Can't decide between Sleeve and By-Pass

[Doo Lally 8]

6 hours ago, Ldyvenus said:

I feel like 300lbs. Should be the cut off for the sleeve. The bypass generally allows for more weight loss because of the malabsorption. But, I also know people on here at much higher weights who are rocking the sleeve. I guess it really depends on your desired goal weight...

Thanks for your thoughts and the reminder that there is a lot of info for me to find on this forum. Being new, it's a bit of a challenge to find my way around yet.

[Berry78 4,261]

The weight loss difference between sleeve and bypass isn't big enough to really make a decision based on that. That last 10 pounds isn't what makes us sick.. it's the first 60.

The diabetes, on the other hand, does respond to the greater metabolic impacts of the bypass. To give you a rough idea: 4 diabetics get a sleeve, and 4 get a bypass. 2 of the sleeve diabetics have improvement long term. 3 of the bypass diabetics have improvement long term.

Those odds may or may not be a deal breaker for you. Diabetes can frequently be minimized through dietary choices as well, so by time you get surgery AND change your diet, things are bound to be better, regardless.

[Apple1 2,572]

I have a had a remission of my type 2 diabetes with the sleeve. I was not insulin dependent and had been on medication for 3.5 years.

I have been off all meds since 2 days post op and my bs are normal.

[OutsideMatchInside 10,166]

I discussed it with my Dr and we decided since I was young and active the Sleeve would work for me.

I also didn't want a long term high maintenance surgery. Long term the sleeve has pretty low maintenance levels compared to other surgeries. as long as you don't have GERD.

If you have GERD, RNY is your only option really, it isn't worth having the sleeve and risking a revision later on.

[Wendy Kreck 7]

When I first met my surgeon, I was on 50 units of Insulin daily. I was 256lbs and had had heart bypass surgery years ago and then a stent put in August 2016. Our decision was to go the bypass route due to the diabetes. Due to the Plavix tablet I had to take for a year, I could not have my bypass until now, and I am due to have it on September 22nd. I can't wait.

When I saw the Dr yesterday he was delighted that I had lost 34lbs since my last appointment with him and was even more delighted to hear that I have reduced my insulin to just 15 units per day. As I have improved so much, through hard work these past months, he said if I would prefer to have the sleeve he wouldn't be against it. I thought for about 10 seconds, and told him that I still wanted the bypass as I desperately want to get rid of my diabetes and feel this is the best chance I will have. My dad had diabetes and was VERY overweight, and almost lost his leg from ulcers caused by diabetes. He has since died, from complications from the disease.

I do know there is no guarantee that my diabetes will disappear, but I have proved already that with diet and exercise I can probably get off the insulin at the very least;

Good luck with your decision. You have time to get all the information out there and then to make a very well informed decision with your Doctors help.

[Marblicious 130]

My BMI was 61 with insulin resistance, High Blood Pressure, and High Cholesterol. I was advised by my surgeon to have the Gastric Sleeve. I am more than happy with the result. I have resolved the insulin resistance and cholesterol issues already, asthma and mobility are much better as well. Working on the high blood pressure now

[CJ Sunshine 241]

I chose the SIPS because it has higher rates of weight loss than either VSG or Gastric Bypass. It does have malabsorption risks but I feel confident those can be well managed with commitment to supplements and follow up.

[dreamingsmall 1,125]

13 hours ago, Doo Lally said:

I shared the info on myself that I thought was most pertinent, I don't have a surgery date set, won't even meet the surgeon for months yet. I tried to go back and edit in my weight etc., but find it a challenge to do so. I was not aware that I had to provide certain info to post.

I'm glad your choice worked out for you so well.

No you dont have to do anything at all no requirment i just meant for example if you said you were on tablets that if you had malabsorption surgery may make you sick, as you were saying you cant decide, i might have said " the sleeve doesnt cause malabsorption issuesas a pro and sort of thing so that may help you kind of thing lol was only trying to help on my limited info lol , i just meant abit of info may have helped with the discussion for pros and cons etc, good luck

I dont know about the future il let you know how well it works when i hit goal but i just meant so far its helped be get of blood preasure meds so hope it continues to help with other things.

Edited September 10, 2017 by dreamingsmall

[XYZXYZXYZ1955 675]

I seem to have had the "wrong" surgery according to much of the advice here . . . I had the sleeve even though I was above 300 pounds and have both diabetes and GERD. I don't think I was misinformed, but perhaps: I was told diabetes disappeared for 84 percent of patients who had the sleeve. I'm about two weeks post-op and I've reduced my daily insulin dose by a half (and I was taking a lot, 120 units a day). My numbers have been very good.

I'm not obsessed with my goal weight--I'd like to be under 200 pounds, I'd like my knee pain to go away, and then, it would be great if my BMI would be normal (so, I would then meet my goal weight). I hope my diabetes disappears. But it's far too soon to tell how any of this will work out--for the moment, I'm good with what's going on. Just want to be consuming Protein other than from shakes, basically . . .

[Berry78 4,261]

14 minutes ago, XYZXYZXYZ1955 said:

I seem to have had the "wrong" surgery according to much of the advice here . . . I had the sleeve even though I was above 300 pounds and have both diabetes and GERD. I don't think I was misinformed, but perhaps: I was told diabetes disappeared for 84 percent of patients who had the sleeve.

You probably were told correctly.. a large percentage of sleeve patients DO experience diabetes improvement or remission postop. The problem is that many of those patients have diabetes come back. I do need to go and get some sources.. my numbers are just generally off the top of my head, and could be quite wrong.

Diabetes is kinda a borderline issue. Some people REALLY want the best chance of remission forever, others don't worry too much. Personal decision stuff.

The GERD issue can be a bit hairy too. My surgeon says if you only get occasional heartburn from rich/spicy foods, then the sleeve is a good option. If you have severe GERD that isn't food-related, then there is a small chance it will actually improve with the sleeve, but worsening symptoms happen all too often. GERD isn't just uncomfortable, it's dangerous too. (linked to esophageal cancer).

But don't despair. Something like 75% of bariatric patients have GERD going into surgery (likely so high because the extra weight of the abdominal fat on the stomach creates a high-pressure environment.. essentially pushing the acid up and out of the stomach into the esophagus). But, more than 50% of procedures are sleeves.. so obviously many people with GERD are getting sleeved.

A certain percentage of sleeve patients are getting revisons to bypass if their GERD is too bad (and lots of them didn't have GERD to begin with).. so there's always that if you end up having trouble.

Ultimately everything about this surgery is a risk and playing a numbers game.. we all jump in, hoping for the best, and let the chips fall where they may. If complications happen, handle them as they come. Ultimately, the VAST majority of patients are thrilled with their surgery and results. So.. no worries!

[Berry78 4,261]

Ok, I just went to find those stats, and found something better! Apparently I had some things backwards!

http://www.medscape.com/viewarticle/879917

http://riskcalc.org/Metabolic_Surgery_Score/

[XYZXYZXYZ1955 675]

2 hours ago, Berry78 said:

Ok, I just went to find those stats, and found something better! Apparently I had some things backwards!

http://www.medscape.com/viewarticle/879917

http://riskcalc.org/Metabolic_Surgery_Score/

Thanks--I do love the statistics. The first link didn't work for me because I'm not a member of the site, but the second said that the sleeve was recommended, barring other factors.

I basically think my surgeon is a genius, so I'm good overall with the decision. Time will tell, of course. My major issue at the moment, other than hating Protein Shakes, is lack of energy. But I'm assuming that, too, will improve eventually.

[Berry78 4,261]

Oh, absolutely trust your surgeon.. they're the experts!

Your energy will return. Sometimes it just takes a while. Personally I started feeling normal levels of energy about 3 months postop.

Sorry about the link. I got to the page through a google search. Basically it was just explaining that the people can be categorized according to diabetes severity as to whether they should get a sleeve or bypass.

Mild diabetes is good for both surgeries, but the bypass did perform a little better.

Moderate diabetes had significantly more improvement with bypass.

Severe diabetes didn't respond as well to either surgery, so the lower risk surgery (sleeve) was the best option.