Gastric Bypass better than Gastric sleeve in reducing co-morbidities

[over65 133]

I thought I wanted gastric sleeve for WLS. My main reason was my concern about malabsorption at my age. I have multiple co-morbidities associated with my obesity. Now I am considering gastric bypass instead. Of course, I will make final decision with my surgeon.

"Laparoscopic Roux-en-Y Gastric Bypass Versus Laparoscopic Sleeve Gastrectomy to Treat Morbid Obesity-Related Comorbidities: a Systematic Review and Meta-analysis."

https://www.ncbi.nlm.nih.gov/pubmed/26661105

"a total of 18,455 patients, enrolled in 62 recent studies, were included in this meta-analysis. Patients receiving LRYGB had a significantly higher percentage of excess weight loss and better resolution of hypertension, dyslipidemia, gastroesophageal reflux disease, and arthritis compared with those receiving LSG. LRYGB and LSG showed similar effects on type 2 diabetes mellitus and sleep apnea."

Found a journal article "Biological effects of bariatric surgery on obesity-related comorbidities"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569476/

DIABETES AND IMPAIRED GLUCOSE TOLERANCE

"A landmark paper by Pories and colleagues demonstrated that of 141 patients with diabetes or impaired glucose tolerance (IGT), all but 2 became euglycemic within 10 days after RYGB. Longer follow-up demonstrated that over 8 years, 83% of patients with preoperative T2DM and 99% of those with IGT were able to maintain normal levels of plasma glucose, HgA1C and insulin."

OBSTRUCTIVE SLEEP APNEA

"Most patients (62%) had residual disease. In fact, only 25% of patients in the 6 studies that reported individual patient data (representing 23% of all patients in the meta-analysis) were able to reach an AHI consistent with OSA resolution (

DYSLIPIDEMIA

Hyperlipidemia, hypercholesterolemia and hypertriglyceridemia were significantly improved across all surgical procedures at 2 year follow-up. The percentage of patients whose conditions improved was typically 70% or higher, with maximum improvements in hyperlipidemia in the BPD-DS (91%) and RYGB groups (96.9%).

HYPERTENSION

"The percentages of patients in the total population whose hypertension resolved or improved were 61.7% and 78.5%, respectively." Only those who did not regain weight maintained lower blood pressure after two years.

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[TheAngryMeow 99]

I thought I wanted gastric sleeve myself. Since I didn't want the malabsorption effects either. But I talked to my surgeon and he convinced me to get the RNY instead. He said it's better suited for people my size and that there is more evidence to show that RNY has long term success and more weight loss than GS.

It's totally something you and your provider should discuss though, so it's good you are gonna make a decision with them. Ultimately, both are good choices for weight loss but I feel RNY was right for me. Maybe it will be right for you, too!

Good luck! 👍

[over65 133]

Another article said 15% of patients have sleeve developed GERD who didn't have before surgery. Those with GERD before surgery were much worse after sleeve. But bypass resolved pre-existing GERD.

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[over65 133]

Oh, and most patients with obstructive sleep apnea still needed CPAP after WLS.

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[TheAngryMeow 99]

12 minutes ago, over65 said:

Another article said 15% of patients have sleeve developed GERD who didn't have before surgery. Those with GERD before surgery were much worse after sleeve. But bypass resolved pre-existing GERD.

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I don't have sleep apnea, but I DO have GERD. And that was another major reason why we both decided upon bypass.

[AZhiker 2,252]

My GERD required bypass. It has been fine. I am happy with the results. BTW - my sleep apnea is now resolved and I don't need Cpap anymore!

[Marthalynn 11]

Same here no c-pap anymore.

[kristieshannon 1,628]

I was able to ditch my CPAP 5 months post sleeve. Also my BP meds.

[kristieshannon 1,628]

And a weird improvement-my heals/feet used to be so dry and cracked. Now at almost 90 lbs down this is completely resolved!

[catwoman7 11,212]

yes - people with GERD should go with bypass. GERD doesn't get worse - or start up - for EVERYONE, but it's a significant enough minority that I didn't want to risk it (I had GERD pre-surgery). I've seen too many people getting revisions because of out-of-control GERD after sleeve. No thanks.

and yes - either surgery can throw diabetes into remission, but the percentage is quite a bit higher with bypass.

[Mello1 227]

9 hours ago, catwoman7 said:

yes - people with GERD should go with bypass. GERD doesn't get worse - or start up - for EVERYONE, but it's a significant enough minority that I didn't want to risk it (I had GERD pre-surgery). I've seen too many people getting revisions because of out-of-control GERD after sleeve. No thanks.

and yes - either surgery can throw diabetes into remission, but the percentage is quite a bit higher with bypass.

When I had my initial appointment in October, I thought the VSG was what I wanted. The doctor had a long conference with his assistant and it was taking a long time for him to come in. When he did (I was getting mad because they were taking so long), he recommended the By-Pass for that very reason. I had a GERD/Reflux episode so bad earlier that year that I had to go to critical care. Once I read that some VSG patients developed Reflux, I was like NOPE. I'm going with the By-pass.

I think I read that technical study or one similar to it a few months ago -- you tend to lose more weight faster and your metabolism seems to reset with the Bypass. Bypass, I'm all in. 3 weeks until the surgery.

[TheAngryMeow 99]

I'm super excited to no longer be a prisoner to my Omeprazole! Bypass FTW!

[Mello1 227]

I found the NIH article regarding bypass and body rate set point:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485884/

[Lily66 425]

39 minutes ago, Mello1 said:

I found the NIH article regarding bypass and body rate set point:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485884/

Great article and website! Makes me very pleased to be heading in this direction. The human body is remarkably resilient in its ability to reset and reinvent itself🌟 Thanks for sharing!