabsorption has very little to do with the weight loss)

--The RNY is safer than the sleeve; the sleeve is actually more invasive and dangerous to recover from because it's more prone to leaks due to the length of cut and pressure that builds in the sleeve.

--The sleeve causes less weight loss and you will regain more in the long term. I have read that the long term results are VERY similar to the RNY. She says no, long term for RNY is much better.

--The least I can ever weigh with the sleeve is 180-190 lbs (currently 5'2" and 250 lbs) and I likely won't get that low.

--I can take time release medicines in the future and they will probably work.

--The sleeve will rarely be performed five years from now because it's not effective; but I thought the sleeve was becoming the WLS of choice

I was confused by what she was saying, so she referred me to the Cleveland Clinic's "Stampede" study, as it compares the RNY to the sleeve. But I read it and it is all about the effects of both surgeries on diabetic patients. I don't have diabetes.

Does any of this sound like what you've understood from your surgeons?

My surgeon is loved by all. She is smart, has great bedside manner, has been doing this for over ten years and has one of the Bariatric Centers of Excellence. I do trust her, but some of this sounds strange to me. In the end, I want solid info so I can make the decision that's best for me.

Any thoughts on why surgeons might try to "sell" the bypass more often?

Also, any thoughts on what she said to me when I went in to ask her about doing the RNY vs. the sleeve?

Thanks!

[GBLady41 393]

Does anyone feel pressured by their surgeon to do the RNY/bypass over the sleeve?

Like everyone else, I sat through the initial info session my surgeon offered and I felt like she was really selling the RNY. The whole session was about the RNY, in fact, and how it's the "gold standard" and best procedure.

Then, I met with her for my initial appointment. She predictably said I was a better candidate for the RNY. I am 5'2" and weigh 250. Fair enough. I went home and had my mind set on the bypass.

But then I started doing my homework and, after much thought, I decided the sleeve may be better for me for many of the same reasons as others who make this decision: I have no comorbidities, research seems to say it's less invasive, no rerouting, no dumping, no vitamin/medicine probs and it would cut out the hunger hormone grehlin. Equally as important it would restrict the amount I can eat and, according to the many pieces of research I read, offer practically the same amount of weight loss as the RNY over the long term, albeit at a slower rate.

I am also a cancer survivor and I had concerns about the malabsorption that comes with the RNY and whether or not I could effectively be treated in the future (if needed) if my body would no longer absorb medicines (including oral chemo).

That said, I did have a couple of concerns about the sleeve. One, I'm not a necessarily volume eater and this is obviously a purely restrictive procedure. And two, I have a career, a lot of business travel, and a toddler, so I can't commit to constantly exercising like others do. I wondered if I wouldn't lose enough and then regain what I do lose because I won't have that malabsorption so many people benefit from with the RNY.

So, I made a second appointment with my surgeon to discuss all of the above and she was still all about the RNY -- which is totally fine. She is the expert and I am turning to her to help me make an informed decision. However, she mentioned several things that were contrary to everything I've read. She said...

--Malabsorption only lasts six months at the most for both calories and nutrients/medicine (yet, her required nutrition classes talk about the life long Vitamins, etc???)

--People don't lose weight from the RNY because of the malabsorption or restriction; they lose weight because they're bypassing all the hormones in the first part of the small intestine, something you don't get with the sleeve (so malabsorption has very little to do with the weight loss)

--The RNY is safer than the sleeve; the sleeve is actually more invasive and dangerous to recover from because it's more prone to leaks due to the length of cut and pressure that builds in the sleeve.

--The sleeve causes less weight loss and you will regain more in the long term. I have read that the long term results are VERY similar to the RNY. She says no, long term for RNY is much better.

--The least I can ever weigh with the sleeve is 180-190 lbs (currently 5'2" and 250 lbs) and I likely won't get that low.

--I can take time release medicines in the future and they will probably work.

--The sleeve will rarely be performed five years from now because it's not effective; but I thought the sleeve was becoming the WLS of choice

I was confused by what she was saying, so she referred me to the Cleveland Clinic's "Stampede" study, as it compares the RNY to the sleeve. But I read it and it is all about the effects of both surgeries on diabetic patients. I don't have diabetes.

Does any of this sound like what you've understood from your surgeons?

My surgeon is loved by all. She is smart, has great bedside manner, has been doing this for over ten years and has one of the Bariatric Centers of Excellence. I do trust her, but some of this sounds strange to me. In the end, I want solid info so I can make the decision that's best for me.

Any thoughts on why surgeons might try to "sell" the bypass more often?

Also, any thoughts on what she said to me when I went in to ask her about doing the RNY vs. the sleeve?

Thanks!

Hi, Mayastone! Well, I do know from research that the gastric sleeve does not help you lose as much weight as the gastric bypass. Every website I've looked has stated the same thing. I've also thought that malabsorption will be part of a person's life with RNY. But I know that people need to take Vitamins all their lives anyway.

As far as the other things, as a surgeon, she probably knows how much risk is involved in both surgeries, as well as the sleeve being done away with. I would do some more research and maybe ask this question in the sleeve forum to see what others have found out about the gastric sleeve. ????

[Kelsey Marie 49]

@@Mayastone So these are a few things I know from discussing the options with my surgeon and from watching family members have WLS's.

-Malabsorption is a huge part of the RNY. I think maybe what she meant by the first 6 months is that that's when people who have the RNY have the majority of their weight loss. But according to my surgeon, it's always about that, unless you stretch out your stomach enough, and then you have other issues.

-People who choose to have the RNY loose weight for both reasons, not just one or the other; they work together to help the person lose their weight.

-As for the safety, I'd say they're both equally as safe as long as you have a surgeon who knows what they're doing, and depending on the patients other health issues at the time of surgery.

-I highly doubt the sleeve will be rarely be preformed in 5 years. According to my surgeon and my moms surgeon (who has since passed away) the Sleeve has been and will be a wonderful option for people. Unless they develop something new even better, which you never know.

-My mom had Bypass 5 years ago in May, she lost 101 pounds, and has gained 15 back in the last 2 years. She doesn't have to work very hard to keep the weight off. My aunt had the Sleeve 3 years ago (not sure what month) and lost about 50 pounds, she doesn't work out, but she drinks shakes regularly, but has still gained back about 10 pounds in the last year. My brother had the Sleeve 3 years ago in November, he lost 60 pounds, gained back 25 because he got "sloppy" (his word) so he started working out and watching his food intake, and lost 20 of those pounds.

-When I first met with my surgeon, he explained to me that with the Sleeve, you lose about 60-70% of your fat; with the RNY, you lose about 70-80%. He also explained that within 5 years, people who have the sleeve gain an average of 5-10% and people who have RNY gain 10-15% back.

Honestly, I would see a different surgeon. You have quite a few other things to consider, like the oral chemo, and you need a surgeon who is 100% on your side and not just trying to make the most money off of you. I mean, from what I've read about you, I would do the Sleeve, and I'm a huge RNY person. You should never do anything that makes you feel uncomfortable.

Let us know what you decide!

[GBLady41 393]

Mayastone,

I'm reading this book, The Complete Idiot's Guide to Eating Well After Weight Loss Surgery. I just started but it does say that "It's also important to realize that over time, your gastrointestinal (GI) tract adapts or evolves by increasing its absorption of more nutrients and, therefore, calories." - pg. 6 (Nutrional Needs After Weight Loss Surgery)

This is something I didn't know. I thought the malabsorption never stopped. It might be a good idea to check this book out. ????

[kmc0812 13]

I did feel that way. But ultimately I know that this will be the best option for me in regaining my health. If you aren't comfortable, tell your surgeon that it's not what you want to do. You are your best advocate. You know you and your body better than anyone else on this earth. Do what feels right for you.

I did feel that way. But ultimately I know that this will be the best option for me in regaining my health. If you aren't comfortable, tell your surgeon that it's not what you want to do. You are your best advocate. You know you and your body better than anyone else on this earth. Do what feels right for you.

By "this", I mean bypass. =)

[quiltermom65 38]

I'm still pre op and when I went to the informational talk by the health educator and doctor I feel they really pushed the RNY. I had originally wanted sleeve for most of the reasons you do. I don't yet have co morbidities, didn't like the idea of dumping etc. However I do have gastritis and acid reflux and decided for me I think I'll do the RNY because of that. I'm not a gambling woman and didn't want to end up with worse reflux after the sleeve. I think doctors push the RNY because that's what they are used to. Because of your past cancer I would agree that the sleeve may be better for you, but that's a discussion you need with the bariatric surgeon and an oncologist. Good luck to you and whatever tool you decide on will be the better choice for you.

[Inner Surfer Girl 12,015]

I have an awesome surgeon and he does almost all sleeves. It sounds to me like she has a bias toward RNY. Maybe she is more comfortable with it. It wouldn't hurt to get a second opinion if you think the sleeve is right for you and she isn't on board.

[Pinkgirl1234 761]

Listen to your doctor!!!!

[Pinkgirl1234 761]

I was all set to request a revision from this miserable band to sleeve...after research ...the Gold Standard of WLS...the data is there...no more "flavor of the month procedures...this lapband is pure misery

[Djmohr 6,965]

I would honestly see a new surgeon. A lot of the information you articulated is not correct. Either she misinformed you or you misunderstood or a combination of both.

Given your health history and the fact that you have no comorbitities the sleeve may be the right thing for you to do and if she is pushing the RNY for her own reasons you don't need that.

There are plenty of people on this site who have lost just as much weight with the sleeve vs. bypass. You just have to work harder at it.

Now all surgeries require exercise to be part of the winning solution if you intend to get to a healthy weight. Trust me when I say, I cannot simply eat differently and lose all my weight. That is part of the commitment. I had bypass and am a big supported of the right surgery for the right person and you must include ones health history into that decision.

Personally, I would get a new surgeon if I was uncomfortable with their approach.

[Pinkgirl1234 761]

In the end it is your choice...the doctor will perform the sleeve if you want it...YOU need to take control!do your research and make a decision...you after all have to live with it.

[GBLady41 393]

I agree with Pinkgirl1234. You don't need to change doctors. I would check with your oncologist, do some more research and tell your surgeon which surgery you want. At the end of the day, it is your choice and yours alone.

[Pinkgirl1234 761]

By the way I had metatastic breast cancer in 2012...I am opting for the bypass...I was until next week going to get the sleeve.My stomach and esophagus is severely damaged from the band ...right now I am sitting up because this band has decided that it wants to reject my medication...including Anastrozole....cancer medication...the band doesn't discriminate!I want to heave but can't...its one of those nights for me....my acid reflux is over the top!

At the same time my friend who had the sleeve 2 months ago is quite happy...she is a 1st timer...excuse me...I need to throw up now..,goodnight.

[drmeow 323]

One thing I would caution you about regarding the sleeve - it is not less invasive, even though that seems to be a big reason some people choose it. Yes, your intestines are not re-routed, but hey, most of your stomach is actually removed for good! you can't get that back if there are problems. With GB, everything is still there and can theoretically be revised back to normal (I think I've seen it called a takedown)

For me, I'm not a huge volume eater; it's more about eating the junk - the fast food, the carbs, etc. I can stick to low carb for awhile but then go off-track and lose my momentum, get all the cravings back, etc. So I have chosen bypass b/c I need the possibility of dumping to keep me straight, at least long enough for me to learn better longterm habits. Just my 2 cents.

[leroy mann 19]

Definitely not, but I have done research on my own and the sleeve is nowhere as effective as the bypass, I will put it like this, why try the sleeve only to possible have to go back and redo the surgery? GI with the real deal from the get go! I did and I am extremely happy!!