Sleeve vs Bypass

[Hopefulin2021 244]

Hi when I initially started this journey I was set up for a sleeve. After undergoing two endoscopies it was found that I have a small benign tumor in the lining of my stomach which will have to be removed during surgery but now I have to have a bypass. I am still going through with it but I am a little more nervous because bypass is more invasive or maybe it isn’t, any ideas about this ?

[GradyCat 3,695]

I've heard the bypass is more invasive but I don't understand why since the sleeve is basically cutting off 3/4 of your stomach, which is pretty damned invasive! 😀 I guess the bypass is more complicated. I'm happy with my sleeve.

[catwoman7 11,211]

I agree with GradyCat. I don't think it's that much more invasive. Plus it's an older surgery - lots of research behind it. I was also advised to get RNY due to acid reflux, and I've been very happy with it.

[ChubRub 1,702]

I love my bypass, and you will love yours too! Best of luck to you and I'm glad they discovered the benign tumor before it did any damage!!

[njlimmer 343]

I also went to the doctor anticipating the sleeve, but he suggested the bypass. He was really good about explaining the whys. He asked what my concerns were about the bypass, and I mentioned that I thought it was more invasive. He said that it's a more technically complicated surgery than the sleeve for the doctor, but on the patient side of it, the pre/post op are pretty much the same. When it wasn't done laparoscopically, I'm sure it was much more invasive, but now it's pretty much the same as the sleeve. I've decided to take his advice and go with the sleeve. Also, my insurance made it very clear this one a one time surgery, and I've seen so many people with revisions that I'm just going straight to bypass.

[Hopefulin2021 244]

Thanks everyone this really helps! Don you lose more weight with bypass or is it the same?

[WishMeSmaller 1,273]

Weight loss averages are slightly higher with bypass, but not by a huge amount, and results for both surgeries are dependent on what the individual does with the tool. I had bypass due to GERD, and have been very happy with my recovery and results. Good luck! 😊

[catwoman7 11,211]

2 hours ago, Hopefulin2021 said:

Thanks everyone this really helps! Don you lose more weight with bypass or is it the same?

I agree with the other poster that if you look at statistics, bypass patients tend to lose more, but not by a lot. And this all really comes down to the individual. You'll find people who've been wildly successful at both, and people who have failed at both....and people in the middle, too (those who've lost a bunch of weight, yet not made it all the way to their goal). Success is really more a factor of the person's commitment to their program rather than which surgery they get.

[RickM 1,747]

As noted, the difference in weight loss performance between the VSG and RNY is minimal - there is more variation between individuals than there is between the procedures themselves. If one wants/needs something demonstrably better than the VSG/RNY, then there is the DS available; if ones needs are less than that provided by the VSG/RNY, then there are the balloons and lapbands available.

The bypass will be somewhat fussier than the sleeve when it comes to supplements and some medications (some time release meds may not work well with it, and some meds that are known to possibly be ulcer prone are more restricted or forbidden.} Diet may be a little more restricted, but there isn't a great difference.

What I would be concerned about is whether the finding of this benign tumor makes you any more susceptible to something more malignant that should be monitored? One of the drawbacks or the RNY is the loss of the ability to easily scope the remnant stomach post-op, as that is left in a blind loop along with the duodenum and associated bile and pancreatic ducts. I assume that the tumor was found somewhere in the lower part of the stomach near the pyloric valve, and that is why they are interested in doing a bypass instead of a sleeve as that would naturally remove the tumor and surrounding tissue (if it were found in the central fundus, that would naturally be removed as part of the VSG). If this is a concern to them, the RNY can be performed without leaving a remnant stomach behind (it's basically what's done in many cased of stomach cancer); I have run into a few who have had WLS/RNY performed that way for various reasons and while there are some tradeoffs to doing it that way, they are not real big ones - most don't know the difference other than it removes the theoretical reversibility of the bypass.

In short, the difference in making the switch is not great, but my biggest concern would be what the tumor finding means to you long term and how do you mitigate whatever tendencies there might be (for instance, I am subject to stomach polyps, which like those in the colon are considered to be pre-cancerous, so that is something that we monitor with periodic endoscopies.)

[Hopefulin2021 244]

8 hours ago, RickM said:

As noted, the difference in weight loss performance between the VSG and RNY is minimal - there is more variation between individuals than there is between the procedures themselves. If one wants/needs something demonstrably better than the VSG/RNY, then there is the DS available; if ones needs are less than that provided by the VSG/RNY, then there are the balloons and lapbands available.

The bypass will be somewhat fussier than the sleeve when it comes to supplements and some medications (some time release meds may not work well with it, and some meds that are known to possibly be ulcer prone are more restricted or forbidden.} Diet may be a little more restricted, but there isn't a great difference.

What I would be concerned about is whether the finding of this benign tumor makes you any more susceptible to something more malignant that should be monitored? One of the drawbacks or the RNY is the loss of the ability to easily scope the remnant stomach post-op, as that is left in a blind loop along with the duodenum and associated bile and pancreatic ducts. I assume that the tumor was found somewhere in the lower part of the stomach near the pyloric valve, and that is why they are interested in doing a bypass instead of a sleeve as that would naturally remove the tumor and surrounding tissue (if it were found in the central fundus, that would naturally be removed as part of the VSG). If this is a concern to them, the RNY can be performed without leaving a remnant stomach behind (it's basically what's done in many cased of stomach cancer); I have run into a few who have had WLS/RNY performed that way for various reasons and while there are some tradeoffs to doing it that way, they are not real big ones - most don't know the difference other than it removes the theoretical reversibility of the bypass.

In short, the difference in making the switch is not great, but my biggest concern would be what the tumor finding means to you long term and how do you mitigate whatever tendencies there might be (for instance, I am subject to stomach polyps, which like those in the colon are considered to be pre-cancerous, so that is something that we monitor with periodic endoscopies.)

Great comment and you have definitely given me some food for thought. They did advise it was a GIST tumor. As per my google search is:

A gastrointestinal stromal tumor (GIST) is a type of tumor that occurs in the gastrointestinal tract, most commonly in the stomach or small intestine. The tumors are thought to grow from specialized cells found in the gastrointestinal tract called interstitial cells of Cajal (ICCs) or precursors to these cells.

basically it hasn’t spread and they typically don’t and it’ll be very easy to remove. It is very slow growing and not big enough to cause any damage but it definitely has to get removed whether or not I was having the surgery.

[cyndeelouwho 13]

Thank you for all of your help with I think I will ask my doctor what he thinks about a MGB. I don't know if that is going to be an option or not. I had a gastric bypass surgery in 1980 and gained all of my weight back. My consultation with surgeon on 1/4/21. Wish me luck 🙏 😅

[RickM 1,747]

On 12/19/2020 at 4:50 PM, cyndeelouwho said:

Thank you for all of your help with I think I will ask my doctor what he thinks about a MGB. I don't know if that is going to be an option or not. I had a gastric bypass surgery in 1980 and gained all of my weight back. My consultation with surgeon on 1/4/21. Wish me luck 🙏 😅

Here in the US, the MGB is not a common option, though it has been adopted by bariatric groups in other countries.

When my wife and I were first investigating WLS some twenty years ago, the MGB was kicking around the sidelines of the bariatric field trying to find its place, but it never did here, failing to gain acceptance of either the ASBS/ASMBS or the insurance industry. In the meantime, both the DS and VSG have gone mainstream. There may still be a few isolated practices that offer it on a self pay basis, and there are several groups in Mexico that offer it, mainly as a cheaper, but not necessarily better, alternative to the RNY. The main bugaboo that I recall with it has been a greater propensity toward bile reflux, which is easy to understand if you look at its anatomy.

As for a revision to counter regain, It doesn't make a lot of sense to me, as its metabolic strength is so similar to the RNY - much the same as switching between the VSG and RNY, or vice versa, for weightloss/gain reasons, doesn't make a lot of sense. To counter a regain problem, one should look to a stronger procedure, which in the current world is the duodenal switch (DS). Unfortunately, that is a very complex revision which only a half dozen or so surgeons around the country are capable of doing. That would be your best shot at losing a major part of your regain, but also the hardest. There is the newer SIPS/SADI/"Loop DS" that is a simpler and more accessible procedure that seems to sit between the RNY/VSG in DS in effectiveness, but it is still working on gaining acceptance from the ASMBS and insurance industry, but it doesn't seem far off now; that would be a compromise worth looking into, but it's not an easy revision, either, as it is sleeve based procedure, so the stomach first needs to be but back together before proceeding with the revision.

The RNY, overall, is a difficult configuration to work with if it's not working right. The "simple" regain fixes such as re-doing the pouch, tightening the stoma or putting a band over the pouch don't seem to work all that well - figure on losing maybe 20 lb, on average, mostly from having to go through all of the restrictive diets around surgery time again, but beyond that it is mostly individual effort (which is what one does without surgery.) The other major option may be offered is to change it to a distal RNY (as opposed to the familiar proximal RNY) which dramatically increases the malabsorption component, with the trade off of the expected increase in supplement needs and potential for more significant nutritional problems. It is not usually approved by US insurance as a primary WLS procedure, but sometimes can be justified for special circumstances.

Revisions are not a simple thing - research them carefully to fully understand what is involved, and what the potential risks and benefits are.

Good luck,

[MamT 17]

These have been the most interesting posts and comments! Thanks! I’ve enjoyed reading them all.
I had VSG for weight loss 10 years ago and had major reflux, hiatal hernia, Cameron lesions, etc.... so just recently had to have the RNY. I didn’t want to have it but I needed to for health reasons. It’s been great! I had gained back over half of the weight I lost with the VSG and have now lost over 25 pounds since this surgery. I wish I would have had the RNY 10 years ago and probably would have not had the reflux issues that I have had. But anyway, my point is that the RNY is a good surgery that will help with other health issues other than just weight loss. Good luck!

[Hopefulin2021 244]

Thanks everyone I am feeling a lot better about the doctor’s decision! Tomorrow I go meet with the surgeon to sign consents and discuss next steps. I am so ready to get this done!