Choosing between sleeve and bypass

[lunadreams 22]

I've been planning to have the sleeve, and have done all the pre-op requirements. If all goes well, I want to do WLS over the summer. I've been planning on the sleeve, as it's what my surgeon recommended for me, but now I'm wondering if I should go for the bypass.

I'm in my late 40s (done having kids, so fertility/pregnancy is not a factor in my decision), have a BMI of just over 35, with PCOS, diabetes, hypertension, and recently diagnosed with small Fiber neuropathy (we're not sure of the cause, though I've read a study showing WLS improves symptoms). When I asked my surgeon why she recommended the sleeve, she said it's because I have relatively less weight to lose, and, although it will require work and being vigilant with diet, she thinks it will be successful for me, and is less invasive and risky, though she also said she would be willing to do the bypass if it's what I want.

My endocrinologist said that the bypass has additional mechanisms by which it can resolve metabolic issues, but she'd suggest asking my surgeon about her rate of complications with bypass. She also said she'd be less inclined to push bypass for me, though, because my diabetes is well-controlled on one medication (A1c is usually between 5.7 to 6.0). My cardiologist strongly advised me to go with the sleeve, because she has a number of patients who were a "hot mess," medically, after bypass.

I want to resolve my cardio-metabolic issues, but the risks of bypass also really concern me. I've never been anemic, but I've been deficient in other Vitamins and have experienced Hair loss and other issues as a result, so I'm concerned I may be at greater risk for deficiencies and other unwanted consequences with the bypass.

I'm not sure how to decide this...help?

Edited May 21, 2021 by lunadreams

[catwoman7 11,212]

there are statistically more complications with bypass, but complications with either surgery are really pretty low. The rule of thumb lately seems to be if you have GERD issues, go with bypass, otherwise, it comes down to personal preference. They're both good surgeries, and you'll find people on this site who've been very successful with both.

you will have to take Vitamins for life with both surgeries, but there are more consequences if you slack off on vitamin-taking with bypass because of the malabsorption. But if you're diligent about taking your vitamins, then Vitamin deficiency is rare.

about 30% of sleeve patients develop GERD (or if they have it prior to surgery, it can get worse), and about the same percentage of bypass patients (about 30%) experience dumping syndrome, and in both cases that's kind of a crap shoot. You can't really predict ahead of time if you'll get those or not (although if you already have GERD, it's very likely not to improve and there's a decent chance it'll get worse with the sleeve. On the other hand, bypass usually improves if not outright cures GERD). If you have bypass and are one of the 30% who dump, it can be controlled by not eating a lot of sugar (or fat - some people dump on fat) at one sitting.

Hair loss is very common with both surgeries. Actually, it's a potential side effect of any major surgery (and childbirth, too), due to stress on the body. I think we see it more after bariatric surgeries than other surgeries, though, because in addition to the trauma from the surgery, we're also taking in very few calories the first few weeks/months. The good news is, it's temporary - the hair will grow back - and in most cases, you're the only one who'll notice it. A few people don't lose any hair at all, a few lose noticeable clumps of it, but most of us are somewhere in the middle. It's more like "shedding", and it's not enough for others to notice. I didn't lose much at all. It lasted maybe three months and then started growing back. But anyway, don't make your decision based on hair loss, because that's very common regardless of surgery.

I don't think you can really make a wrong decision either way. I'd take into account what your doctors say, and also consider your personal preference. Some people are more comfortable with one or the other. As I mentioned, they're both good surgeries and you can get good results with either one.

Edited May 21, 2021 by catwoman7

[GreenTealael 25,336]

8 minutes ago, catwoman7 said:

there are statistically more complications with bypass, but complications with either surgery are really pretty low. The rule of thumb lately seems to be if you have GERD issues, go with bypass, otherwise, it comes down to personal preference. They're both good surgeries, and you'll find people on this site who've been very successful with both.

you will have to take Vitamins for life with both surgeries, but there are more consequences if you slack off on vitamin-taking with bypass because of the malabsorption. But if you're diligent about taking your Vitamins, then Vitamin deficiency is rare.

about 30% of sleeve patients develop GERD (or if they have it prior to surgery, it can get worse), and about the same percentage of bypass patients (about 30%) experience dumping syndrome, and in both cases that's kind of a crap shoot. You can't really predict ahead of time if you'll get those or not (although if you already have GERD, it's very likely not to improve and there's a decent chance it'll get worse with the sleeve. On the other hand, bypass usually improves if not outright cures GERD). If you have bypass and are one of the 30% who dump, it can be controlled by not eating a lot of sugar (or fat - some people dump on fat) at one sitting.

Hair loss is very common with both surgeries. Actually, it's a potential side effect of any major surgery (and childbirth, too), due to stress on the body. I think we see it more after bariatric surgeries than other surgeries, though, because in addition to the trauma from the surgery, we're also taking in very few calories the first few weeks/months. The good news is, it's temporary - the hair will grow back - and in most cases, you're the only one who'll notice it. A few people don't lose any hair at all, a few lose noticeable clumps of it, but most of us are somewhere in the middle. It's more like "shedding", and it's not enough for others to notice. I didn't lose much at all. It lasted maybe three months and then started growing back. But anyway, don't make your decision based on Hair loss, because that's very common regardless of surgery.

I don't think you can really make a wrong decision either way. I'd take into account what your doctors say, and also consider your personal preference. Some people are more comfortable with one or the other. As I mentioned, they're both good surgeries and you can get good results with either one.

Great response

[STLoser 1,099]

there are statistically more complications with bypass, but complications with either surgery are really pretty low. The rule of thumb lately seems to be if you have GERD issues, go with bypass, otherwise, it comes down to personal preference. They're both good surgeries, and you'll find people on this site who've been very successful with both.
you will have to take Vitamins for life with both surgeries, but there are more consequences if you slack off on vitamin-taking with bypass because of the malabsorption. But if you're diligent about taking your vitamins, then Vitamin deficiency is rare.
about 30% of sleeve patients develop GERD (or if they have it prior to surgery, it can get worse), and about the same percentage of bypass patients (about 30%) experience dumping syndrome, and in both cases that's kind of a crap shoot. You can't really predict ahead of time if you'll get those or not (although if you already have GERD, it's very likely not to improve and there's a decent chance it'll get worse with the sleeve. On the other hand, bypass usually improves if not outright cures GERD). If you have bypass and are one of the 30% who dump, it can be controlled by not eating a lot of sugar (or fat - some people dump on fat) at one sitting.
Hair loss is very common with both surgeries. Actually, it's a potential side effect of any major surgery (and childbirth, too), due to stress on the body. I think we see it more after bariatric surgeries than other surgeries, though, because in addition to the trauma from the surgery, we're also taking in very few calories the first few weeks/months. The good news is, it's temporary - the hair will grow back - and in most cases, you're the only one who'll notice it. A few people don't lose any hair at all, a few lose noticeable clumps of it, but most of us are somewhere in the middle. It's more like "shedding", and it's not enough for others to notice. I didn't lose much at all. It lasted maybe three months and then started growing back. But anyway, don't make your decision based on hair loss, because that's very common regardless of surgery.
I don't think you can really make a wrong decision either way. I'd take into account what your doctors say, and also consider your personal preference. Some people are more comfortable with one or the other. As I mentioned, they're both good surgeries and you can get good results with either one.

You always have the best advice!

Sent from my Nokia 7.2 using BariatricPal mobile app

[catwoman7 11,212]

3 minutes ago, STLoser said:

You always have the best advice!

Sent from my Nokia 7.2 using BariatricPal mobile app

LOL - thanks! I've been hanging out on bariatric boards for a few years - plus I used to work with the pre-op groups at my clinic (well until COVID hit, anyway - so for three or four years). You hear and learn a lot of stuff that way!

[SunnyinSC 137]

I haven't had surgery yet, but I had the same choice to make so figured I'd share my experience. Keep in mind everyone is different and my choice is just mine. I'm not suggesting that you should make the same decision or anything.

So I have had issues with heartburn and I went into my surgery consult set on Gastric Bypass because of that. However, the surgeon recommended, due to my weight, Sleeve because it's less risk of complications. At my weight, the amount of actual loss would be about the same. My nurse then stepped in on my behalf and got an endoscopy to check out my heartburn issues. This was because I am self pay, and I can't really afford to do a sleeve, only to have to get a revision later, so she wanted to see if we could find a root cause of the heartburn/GERD.

Endoscopy revealed I had a medium sized Type III hiatal hernia. While the hernia could be repaired during surgery, it also meant I had a good chance of needing a revision in the future if I went with Sleeve. Not guaranteed, but still a high probability. Since I'm self-pay and I definitely don't want to find myself in a position where my heartburn/GERD have gotten worse and I can't pay for a revision, we decided it would be best for me to go with Gastric Bypass.

Gastic Bypass is a mal-absorption procedure in addition to just restrictive, so I will have to be extra sure my Vitamins are okay, and it is more at risk of complications during surgery/recovery due to multiple incision sites. That being said, overall risk is still really low, it's just higher when compared to sleeve.

Definitely weigh out the options, talk honestly and openly with your medical team about risks and complications. Hopefully you can come to a decision that works for you Best of luck!

[lunadreams 22]

Thanks, everyone, for the thoughtful advice! 😊

It seems difficult to get a consensus amongst my doctors (and myself). It seems like they feel either would be appropriate, and that switching to bypass would be a toss-up between a somewhat increased chance of resolving diabetes and losing a little more weight versus an increased risk of long-term complications and Vitamin deficiencies (which I've struggled with in the past). I don't think any of my doctors feel there's a really clear answer, and that's what's making this decision really difficult. 😳

Edited May 26, 2021 by lunadreams

[HealthyLifeStyle 351]

I was on the fence choosing between the two also. My doctor was ready to do either. I chose the bypass because I was a diabetic. 2 months after surgery I was no longer. I also chose it because I knew so many people that got the sleeve and then regretted it and ended up getting the bypass anyway. I just wanted to get it over with.

[Leafstrong 14]

I was all set to do bypass but then the doctor a few days ago brought up about doing sleeve as she felt I would have a lower probability of adhesions and bowel obstructions . I do have Gerd so tomorrow I’m having a test to see exactly how bad and she said if it’s not super severe she would still rather do sleeve and then down the road do bypass. No I was on another board that I didn’t fine before brought up all sorts of negatives I’m due to have surgery on Thursday, June 3 & the way I’m feeling right now I just want to run and cancel surgery .

[ShoppGirl 4,785]

On 5/21/2021 at 8:42 AM, catwoman7 said:

there are statistically more complications with bypass, but complications with either surgery are really pretty low. The rule of thumb lately seems to be if you have GERD issues, go with bypass, otherwise, it comes down to personal preference. They're both good surgeries, and you'll find people on this site who've been very successful with both.

you will have to take Vitamins for life with both surgeries, but there are more consequences if you slack off on vitamin-taking with bypass because of the malabsorption. But if you're diligent about taking your Vitamins, then Vitamin deficiency is rare.

about 30% of sleeve patients develop GERD (or if they have it prior to surgery, it can get worse), and about the same percentage of bypass patients (about 30%) experience dumping syndrome, and in both cases that's kind of a crap shoot. You can't really predict ahead of time if you'll get those or not (although if you already have GERD, it's very likely not to improve and there's a decent chance it'll get worse with the sleeve. On the other hand, bypass usually improves if not outright cures GERD). If you have bypass and are one of the 30% who dump, it can be controlled by not eating a lot of sugar (or fat - some people dump on fat) at one sitting.

Hair loss is very common with both surgeries. Actually, it's a potential side effect of any major surgery (and childbirth, too), due to stress on the body. I think we see it more after bariatric surgeries than other surgeries, though, because in addition to the trauma from the surgery, we're also taking in very few calories the first few weeks/months. The good news is, it's temporary - the hair will grow back - and in most cases, you're the only one who'll notice it. A few people don't lose any hair at all, a few lose noticeable clumps of it, but most of us are somewhere in the middle. It's more like "shedding", and it's not enough for others to notice. I didn't lose much at all. It lasted maybe three months and then started growing back. But anyway, don't make your decision based on Hair loss, because that's very common regardless of surgery.

I don't think you can really make a wrong decision either way. I'd take into account what your doctors say, and also consider your personal preference. Some people are more comfortable with one or the other. As I mentioned, they're both good surgeries and you can get good results with either one.

Bariatric Pal should put you on their payroll for your well thought out responses.

[catwoman7 11,212]

1 minute ago, ShoppGirl said:

Bariatric Pal should put you on their payroll for your well thought out responses.

LOL - thanks! It's just that I've been hanging around on bariatric boards for several years - plus I used to volunteer for my bariatric clinic - leading one of the pre-op classes. After awhile, you absorb a lot of info..

[HealthyLifeStyle 351]

On 5/21/2021 at 12:31 PM, catwoman7 said:

LOL - thanks! I've been hanging out on bariatric boards for a few years - plus I used to work with the pre-op groups at my clinic (well until COVID hit, anyway - so for three or four years). You hear and learn a lot of stuff that way!

I agree. You are extremely helpful. You always give great advice. Thank You

[lunadreams 22]

Update: I decided to go with the sleeve, after a consultation with my neurologist. She had said that the risks for neuropathy are higher with bypass, and since I already have it and don't want to do anything that could exacerbate it, I just feel more comfortable with the sleeve. Thanks to everyone for the advice.

[Beth_gs 0]

I've been planning to have the sleeve, and have done all the pre-op requirements. If all goes well, I want to do WLS over the summer. I've been planning on the sleeve, as it's what my surgeon recommended for me, but now I'm wondering if I should go for the bypass.
I'm in my late 40s (done having kids, so fertility/pregnancy is not a factor in my decision), have a BMI of just over 35, with PCOS, diabetes, hypertension, and recently diagnosed with small Fiber neuropathy (we're not sure of the cause, though I've read a study showing WLS improves symptoms). When I asked my surgeon why she recommended the sleeve, she said it's because I have relatively less weight to lose, and, although it will require work and being vigilant with diet, she thinks it will be successful for me, and is less invasive and risky, though she also said she would be willing to do the bypass if it's what I want.
My endocrinologist said that the bypass has additional mechanisms by which it can resolve metabolic issues, but she'd suggest asking my surgeon about her rate of complications with bypass. She also said she'd be less inclined to push bypass for me, though, because my diabetes is well-controlled on one medication (A1c is usually between 5.7 to 6.0). My cardiologist strongly advised me to go with the sleeve, because she has a number of patients who were a "hot mess," medically, after bypass.
I want to resolve my cardio-metabolic issues, but the risks of bypass also really concern me. I've never been anemic, but I've been deficient in other Vitamins and have experienced Hair loss and other issues as a result, so I'm concerned I may be at greater risk for deficiencies and other unwanted consequences with the bypass.
I'm not sure how to decide this...help?

Omg me too.
My doctor recommend me to have the sleeve she said gastric bypass has many complications and it is an invasive surgery but my endocrinologist said that bypass will be a better option for my metabolic issues... And here I am undecided on which surgery I should get.
She wants me to watch some gastric bypass surgery videos to get my surgery date....

Sent from my LM-K920 using BariatricPal mobile app

[lunadreams 22]

On 6/29/2021 at 10:37 PM, Beth_gs said:

Omg me too.
My doctor recommend me to have the sleeve she said gastric bypass has many complications and it is an invasive surgery but my endocrinologist said that bypass will be a better option for my metabolic issues... And here I am undecided on which surgery I should get.
She wants me to watch some gastric bypass surgery videos to get my surgery date....

Sent from my LM-K920 using BariatricPal mobile app

Not sure if you saw my update, but after speaking with my neurologist, I decided to go with the sleeve. She told me there is more of a risk of complications involving neuropathy with the bypass, and I don't want to risk that. From what I've seen, bypass is somewhat more effective for resolving metabolic issues than sleeve, but sleeve still has a very good showing in terms of that. Good luck, whatever you decide!