Weight regain sleeve vs. bypass

[P7rancher 27]

One of the surgeons in the clinic I am using is adamant that they are seeing more issues with weight regain after sleeve compared to bypass. I have not been able to find any research to back this up. Any help would be appreciated as I have my mind wrapped up in the sleeve surgery not the bypass.

Thanks in advance

Edited May 19, 2016 by P7rancher

[Kindle 8,667]

Weight regain is based on a patient's ability to make the necessary lifestyle changes and continuing to adhere to a bariatric friendly diet plan, NOT what kind of surgery they had. The type of surgery doesn't dictate success or failure, an individual's behavior does that.

I will add in an exception....with the malabsorption of bypass, you may be able to get away with eating off plan without regain more so than a sleeve patient. I have two good friends that had bypass almost 10 years ago and I would certainly regain if I ate like they do. However, they suffer from a variety of illnesses related to nutritional deficiencies. Personally, I'd rather take on the added accountability and stick with the healthier lifestyle required in order to maintain my loss.

And as for studies comparing weight gain between the two surgeries you probably won't find that many. VSG just hasn't been around long enough to have accumulated enough long term data. But really, that data is only going to tell you what OTHER people have done, not what YOU are capable of.

[TheRealMeIsHere! 863]

@@Kindle EXACTLY what I was going to say!!

@@P7rancher It all depends on how well you use your "tool" The malabsorption of the sleeve may make it so you have a little more leeway, but there are also downsides to malabsorption.

[KristenLe 5,979]

My surgeon recommended the sleeve - he said I may not lose as quickly but I should be able to lose as much as I need to in 12-18 months. I'm okay with that. I'd rather lose slower and not have to deal with malabsorption. My Team feels I need restriction only. I'm going to my 1st group next week so I'll be curious to hear from some of the post-op folks.

[BestDayEver 418]

Check out the bariatriceating Facebook page. Many of the people using this site had bypass and struggle with regain. It's been an eye opener for me and I'm grateful I have the sleeve.

My sister had bypass and has regained most but not all of the weight back but she has terrible eating habits. Long story short, you have to commit to changing the way you eat for the rest of your life regardless of which surgery you choose if you want to maintain the weight loss. I say this based upon what I read from those that are years out. I've been maintaining for a couple of months.

[Inner Surfer Girl 12,015]

I would like to see a comparison of people with malnutrition between the sleeve and RNY. I bet that is a more interesting comparison.

[P7rancher 27]

Thank you for the replies. I guess i'm a little surprised that given the number of years the sleeve has been being performed (since around 2001 I believe in the USA) and the many thousands performed that there has not been more comparison research accomplished. My BMI is around 42, I have been able to lose significant weight in the past by diet and exercise (2008 start 295 lbs. five months later lost 70 lbs. down to 225 lbs.). Injured my knee, poor insurance, delayed surgery for three years, regained 85 lbs., currently around 310 and able to do only limited exercise.

The point of this life history is that my research suggests that if you have been able to change your set point by diet and exercise then the sleeve should be as effective as the bypass in accomplishing long term weight loss. Also, a starting BMI in the mid to lower 40's seems to also indicate a sleeve will be successful. One source of this research is Dr. Weiner and his excellent videos.

I'm 67 and I need a tool to get back to being active. I can't exercise enough, even with a good diet, to lose weight. My historic metabolism shows that I have been able to change my set point. i know that many people can't change their set point and that is where I believe the bypass with the addition of the malabsorption provides a significant benefit.

I wish there was more research on the personal characteristics and life history of a patient that would suggest one technique, sleeve vs. bypass, over the other.

Please feel free to critique or add to my research findings.

Edited May 20, 2016 by P7rancher

[Kindle 8,667]

I wish there was more research on the personal characteristics and life history of a patient that would suggest one technique, sleeve vs. bypass, over the other.

Please feel free to critique or add to my research findings.

Unfortunately an individual can't have bypass and VSG at the same time so you will never get a perfect apples to apples comparison of the two surgeries. And there are too many variables that go into someone becoming obese to ever be able to plug in some numbers and get a definite answer to which surgery is best. Your decision has to come down to weighing your personal pros vs cons and what your priorities are.

And unfortunately for the number crunchers that like to try and simplify the answers with statistics, Collecting long term data from all those thousands of patients for comparison is also very difficult. Mostly because of the elective, mostly complication-free nature of the surgeries.

Here's what I see happening...,For those that are successful, they've moved on and likely do not require follow up care. Why would they check in 10 years later just to let their bariatric team know how they're doing? On the flip side, those that fail may be embarrassed or resentful and again, don't follow up. Seems the majority of long term data would come from those that may not be entirely successful but are continuing to seek help, or from those with complications. Makes for pretty biased statistics. And then there's the thousands that have gone abroad to have surgery. I went to Mexico, and the facility I went to is a Center of Excellence so they send me surveys every year. I do return them, but I am probably in the minority of patients that do. And as far as the US healthcare system is concerned, I never even had WLS. So my 100% success will likely never get recorded in any study performed in the states.

[P7rancher 27]

In one of Dr. Weiner's videos he states that the sleeve is more appropriate for patients with a faster metabolism.

How can your metabolism rate be measured?

Thanks in advance

[brittu 42]

You can have your metabolism tested. It's a breathing test with a computerized monitor. My doctor does it to calculate caloric needs as well as improvement in metabolism related to exercise and carb reduction.

Also, the DS is a sleeve plus a different type of bypass. It's the most effective of the surgeries but can have complications related to malnutrition. There are fewer surgeons who do it.

Sent from my iPad using the BariatricPal App

[OutsideMatchInside 10,166]

If I was 67, I wouldn't take the chance on having my intestines touched. Too many issues can happen. The sleeve is a faster and easier surgery. You have to think about recovery too.

Bypass makes them more money than the sleeve because they operate longer.

The bypass part can help you lose weight faster in the short term. Long term you never know how much malabsoprtion you will keep, and it comes with other issues.

You have to live with this decision, no one else, not the Drs, not us. Good luck in making your choice.

[VSGAnn2014 12,992]

OK, I'm gonna throw this out there ...

Maybe the surgeons at your local clinic don't know how to do sleeves correctly?

Seriously -- the more I read about the sleeve, the more persuaded I am that your surgeon's skill in shaping the sleeve and their skill in using the surgical stapler is critical to your long-term success. If they screw up the shape or the width of your sleeve at any point along the staple line, don't leave enough room near the hiatal valve at the top and near the pyloricc valve, and don't remove all the stomach fundus, you won't ever have the full benefits of your sleeve's potential restriction and/or ghrelin reduction.

FYI, my surgeon (who's done thousands of WLS surgeries over the last 15+ years) is tremendously enthused about his sleeved patients' long-term successes.

On a different point, I learned yesterday that he has quit doing ANY lapband surgeries.

[OutsideMatchInside 10,166]

@@VSGAnn2014

I never thought about it like that, but you might be onto something. My doctor only does sleeves, because he takes out too many lapbands, and he doesn't want to deal with bypass. He is enthusiastic about the sleeve, and he sees that it works with few complications. People that really need bypass or DS he sends to another Doctor.

And yeah, reading forums over the years, it is pretty obvious the sleeve is dependent on the skill of the surgeon. There are so many people that post that have issues that would never happen if they were properly sleeved in the first place.

[VSGAnn2014 12,992]

Thanks, @@OutsideMatchInside .

But I hasten to add that this theory of mine is just that -- a theory. It's sparked, however, by things I've read that were written by surgeons who do a lot of WLS and on outlier, negative results reported by some sleeved patients. (I've been reading WLS boards for almost three years now.)

Long story short, if I were choosing a sleeve surgeon today, I would be asking much more detailed questions than I did two years ago. I'd make the questions open-ended and encourage the surgeon to talk as much as she/he wanted to. E.g.:

* What can go wrong during the surgery with the surgical stapler that you and other surgeons use?

* In what percentage of those WLS surgeries you have performed has the stapler(s) "screwed up"?

* How do you think your skill with the surgical stapler compares to those of other bariatric surgeons?

* When you're shaping the sleeve, what are you trying to achieve? And how do you do that?

* What other tools do you use to shape the sleeve?

* Would you draw a picture that shows how much of my stomach you're going to remove and how my sleeve will look after you have shaped it?

* Months post-op, after the sleeve has healed, what does the ideal sleeve look like next to the hiatal valve and next to the duodenal valve?

* Do you ever leave any of the fundus during surgery -- and if so, when and why would you decide to do so?

FTR, I've never had any problems with my sleeve (so far). My post-op recovery was pretty easy. My mild acid reflux (which I had pre-op) is about the same as it was pre-op. I've never thrown up post-op. I've followed my surgeon's eating protocols closely. I'm maintaining well (so far).

Knock on wood.

[stacyrg2 350]

Thanks, @@OutsideMatchInside .

But I hasten to add that this theory of mine is just that -- a theory. It's sparked, however, by things I've read that were written by surgeons who do a lot of WLS and on outlier, negative results reported by some sleeved patients. (I've been reading WLS boards for almost three years now.)

Long story short, if I were choosing a sleeve surgeon today, I would be asking much more detailed questions than I did two years ago. I'd make the questions open-ended and encourage the surgeon to talk as much as she/he wanted to. E.g.:

* What can go wrong during the surgery with the surgical stapler that you and other surgeons use?

* In what percentage of those WLS surgeries you have performed has the stapler(s) "screwed up"?

* How do you think your skill with the surgical stapler compares to those of other bariatric surgeons?

* When you're shaping the sleeve, what are you trying to achieve? And how do you do that?

* What other tools do you use to shape the sleeve?

* Would you draw a picture that shows how much of my stomach you're going to remove and how my sleeve will look after you have shaped it?

* Months post-op, after the sleeve has healed, what does the ideal sleeve look like next to the hiatal valve and next to the duodenal valve?

* Do you ever leave any of the fundus during surgery -- and if so, when and why would you decide to do so?

FTR, I've never had any problems with my sleeve (so far). My post-op recovery was pretty easy. My mild acid reflux (which I had pre-op) is about the same as it was pre-op. I've never thrown up post-op. I've followed my surgeon's eating protocols closely. I'm maintaining well (so far).

Knock on wood.

I think those are excellent questions to ask. I'm currently preparing for a conversion from sleeve to bypass . . . not because of weight loss issues, I'm maintaining a 120 lb loss 2 years post surgery, but because of GERD uncontrolled by medication. At one of my appointments, I asked my surgeon to draw out the procedure to explain how it will eliminate my GERD and reverse the damage to my esophagus. He did, and it was amazingly helpful. ( I have that drawing hanging up in my office . . . my bit of modern art.) Anyway, I think it's beneficial to everyone to ask pointed, precise questions so they understand what is being done to their anatomy.