Gastric bypass versus sleeve for the 300+

[Phynale 9]

I finally had my first visit and the surgeon is recommending that I get the bypass while I was already heavily in the sleeve camp. He said he's not trying to talk me into it but that the bypass would be better for me since my biggest problem is eating the wrong foods.

I am 57 years old and weigh well past 300.

Can you give me your opinion on this topic? I'm assuming most of you will go with what you chose but if you can be objective for someone in my situation what would you advise?

The other difference is that I am a cash pay patient so I believe the difference is going to be an additional 4k out of pocket to get the bypass. I keep reading good things about the sleeve but also read the bypass is the gold standard and that you lose more weight with the bypass.

Is that still true?

Thank you to everyone that responds.

[OutsideMatchInside 10,166]

If eating the wrong foods and not Portion Control are really your issue, bypass might be a better option. Once most people heal from the sleeve you can eat almost anything.

[Phynale 9]

I do overeat too but mainly just the foods I really like. Either that or I try to eat right and I'm not satisfied so I keep getting something else and something else until I finally get what I wanted in the first place.

[Daisee68 2,493]

I was in the same boat as you. At my consultation, I was having very bad acid reflux and the dr suggested that bypass would be much better because many with sleeve (not all) have increased acid reflux after surgery. I was dead-set against bypass and left there upset but did finally come around to it (a lot thanks to this site). I would say this though - not every with bypass gets dumping syndrome (likely the drs reason for saying it would be best for you because of the foods you eat). I do not have dumping (or at least haven't thus far at 7 months post-op but I am very careful about what I eat - so far). In the end, I am quite glad I did the bypass.

[jj7481 363]

My choices came down to sleeve vs. bypass. I ultimately decided on bypass due to several reasons:

1. The plumbing is rerouted, but remains in your body. With the sleeve you lose a majority of your stomach that cannot be returned.

2. Bypass has been around for decades with a multitude of research about it's safety and efficacy.

3. My major problem was portions and Portion Control. This not only helps me lose weight but retrain myself to regulate the portions I eat, how fast I eat, and making sure I chew plenty.

[CowgirlJane 14,259]

They are both good procedures. I weighed 308 when I revised from band to sleeve 4 years ago and am maintaining in the 150s now. Here is what I think, if a person thinks any WLS is going to keep them from making"bad" choices over the long haul, they are likely to be disappointed. I have read that not all bypass patients "dump" and that extra help offen goes away over time. You must be committed to a lifestyle overhaul with either procedure or you risk regain.

The sleeve helped me change my relationship with food for several reasons, but I think the key was the elimination of the 24/7 drive to eat, constant hunger. Years later, My hunger is now what a normal person experiences and that period of time of no hunger helped me figure out how to keep it in check and how my choices dictate my hunger drive.

They each have risks, and benefits. The bypass has a much longer proven track record. I had my , probably somewhat irrational reasons for avoiding the bypass, but I guess in the end I came to "believe" that the sleeve would help me and i proceeded to make sure it did. Research, and decide which seems to fit your life better and go for it!

[Pinkgirl1234 761]

Listen to your surgeon.I didn't back in 2004 ...wanted the" less invasive procedure"...proved to be the worst decision and now I have finally gotten what I should have done to begin with.The bypass...Gold Standard.When yo have a lot of weight to lose why play games.?

[JamieLogical 8,708]

I don't think anyone on these forums can answer this question for you. We all made out choice based on our OWN priorities and criteria. It's tough to put ourselves in someone else's shoes (especially with so little knowledge about that person). Both bypass and sleeve are excellent options with the potential for success. So much of the outcome will depend on YOU and how you use whichever tool you are given. People with bypass do tend to lose weight more quickly, but not necessarily more weight overall. Here are some of MY reasons for choosing sleeve, but they may not be YOUR reasons.

• Terrified to have my plumbing all rerouted and the additional risks associated with that.
• Didn't want to lose the use of my pyloric valve.
• Worried about the idea of my old stomach still just sitting inside of me where it could potentially develop ulcers or cancer and not be accessible with a simple endoscopy.
• Malabsorption is permanent. It may help you lose weight more quickly in the beginning, but it doesn't magically go away at goal. That might make it harder to STOP losing weight and means life-long risk of Vitamin deficiencies.
• Dumping syndrome. On the one hand, this sounds like great aversion therapy to keep me from eating sugary foods, but on the other, I wanted to ultimately be able to eat any food I wanted. Plus, there are no guarantees patients will even experience dumping syndrome in the first place.
• With sleeve, I felt like I could ultimately lead a more "normal" life. While I still have to be on Vitamins forever and focus on "Protein first", I can eat anything at all (just not much of it). Plus there aren't so many risks of complications years down the road and no special precautions that need to be take with future medical procedures or medications.

[Chrystee 838]

I started at 314. I am definitely addicted to foods. At 10 months out, I can eat without restriction, so I would agree with him, if you don't think you can be disciplined after, then the bypass would probably be best. There have been times I wish I would have went ahead with RNY.

[snickysnack78 131]

When I originally started my journey, my heart was set on getting the sleeve surgery. It wasn't until I met with the surgeon the first time that he thought I would benefit from gastric bypass. I was a full blown diabetic at the time, who had to take insulin at night as well as meds, and had high blood pressure. The surgeon mentioned that I could go with the sleeve, however if I am not happy with my progress, I would have a sleeve to bypass revision. I only wanted to go under the knife once, so I eventually decided on bypass. Its been almost 7 months since I had surgery and I cant tell you how happy I am with the results. I was almost400pds when I started, and I am now in the 200s. I still have a long way until I meet my goals, however I am no longer diabetic by medical standards, they even took it off my medical chart.

I say good luck to you in whatever journey you decide. You may want to make a list pros and cons for each, and see what you come up with. You are the one in this

[4MRB4PHOTO 3,900]

Asking a question is good, but I recommend you do extensive research from major bariatric surgery center of excellence hospitals, JAMA, ASMBS and other respected publications, attend a WLS informational meeting, WLS support group meetings and discuss your findings and concerns with your PCP and surgeon to address your specific medical needs.
Good luck.

[Ruin's Angel 6]

I joined a couple of bariatric support groups on Facebook and listened to those that have gone through both procedures to help me make my decision between the sleeve and the bypass. After a lot of research I have decided to go with the bypass and here are my reasons why:

1. Sleeve is not recommended for people with heartburn and acid reflux and I have a problem with this.

2. I noticed a lot of people that have had the sleeve reported frequent stalling of weight loss as well as more frequent regain as opposed to bypass patients.

3. I also need the discipline that gastric bypass provides. Just knowing I may dump from eating something bad (whether I actually do or not) is enough to stop me from eating it. I am afraid that knowing I would be able to eat whatever I want with the sleeve is going to make me do just that, and that may lead to overeating since I have problems with Portion Control and eating when I am not hungry.

Good luck with whatever you decide Phynale! Btw I am 392...

Edited January 14, 2016 by Ruin's Angel

[MichiganChic 3,262]

It's a tough decision, and one only you and your surgeon can make for you. I had the choice of either, and was leaning toward the bypass, but changed my mind at the last minute. I have a need to take NSAIDS, and I wouldn't be able to with bypass. I was also concerned about malabsorption, and didn't like the idea of dumping. I wasn't diabetic, so that didn't factor into my choice. I felt like the sleeve would keep my body functioning more "normal".

Fast forward 3 years, and I'm glad I made the choice I did. I have to take ibuprofen every day, and have done so without difficulty. I wasn't hungry at all for a while, now it's what I think is normal (like regular people probably have). I do not have reflux, unless I eat too much. I always wonder in the back of my mind if I would have lost a few more pounds with bypass, but honestly, it would not have improved the quality of my life at all.

I have to work at maintaining my loss. Rest assured that either surgery will require that! For either procedure, it comes down to what you do with it.

[Pinkgirl1234 761]

Get started .pick one and get that excess weight off.Your journey begins as soon as you start.

[Indi 5]

The bypass is the gold standard because it is older and therefore has more data backing it up. But I think the sleeve will surpass it in a few years. The sleeve is a easier surgery. No malabsorption or rerouting of intestines. I do agree that if you have a hard time making the right decision with food and you don't think you can get it under control then maybe the bypass is better because of the dumping. Also the sleeve's results in weigh loss seem to be a bit smaller then the bypass. But if you put all your effort and do some exercise you can lose tons of weight. Some people can lose 200lbs with the sleeve. It's what you put into it. I hope I helped you make your decision. Good luck!!!