Which surgery should I choose?

[Separ1418 101]

My awesome surgeon has told me I can decide which surgery to have up until they wheel me in. I have a lot to lose 188 pounds to get to the weight suggested by my height and age. I don’t expect to get that low- at all. But I want to optimize my chances.

I first chose sleeve but now I’m leaning towards bypass. What was it that cemented your decision? My insurance will pay for either and the surgeon is not making a firm recommendation either way.

Which should I do??

[Chrisb428 626]

If you have acid reflux or similar issues then i was told not to do sleeve. I am having bypass next week. I chose it because Ive seen alot of revision stories (not saying sleeve isnt good or doesnt work because there are many success stories as well) but for me personally, I wanna make sure I only have to go through it once. I figure ill go all in. I realize i am at higher risk for Vitamin deficiencies, but i will happily replace my blood pressure meds etc. with Vitamins if it means being a healthier weight!

[L@A 11]

Losing close to 200 lbs will be an important accomplishment for you..Its a lot of weight..I’m inclined to recommend the Gastric Bypass. It is a very, very, strict tool in keeping you to your diet. And you must take your Vitamins daily. Which is a good thing!! Be really honest with yourself now...If you feel you need this discipline due to emotional overeating or overeating carbs, combined with an addiction to junk food/ sugar, or eating a lot in general, that’s the one.. your body will immediately let you know when you have blown it with the wrong kind of food., Dumping syndrome etc..Negative reinforcement.🤨.especially if your diabetic, high BP, in severe pain, or have other obesity related health issues, This is my opinion....The reason I say this is, because I believe the Gastric Bypass is MORE punishing than the Gastric Sleeve.. With the Gastric Sleeve, you can still eat pretty much the same, just smaller portions, chewed diligently, and of course, should be healthier, and take the vitamins daily. If you do cheat, you might not feel great for a short time, but everything is working like before, just a streamlined stomach.. Lifestyle change takes a lot of self awareness with sleeve.. With Gastric bypass, you really must do it, you don’t have a choice. They are both great tools, but if you feel like you need more of a highly disciplined approach with very quick results, and are addicted to food, Bypass. If you feel like you can lose 200 lbs using your own motivation, using the Sleeve to keep you in check, and are good at following directions and implementing change, then the Sleeve.. I know you will make the best decision in the days leading up.. you know yourself best. Be honest and congrats on your decision, Good Luck!🌺

[5XNoMo 1]

I had a similar discussion with my surgeon, and I really appreciate having time to consider the merits and challenges of each. The sleeve looks like an attractive option, but I have real concerns about regaining weight. And that seems less likely with the bypass. Taking Vitamins every day forever as required by the bypass doesn't worry me because I've been super-faithful about taking my meds for so many years. But dumping concerns me, especially the idea of it happening at work.

Without question, these are grownup decisions.

Edited August 26, 2018 by 5XNoMo

[Frustr8 7,886]

And join me too also my goal is 15JuniorAgain, will I make it? Jury is out but I am going to work to make it possible. Look for me in September 2019 or the Spring of 2020, I really am Going to Shine!⭐🌝⭐

[Born in Missouri 1,264]

My surgeon recommended the bypass for me, even though I went in thinking that I was the ideal sleeve candidate. I am confident EVERY DAY that I made the correct decision to go with the bypass. Vitamins aren't a big inconvenience or hardship. Once I understood my deficiency-risks and found the correct forms (ie. calcium citrate instead of Calcium carbonate and the best form of Iron, sublingual B12) and dosed my supplements according to "semi-established" guidelines, I felt assured that I made the best choice for myself. My goal is to lose weight and maintain that weight loss while also living in a healthy body. A gastric bypass seemed to fit that goal.

No one can make your decision for you. You live in your body. Hopefully, you understand what limitations you can handle. An informed decision is ultimately going to steer you in the right direction. Don't skimp on researching your options, and go with your gut instinct. Don't be swayed by what other people have done or plan to do. Typically, people want to convince you to go with what THEY would do or with the procedure they have done, which, in a sense, is validating their own choice. I'm no different. I'd probably try to sell you on a bypass. Don't be fooled by me or anyone else. Have faith in your own decision and feel terrific about your choice!

[Separ1418 101]

11 minutes ago, Missouri-Lee's Summit said:

My surgeon recommended the bypass for me, even though I went in thinking that I was the ideal sleeve candidate. I am confident EVERY DAY that I made the correct decision to go with the bypass. Vitamins aren't a big inconvenience or hardship. Once I understood my deficiency-risks and found the correct forms (ie. calcium citrate instead of Calcium carbonate and the best form of Iron, sublingual B12) and dosed my supplements according to "semi-established" guidelines, I felt assured that I made the best choice for myself. My goal is to lose weight and maintain that weight loss while also living in a healthy body. A gastric bypass seemed to fit that goal.

No one can make your decision for you. You live in your body. Hopefully, you understand what limitations you can handle. An informed decision is ultimately going to steer you in the right direction. Don't skimp on researching your options, and go with your gut instinct. Don't be swayed by what other people have done or plan to do. Typically, people want to convince you to go with what THEY would do or with the procedure they have done, which, in a sense, is validating their own choice. I'm no different. I'd probably try to sell you on a bypass. Don't be fooled by me or anyone else. Have faith in your own decision and feel terrific about your choice!

Thank you so much for this, I think with the amount I have to lose and the struggles with Portion Control - I think bypass is the right choice for me. Its weird but the program I am in just will not recommend one surgery over another, they leave it entirely up to me so I've been waffling a bit, which isn't like me.

I know my surgeon will support my decision so I am glad about that - he told me I could change my mind while they are wheeling me into surgery if I wanted!

[Born in Missouri 1,264]

@Separ1418 I'm hoping that your surgeon was mostly kidding about allowing you to change your mind up until being wheeled into the operating room. I wouldn't trust myself to be in the same frame of mind once I'm in that high-anxiety environment of a hospital on the day of my surgery. Besides, you may or may not have been given something to relax you, which may affect your judgment. Arrive the day of your surgery knowing what you want and what you'll wake up having had done. This is too important a decision to leave up to a last-minute change. Yes, it sounds like it's a powerful option being able to swap out one procedure for another while taking a wild, breezy ride in neon footies to the OR, but don't do it. Make up your mind beforehand and stick to it. It's that sticktoitiveness that will get you through the days and weeks ahead post-operatively.

[Frustr8 7,886]

You stated that correctly Missouri- Lee Summit, put it writing if necessary ahead of time. Many on Team Sleeve, a little less,on Team Bypass with,it's 2-3 varieties, some Team ESG and very few now Team Lapband, make your choice, stand by your convictions and don't think,of "waffeling" as you go through the Oprating Room Door. As the song lyrics go " it's a little too late to do the right thing now!"😷✋😷

[Separ1418 101]

23 minutes ago, Missouri-Lee's Summit said:

@Separ1418 I'm hoping that your surgeon was mostly kidding about allowing you to change your mind up until being wheeled into the operating room. I wouldn't trust myself to be in the same frame of mind once I'm in that high-anxiety environment of a hospital on the day of my surgery. Besides, you may or may not have been given something to relax you, which may affect your judgment. Arrive the day of your surgery knowing what you want and what you'll wake up having had done. This is too important a decision to leave up to a last-minute change. Yes, it sounds like it's a powerful option being able to swap out one procedure for another while taking a wild, breezy ride in neon footies to the OR, but don't do it. Make up your mind beforehand and stick to it. It's that sticktoitiveness that will get you through the days and weeks ahead post-operatively.

No, he was definitely kidding

[Born in Missouri 1,264]

1 hour ago, Separ1418 said:

No, he was definitely kidding

Well, now I feel foolish. Sorry for subjecting you to my silly admonition about changing your mind while on the way to the OR. I just didn't want to take the chance that your doctor's words might be horribly, horribly true!

[Separ1418 101]

2 minutes ago, Missouri-Lee's Summit said:

Well, now I feel foolish. Sorry for subjecting you to my silly admonition about changing your mind while on the way to the OR. I just didn't want to take the chance that your doctor's words might be horribly, horribly true!

Oh don't worry at all - I know it was coming from a protective and good place. Thank you!

[Frustr8 7,886]

And remember Separ1418, no matter which you chose we will be behind you all the way!😛You always have friends in us.

[SteveT74 359]

Separ, I am trying to make the same decision myself and have been researching the heck of this subject. It doesn't help that the medical community is split on this subject--just like many of us. There are some facts about both procedures that are not in dispute.

First, if you have Type 2 Diabetes, there are multiple studies that show that bypass has substantially greater likelihood of resolving diabetes when compared to other surgical options. Researchers don't know exactly what mechanism is triggered by bypass that makes so much more effective--but the result is clear (particularly for people with mild to moderate T2DM who have had the disease for 8 years or less). Gastric Sleeve is also beneficial for those with T2DM, but not to the same degree.

Second, if you have acid reflux (all the time, not just after a crazy night of Mexican or Indian food), sleeve is probably not the way to go. It can make reflux worse and it can cause reflux in people that didn't have it before the surgery. The reflux can be control with proton pump inhibitors (pepcid ac etc.), but it's not great to be on those long term. In the alternative, bypass is used as a treatment to reduce reflux for people that suffer from it.

Third, gastric sleeve is a less invasive procedure (although it is still major surgery), but the complication rate between the two procedures are pretty comparable. There are some small statistical differences that favor the sleeve, but those numbers don't really have much real world significance. Some of the historical data for bypass is skewed because the surgery was done as an open procedure in many cases before 2011. It's almost exclusively done laparoscopically today--which reduced the complication rate so it's pretty much the same as the sleeve.

Fourth, the prep and recovery from both procedures is the same, so that shouldn't be a factor in your decision.

Fifth, many people that have bypass experience dumping syndrome, which makes it difficult to process simple carbohydrates and greasy/fatty fried foods. If you have a carb addiction, this will stop you from eating those carbs--and it will punish you. There's a funny story about Al Roker (who had gastric bypass) having explosive diarrhea while he was visiting the White House years ago (worth a google). You can have some food intolerance after sleeve, but it's not the same by any means.

Sixth, gastric bypass has a malabsorption component, which requires more supplementation than is required for the sleeve. There are some long term studies which show that after several years, your body adjusts and the malabsorption component is less of an issue (and less of a benefit). The jury is still out on this.

Seventh, there is a dearth of long term studies on sleeve, so we don't know how effective it will be 10 years post op and what long term issues might arise. Bypass has been around for a lot longer, so we do know that it is generally very effective for the long term. We do know that sleeve and bypass have reasonably comparable weight loss results at the 3 and 5 year mark, although people tend to lose about 5-10% more with the bypass and they lose it faster (which may or may not be a good thing).

Eight, gastric sleeve can be revised and converted to a bypass or a duodenal switch if you fail to lose sufficient weight or have difficulty controlling diabetes or reflux. The benefits of revision are limited when compared to your first surgery (at least as far as weight loss is concerned). The options for revising gastric bypass are more limited. That said, many bariatric surgeons believe that you should go with what they consider the more effective and proven surgery out of the box and that shouldn't go into your primary surgery thinking that if doesn't work out you can just switch it up later on. Moreover, there is a higher complication rate with revisions, revisions are less effective than primary procedures and some insurance carriers have more challenging criteria for qualifying for revisions than primary surgeries.

Ninth, for people that: (i) extremely high BMI's (over 70); (ii) are older (over 65); (iii) have pulmonary or heart issues; and (iv) have had significant abdominal surgery in the past, gastric sleeve may be preferable. It takes less time to perform; therefore, you are under anesthesia for shorter period of time. It also doesn't require any rearrangement of the intestines/digestive track.

Tenth, if you need to take time released medicine or NSAID's for pain management, gastric bypass may not be the way to go. You can develop ulcers in the unused portion of your stomach and they are not easy to treat. This is definitely a disadvantage of the bypass IMO.

I am sure there are some other factors to consider, but these are some of the big ones that strike me as important. I have to make the same decision as you. I am a 44 year old man, 5'9'' and I weighed ~260 at my highest weight (around 245 now). I have mild-moderate T2DM, but a relatively low BMI (just over 35). I am leaning towards bypass because I really want this procedure to resolve my T2DM and I want what I hope will be the most effective. I will have to change some of my medications in the future if I go this route. The surgeon that I am currently working with is a big advocate for the sleeve. I have an appointment to meet with another surgeon in a couple of weeks for a second opinion--so I have definitely not made up my mind yet (and I was also told that I can change my mind last minute--although I assume that means a few days before the surgery date). Anyway, good luck with your choice and ask as many questions as you want!