Please help me figure out surgeries!

[Jessa4140 0]

Hello all! I am new to this community! I had my first appointment with my surgeon today, and I love him, he's really great. We talked a lot about different surgeries but I'm still really undecided and I'm finding myself obsessing about it even though I have several months to decide. So if anyone wants to weigh in (haha, no pun untended) please do.

I'm in my early 30's, female, BMI of 44. SW is 255, GW is 125-135. I'm 5'4. I think that's all the applicable information. Anyways, I have a good friend who has similar stats but is slightly older then me. She had the sleeve and stalled out at 6 months after only a 30lb loss and started regaining. She ended up getting the Duodenal switch which has since worked fabulously for her. She has met her goal and is maintaining. My surgeon has never performed a DS but is not against it. I do not mind being a pioneer patient and I definitely trust his experience. He is not really swaying me in either direction because he wants me to make my own decision. He says the majority of his patients get the sleeve and tend to do really well with it, and the weight loss center has a really nice aftercare program.

It is pretty important to me to hit my goal. I have another friend who counted calories to lose about 100lbs and has now regained it all plus some. Over being skinny, I want to be healthy, but I also want to feel comfortable in my own body, have the self-confidence to be seen in public again, etc. I'm sure a lot of you know where I'm coming from here. I also really don't want to have to come back and pay for a revision. I have kids and I have a lot of things I could be spending those thousands on instead of a second surgery.

So I'm sitting here bouncing back and forth between not losing all the weight I need to with the sleeve and being worried about the harsh side effects of the switch as well as having concern for the severe malabsorption as I age into my twilight years. But then again I won't live to see old age if I don't get a minimum of 100lbs off. Help. Please.

And yes I Know the surgery is a tool and should work if I use it well, and I plan to, but..I don't know. Just help please.

[colormehappy 124]

Do you struggle with reflux currently? If so bypass might be a better option. I had mild reflux so I decided to go with the sleeve. Zero reflux since I had it done a month ago.

Dumping was a consideration for me too. I personally wanted to live my life having a slice of cake on my birthday or a cookie with my kids from time to time. Some people feel like they need the strictness of bypass that will never allow them to eat certain foods again.

Malabsorption was a factor for me as well.

FWIW, obviously I don’t know your friend, but I’d guess it wasn’t the sleeve that failed her. Slider foods, grazing all day, heavy carbs, etc. will definitely stall your progress and cause regain. My head hunger is for sure still there. It’s a lot of work! (I hope that doesn’t sound like I’m judgmental of her. I get it.)

[JordanKylie 83]

I really don't think there's a wrong answer here, just my opinion. All of the operations have their own pro and con lists! The only thing I can add here, and I'm not at all discounting your surgeons experience or technique, but I've got some experience in a surgery center that does weight loss stuff and I'm not sure I'd be a pioneer patient for a DS. There's a lot that goes into it technique wise. Just my two cents! But you seem really committed to finding success and I think that's the most important thing no matter what you choose. [emoji4]

Sent from my SM-G981U using BariatricPal mobile app

[Jessa4140 0]

No worries, I know she's not uber compliant. She still eats almost nothing but fried, processed food.

I am a grazer and I eat a lot of carbs and large portions.

I guess I just want to make sure the sleeve will get me where I need and want to be? I want to lose around 125 lbs, is it possible with a sleeve, or is the sleeve more for 50 lbs weight loss? I won't want to go too aggressive with the switch if I don't need to, but I don't want to regret not going aggressive enough and not losing it.

[Jessa4140 0]

1 minute ago, JordanKylie said:

I really don't think there's a wrong answer here, just my opinion. All of the operations have their own pro and con lists! The only thing I can add here, and I'm not at all discounting your surgeons experience or technique, but I've got some experience in a surgery center that does weight loss stuff and I'm not sure I'd be a pioneer patient for a DS. There's a lot that goes into it technique wise. Just my two cents! But you seem really committed to finding success and I think that's the most important thing no matter what you choose.

Sent from my SM-G981U using BariatricPal mobile app

He is the director of the program and has had training in the DS. He used to be a trauma surgeon. I am oddly not concerned about being the first if I decide that route. I do appreciate your opinion though, I know I have a lot to think about!

[JordanKylie 83]

He is the director of the program and has had training in the DS. He used to be a trauma surgeon. I am oddly not concerned about being the first if I decide that route. I do appreciate your opinion though, I know I have a lot to think about!

Sounds like he's pretty qualified! I think you'll do great no matter what you choose!

Sent from my SM-G981U using BariatricPal mobile app

[colormehappy 124]

18 minutes ago, Jessa4140 said:

No worries, I know she's not uber compliant. She still eats almost nothing but fried, processed food.

I am a grazer and I eat a lot of carbs and large portions.

I guess I just want to make sure the sleeve will get me where I need and want to be? I want to lose around 125 lbs, is it possible with a sleeve, or is the sleeve more for 50 lbs weight loss? I won't want to go too aggressive with the switch if I don't need to, but I don't want to regret not going aggressive enough and not losing it.

I think there’s a misconception that the sleeve and bypass or DS give wildly different weight loss outcomes. I think my surgeon said it’s only about a 5% difference. I know plenty of people who have lost over 100 lbs with the sleeve.

Anecdotally, I started at 288 with a goal of 160. I’m 35 lbs down at 4 weeks.

Edited July 3, 2020 by colormehappy

[catwoman7 11,212]

53 minutes ago, colormehappy said:

Dumping was a consideration for me too. I personally wanted to live my life having a slice of cake on my birthday or a cookie with my kids from time to time. Some people feel like they need the strictness of bypass that will never allow them to eat certain foods again.

only about 30% of bypassers dump, and it can be controlled by limiting - or avoiding - sugar. I've never dumped, and most of us haven't. And there's nothing I can't eat.

[catwoman7 11,212]

DS is a fairly complicated surgery, so I'm not sure I'd want a rookie doing it.

you didn't mention RNY (gastric bypass), but that's another option. If you have trouble with GERD, that's the surgery that's usually recommended. RNY often improves - if not outright cures - GERD. The sleeve CAN make it worse. Not always - and not even in most patients -- but in a significant minority.

if you don't have issues with GERD, then it comes down to personal preference. They're both good surgeries, and I've seen many examples of success on here with both. And of course, people have failed at both, too. If you are a very committed patient, you can succeed with either one.

[rjan 164]

Yeah, I don't think the surgeries differ much in terms of average weight loss. Otherwise most people would probably just choose the one that works best. (Probably one reason why no one likes the lap band anymore - it definitely doesn't work as well.)

Since you said you're a grazer, perhaps you'd prefer a bypass or DS. With the sleeve, you feel much more of a restriction - I feel absolutely stuffed for an hour or two or three after a meal that would have been an appetizer before. It's that drastic reduction in the amount you can eat that does the work with a sleeve. In contrast, I've read comments from people who revise from a sleeve to a bypass, and they often say that they feel less restriction afterwards than they did with the sleeve. With the bypass, things slide through your system faster so you don't feel full for long, but you absorb less calories.

I like the restriction, and I feel like it works really, really well for me. But I've never been a snacker - I like my 2-3 meals and that's it. I think people who like to eat often can make up for the reduced volume by increasing meal frequency if they try.

I didn't really know that when I was deciding though. I decided on the sleeve because I prefer a less invasive procedure (all other things being equal), and didn't want to have to worry about malsorbtion, and I didn't have much of a reflux problem.

[NovaLuna 710]

I'm 32 (almost 33) and had the Loop DS at my surgeons suggestion because along with the original DS it has the highest average percentage of weight loss. I say average because some people can lose just as much with the other surgeries, but I have hypothyroidism and so the Loop DS was their suggestion. I was 321 on the day of my surgery and now five months out I'm 245. So I've lost 76 pounds in these past 5 months (and 64 before my surgery). The thing with the DS though is you occasionally get really BAD stomachaches. Like my system will be fine one minute and the next it's like RUUUUUNNN (or you know, accident). It's kinda the norm now though so... you get used to it, but my family knows when I get an odd look on my face that I'm gonna be 'occupied' for a while. Oh, and this is TMI but don't think you can escape the Constipation curse that people often get with weight loss surgeries if you have the DS, because it happened to me TWICE and it shocked my surgeons office because apparently I'm their first Loop DS patient who ever had that issue... but it CAN happen! Also, I have a reaction to wheat that was remarkably similar to dumping syndrome even though that's not SUPPOSED to be possible with the DS or Loop DS (I started having stomach pain, sweating, nausea, followed by... bathroom time, about 15 minutes after I ate. Worst nausea I'd had since BRAIN SURGERY! Needless to say I avoid wheat products like the plague now!). Soooo, yeah. I don't know if it's just weird abnormal stuff that happens to me or if a lot of Loop DS patients have had similar experiences lol. I don't regret my choice for surgery though. Every surgery has their ups and downs so you kind of just have to go over those and decide what'll work for you! I wish you the best!

Edited July 3, 2020 by NovaLuna

[It's time. 145]

Qualifications on paper are nice, but wouldn't want anyone cutting me without hands on experience...and a lot of it!

[catwoman7 11,212]

6 hours ago, rjan said:

Since you said you're a grazer, perhaps you'd prefer a bypass or DS. With the sleeve, you feel much more of a restriction - I feel absolutely stuffed for an hour or two or three after a meal that would have been an appetizer before. It's that drastic reduction in the amount you can eat that does the work with a sleeve. In contrast, I've read comments from people who revise from a sleeve to a bypass, and they often say that they feel less restriction afterwards than they did with the sleeve. With the bypass, things slide through your system faster so you don't feel full for long, but you absorb less calories.

I like the restriction, and I feel like it works really, really well for me. But I've never been a snacker - I like my 2-3 meals and that's it. I think people who like to eat often can make up for the reduced volume by increasing meal frequency if they try.

I've heard some people say this about revisions, but to be honest, I'm not sure if it's something specific to revision, or if there really is less of a restrictive feeling with bypass. I felt quite a bit of restriction early on (well, I still do at five years out if I overeat), but then, I've never had the sleeve so I have nothing to compare it to. So I honestly don't know if there's less restriction with the bypass, or if it's just something unique to revisions.

[rjan 164]

2 hours ago, catwoman7 said:

I've heard some people say this about revisions, but to be honest, I'm not sure if it's something specific to revision, or if there really is less of a restrictive feeling with bypass. I felt quite a bit of restriction early on (well, I still do at five years out if I overeat), but then, I've never had the sleeve so I have nothing to compare it to. So I honestly don't know if there's less restriction with the bypass, or if it's just something unique to revisions.

Yeah, it's kind of hard to tell since most people never get the chance to compare how the different surgeries feel. For people who get revisions, the fact that they had a 2nd surgery may make how they feel different than someone who just had 1 bypass surgery originally. More scar tissue, less elasticity, lots of things could depend on how many surgeries you've had.

Physically, though, sleevers still have their pyloric sphincter working to control when the stomach empties into the intestines, while for bypassers the rate of stomach emptying depends mainly on the size of the bypass outlet. So it at least makes sense that you'd feel full longer with a sleeve.

Google found this surgeon who offers a version of DS that preserves the pyloric sphincter. They say they do it to prevent long term regain in bypass patients whose stomach can empty too fast if the outlet gets bigger over time.

https://nwhsurgicalweightloss.org/learn-about-your-condition-and-treatment/pyloric-preservation

[ms.sss 15,600]

14 hours ago, Jessa4140 said:

And yes I Know the surgery is a tool and should work if I use it well, and I plan to, but..I don't know. Just help please.

This is basically it. Barring any complications, any surgery will work if you work it. Like others said above, it’s really personal preference...unless you have GERD tendencies, in which case the recommendation would be bypass.

I was sleeved and I’m all good.

Good Luck!