Sleeve vs bypass

[Monasmle 90]

Hi all,

I'm a 30 year old female, around 41/42 BMI. I'm 1 NUT session away from submitting to insurance. I initially went to my surgeon asking for the bypass, to which he said I'm not overweight enough for and wouldn't be worth the complications. He said he wouldn't even consider it for me. And I left it at that.

As I'm reading more, I'm having some doubts about the long term success with the sleeve. I know that one can be equally successful with both, but when looking at averages across many people, bypass wins out. In my mind, I would want to take the option that affords me the best chances at success forever. But I'm not sure if there are other considerations I'm not aware of (besides malabsorption and complications).

At 40bmi and above, I would think I am definitely eligible for it. I like my surgeon, but I'm not sure if I should search out for a second opinion.

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[Djmohr 6,965]

You should definately seek a second opinion. There are pros and cons to both surgeries and both are very effective at massive weight loss.

You and I are close to the same size and weight. I was 310 and 5'10" when I had my surgery.

I chose bypass because of the benefits related to gerd and diabetes among other things.

For him to tell you that you are not overweight enough does not make sense (no offense of course to your current weight)

I originally was going to have the sleeve and because of my gerd and diabetes we chose bypass even though i have Psoriatic arthritis. With the bypass i can no longer take nsaids which is not recommended post either but more so with the bypass.

Anyway, i could not be happier with my choice. I have had literally zero complications. I followed my plan from the beginning and stick very close to it now.

What complications was he referring to?

Lastly I would say either of these surgeries can get you to your goal and help you stay there. I have seen people on this site with both surgeries lose all of their excess weight.

[Travelher 915]

I would get a second opinion. it just never hurts. complication rate is not significantly different between the two surgeries. I went with bypass because i could not risk reflux with the sleeve having had it before. patch Vitamins are working for me, and sleeve patients also have Vitamin supplements in their regimen, just one less. i'd say the major difference seems to be the bypass portion which could give you dumping syndrome if you eat the wrong foods to excess (particularly sugary foods). I will dump if I drink a Protein shake too quickly so I slow down and am fine. I have had a bite of my husbands dessert and am fine and have no desire to test beyond that. The dumping syndrome appealed to me as an extra reinforcement.

bypass takes an additional 25 minutes to perform (75 vs 50 minutes). any surgeon you speak to should share how many of each surgery they have performed and should have their own personal complication rates for their procedures.

got these from my surgeon. first is bypass second is sleeve.

t are the chances I might die from this surgery and are there any other immediate risks?

SHORT TERM (bypass)Death* 0 % Staple line leak 2.1 % Internal bleeding 1.5% Colon perforation 0.1 % Deep vein thrombosis 0.4 % Liver/Spleen laceration 1.4 % Port site infection 1.2 % Heart attack 0.2 % Pulmonary Embolus 0.2 %

* - These are the statistics of Weight Loss Surgery team’s private practice from 2006-2015 with no mortality in over 1,000 cases

SHORT TERM (sleeve) Death* 0 % Staple line leak 2.2% Minor bleeding 1.5 % Liver/Spleen laceration 1.4 % Deep vein thrombosis 0.2 % Port Infection 0.9 %

What are the long term risks from this surgery? LONG TERM (bypass)Anemia 10 % Stricture of the stomach outlet 4% Stomach pouch ulcers 1.4 % Port site hernia 0.8 % Gallstones 2.8 % Small bowel obstruction 2.6 % Kidney Stones 2 % Vitamin/mineral deficiencies 2 % LONG TERM (bypass) Anemia 5% Stricture of the sleeve 2.0 % Stomach ulcers 1.4 % Port site hernia 0.8 % Gallstones 2.8 % Small bowel obstruction 1% Kidney stones 2% Vitamin/mineral deficiencies 1%

Edited January 6, 2017 by Travelher

[Monasmle 90]

Thanks guys. Does bypass have the same hunger lowering effects, even without the removal of the stomach?

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[Monasmle 90]

UPDATE: brought up the question and the surgeon has said they will not do a bypass on me due to my 'low BMI'. So my options are sleeve or to find another surgeon. I'm am now actively searching for second opinions, since my highmark BCBS insurance no longer requires the 6 month nutrition counseling, so I'm eligible to apply for approval now.

It has left a bad taste in my mouth, since that's really contrary to everything I've read about bypass in BMI ~40 patients. And I'm informed on risks and complications, but the long term security in the bypass results vs sleeve, have me really considering looking elsewhere.

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[Redmaxx 740]

I would be looking at a different surgeon. My BMI was lower than yours and my surgeon actually recommended RNY.