Why sleeve and not bypass?

[wannaBthinsoon 1,634]

@@VDLT Ditto!

[JamieLogical 8,708]

For me the choice was easy. Here are my reasons for not choosing bypass:

• I had a lower starting BMI with less than 100 pounds to lose, so felt I didn't need such a "drastic" surgery.
• Hated the idea of my detached stomach and intestines still just sitting inside me where they could still develop ulcers, cancer, or God knows what else while no longer being accessible with a simple endoscopy.
• Didn't like the idea of losing the use of my pyloric valve.
• More disconnections and reconnections meant higher likelihood of leaks.
• Potential for dumping syndrome.
• Potential for malabsorption and vitamin/mineral deficiencies.

Bonus benefits of sleeve over RNY:

• The stretchy part of your stomach (the fundus) is removed with sleeve, but only partially removed with RNY.
• The part of your stomach that produces ghrelin (the hunger hormone) is removed with sleeve.

I want to emphasize that these are MY reasons. RNY is a hugely successful and proven solution and is a fantastic option for a lot of people. You should figure out what is most important to you and what you can live with long term, discuss your goals and concerns with your surgeon, and figure out what the best option for YOU is.

[bikrchk 1,313]

I asked the same question to my surgeon and he did not make the recommendation for me, (thought he does for some based on their particular medical conditions). Instead, he lead me through the pros and cons of each procedure. For me, I was not full blown diabetic, (which can lead to a bypass decision) and I had 90-100 pounds to lose. Definitely no more. We finally decided that I didn't need the extra malabsorption (and the potentially more intense side effects) that comes with the bypass to be successful and went with the sleeve. I had some minor reflux, (which can also lead to a bypass over sleeve decision) but my doc attributed it to a hiatial hernia that would be repaired during either WLS procedure. I reached goal with no major issues 9 months after being sleeved and have settled into maintenance so I guess it was a good decision!

[JamieLogical 8,708]

With the sleeve you still have to take Vitamins everyday correct? So what's the difference between taking them with the sleeve and with bypass?

With sleeve you are sure to absorb the Vitamins you take. With bypass, you could potentially still not absorb the vitamins, even with supplements and have to resort to injections or other more extreme solutions. It's not about taking vitamins or not, it's about being confident you are getting the full benefit from them. Also I know a bypass patient who have to take more vitamins than I do, because she developed deficiencies in the fat soluble vitamins (E & K). So, while I do have to take vitamins everyday, I don't have to take as many as a bypass patient might potentially have to.

[kondasa 28]

I chose the sleeve for all the reasons listed including:

• lower recovery time (2 weeks recommended out of work for sleeve and 3 for bypass). I am taking 7 days off work in addition to the two weekends. I am not telling anyone and just using vacation time.
• I am at a 40 BMI, in my young 30s and no health related issues-- so while the bypass was sold as the gold standard, my doctor said I was not a good candidate because the bypass is a bit more extreme. He said if I had Diabetes he would give me the choice... but for me I didn't really have an option.

[Inner Surfer Girl 12,015]

Just something to keep in mind:

Many people assume that a higher starting BMI automatically means that bypass is the best choice. That is not necessarily so.

[bigbit 99]

I have two chronic conditions for which medication is essential to my well being, so could not have a procedure where the result would cause malabsorption. It was the sleeve or nothing for me.

[cindyw41 761]

My choice was simple...I didn't want the non used part of my stomach still in my body so I chose the sleeve.

My doctor reccomened it obviously for more scientific and medical reasons lol

[rnsamantha 352]

I was worried about long term malabsorption and Vitamin deficiencies with bypass, so I elected for the sleeve. My surgeon said I was a good candidate for either (my initial BMI was 41)

Samantha did your BMI drop below 40 during your pre-op process? If so, how did your insurance company handle that?

I was afraid to lose and to be honest, my surgeon advised me not to lose to much during my 6 month supervised diet. Subsequently, I only "lost" 6 lbs in 6 months which brought my BMI down to 40 (and for that last weigh in I kept my phone, keys, heavy necklace etc. all on!) I think it depends on your insurance. In the end I had mild sleep apnea on the required sleep study, which meant I met the "comorbid condition" requirement so my BMI could be 35+. I have Meritain insurance.

[rnsamantha 352]

Also to clarify, you still need to take Vitamins following gastric sleeve, and there is still potential for deficiencies with both sleeve and bypass. For me personally, I perceived the sleeve as having a lower risk for malabsorption because it did not involve bypassing a portion of my small intestine. Bottom line: there's benefits and risks to both surgeries.

[tmcx28 297]

My only issue was being hungry constantly, I was hungry and I over ate so I got fat. I have no comorbidities so the bypass just didn't seem right for me. I'm very happy with my decision. At 2 and a half weeks out I DO get hungry, but I eat my small portion and I'm completely satisfied. I have no desire to overeat (I'm pretty sure my sleeve would protest even if I tried!).

[WalkOnWaking 139]

Yes I'm wondering that too, I'm at 42 now and scared to "lose" because I have heard insurance has denied people due to dropping BMI.

I asked exactly this of my insurance company (BCBS of Ohio). I was given a link to the medical policy. It specified that my starting BMI had to be at least 40, or at least 35 with comorbidities. I was concerned about doing the six medically supervised dietitian visit would push me to being out of the BMI.

That's when they asked me to re-read: the STARTING BMI, not the BMI at the end of the 6 visits.

I think I called the insurance company a dozen times to learn how all this worked. I'll bet they are glad I'm done now! haha!

[Susan66 128]

Yes I'm wondering that too, I'm at 42 now and scared to "lose" because I have heard insurance has denied people due to dropping BMI.

In my case, my BMI at initial surgeon consultation was 40.2.

At the time we submitted to my insurance company it was 38.

[Pinkgirl1234 761]

Converting from lapband to bypass...my research...my lapband misery and damage to my esophagus and erosion ...Gerd...made it easy for me to know that cutting 85% of my stomach was not for me...I was initially going for the sleeve but for me bypass is a better option.....by the way my friend had the sleeve performed on her and her daughter 2 weeks apart and she is doing fantastic...everybody needs to do what they feel is right...and go with it.

[wannaBthinsoon 1,634]

Mine only had to show a loss. I lost 2 pounds. My BMI did not change. You need to "manage" this for your own benefit. The hoops they make you go through are sometimes ridiculous, and you need to play the game..."smartly". (is that a word?)