Gastric Bypass or Sleeve Gastrectomy?

[flee75 0]

Hi there,

I was banded in Feb 2003 and went from 133 kg to 60 kg. Unfortunately the band slipped and I had emergency surgery in May 2008.

Living such a different life which included working out 5x / week, cutting out sugared drinks etc, I thought I could keep the weight off, but lo and behold ... it was not to be ... and I have since gained over 20kg = > 44 lbs.

Have gone back to the surgeons and have been asked to consider either the sleeve or the gastric bypass. Would greatly appreciate any thoughts / inputs from all you experienced folks.

Maybe if I give u a little info about me, it may be easier for you to give me your input ... I just turned 33 ... single with no kids. Am not attached now but would like to have a kid of my own someday. Had been diabetic and on insulin and medication since I was 16 but the lap band and weight loss helped me to be diabetes free. Had problems with menstrual cycles, but the weight loss fixed that too as it did with my fatty liver, sleep apnea, hypertension, chronic backaches etc. And going back to where I was isn't the most comforting thought.

Any input would be great ...

p/s: this is a cross post from the sleeve gastrectomy forum.

[MacMadame 81]

I would go for the sleeve. You will get similar results in terms of weight loss as you will with the bypass, but without the risks of malabsorption. Also, it appears that there is less chance of regain with a sleeve.

The reason is that the bypass pouch is made out of the stretchy part of the stomach whereas with the sleeve, the stretchy part is cut off. Also, with the bypass pouch, you end up with a stoma which can stretch. It's also because of the stoma that bypass people will get food "stuck" similar to what happens with the band. Sleevesters have a fully functional, normal stomach so sometimes we get the "foamies" when we eat too fast, but it's really hard to get stuck.

[Guest zsflower]

The answer is, there is no one right answer. If you did well with the band, chances are you will also do well with the sleeve. The sleeve is a purely restrictive procedure just like the band. The bypass is a combination procedure, meaning it combines restriction with malabsorption. The malabsorption varies according to how much intestine is bypassed.

If someone doesn't do well with the band, the bypass might be a better choice for them as they may need the added boost of the malabsorption component of that surgery.

While there is no stoma with the sleeve, the stomach can and does stretch. The stomach can also stretch with the bypass though it is a much smaller stomach than the sleeve. However, the stoma can enlarge in the bypass. Both surgeries have their pros and cons.

There is more long term data on the bypass than the sleeve, but that doesn't mean that's a bad thing. The best thing to do is look at your history with the band, your lifestyle, read as much as you can on both surgeries and discuss your options with your surgeon.

[MacMadame 81]

While there is no stoma with the sleeve, the stomach can and does stretch. The stomach can also stretch with the bypass though it is a much smaller stomach than the sleeve.

The sleeve stomach doesn't stretch. All the stretchy part is cut away. Maybe early sleeves which were made as large as a DS sleeve had this issue, but the sleeves being done today with the 32 & 34 f bougies, don't have this issue.

You are left with a 40-60cc stomach, which is slightly larger than the RnY pouch, but the RnY pouch is made from the stretchy part of the stomach and stretching is an issue with it. That is why average EWL for a RnY tends to go down over time.

In the 5 year data that LapSF is collecting, regain for RnY is around 25%, but for the sleeve only about 10% regain.

[Guest zsflower]

The sleeve stomach doesn't stretch. All the stretchy part is cut away..... the RnY pouch is made from the stretchy part of the stomach and stretching is an issue with it....

The stomach (the whole stomach) is a muscle. All of it can stretch if constantly filled over capacity. There is not a "stretchy and non-stretchy part" of the stomach.

I'm not knocking the sleeve. It's a good surgery. But to say it's better than the bypass, depends on who you talk to. Cirangle in SF is very pro sleeve and likes to do a lot of them. This data you mention is from a study that he has done himself. Again, I'm not saying the data is skewed however, it's possible. The fact is that there is still much more long term data on the bypass only because the sleeve has not been around nearly as long.

The point is I really believe there is no one correct surgery for everyone. I got caught up in believing that myself (the band was the only way) and found out this is not the case. Some people do well with the sleeve, others do better with a bypass and vice versa. The best thing to do is do as much research as you can on all your options, speak to your doctor and then make your choice.

[MacMadame 81]

The stomach (the whole stomach) is a muscle. All of it can stretch if constantly filled over capacity. There is not a "stretchy and non-stretchy part" of the stomach.

I'm sorry, but that's simply not true and it's a matter of biological fact. The greater curvature of the stomach is the big stretchy part. It is designed to expand when food is put into it. The part that remains after a sleeve is a very tough muscle Fiber and is extremely hard to stretch.

Bypass pouches (which are made out of the fundus) typically start out holding 1-2 oz immediately post-op as they are swollen. So do the sleeves. Then over time the swelling goes down and by one year out, many bypass patients can eat as much as a cup of food at time even hard Protein, while at the end of the first year a sleeve patient's sleeve typically holds 4-5 oz. of food only and never gets bigger.

Stretching of the pouch is an issue with bypass and that's why regain is an issue. Over a period of time, average EWL for bypass and band approach each other. This is largely due to regain on the part of bypass patients.

Generally 25% of bypass patients experience regain compared to 10% of sleeve patients.

Btw, LapSF publishes their results in respected peer-reviewed journals. To imply that their data is biased is laughable. They do a lot of sleeves because they've seen how well they work.

[WASaBubbleButt 41]

The stomach (the whole stomach) is a muscle. All of it can stretch if constantly filled over capacity. There is not a "stretchy and non-stretchy part" of the stomach.

I'm not knocking the sleeve. It's a good surgery. But to say it's better than the bypass, depends on who you talk to. Cirangle in SF is very pro sleeve and likes to do a lot of them. This data you mention is from a study that he has done himself. Again, I'm not saying the data is skewed however, it's possible. The fact is that there is still much more long term data on the bypass only because the sleeve has not been around nearly as long.

The point is I really believe there is no one correct surgery for everyone. I got caught up in believing that myself (the band was the only way) and found out this is not the case. Some people do well with the sleeve, others do better with a bypass and vice versa. The best thing to do is do as much research as you can on all your options, speak to your doctor and then make your choice.

MacMadame is correct in what she is trying to explain to you regarding the anatomical differences.

I agree with you that there is no one surgery type that is best for everyone across the board. I have a friend that there is no surgery type that will ever work for her. It just isn't going to happen. ( DS would be her only option that might be workable but she's be totally non compliant with supplements. So... that leaves her nothing.

[Guest zsflower]

I don't want to offend anyone and I really wasn't implying that the data from Dr. Cirangle is incorrect. I just meant that it depends on which surgeon you talk to. Yes, Dr. Cirangle is very pro sleeve and he has seen much success. I enjoyed hearing him speak at the ASMBS meeting in Cabo a few months ago. The sleeve is a great surgery. However, some surgeons hate it and they love the bypass. The same is true with the band.

The bypass' pouch is NOT made from the greater curvature.

I tried to post a picture, but can't figure out how to do it. Just click on this link, bypass and this link, sleeve (I hope this works)

Not much fundus in either surgery.

Wasa is very correct in that you can out eat any surgery if you want to. I've seen many people do it, unfortunately. I'm happy that you have done well with the sleeve.

One reason I chose the bypass is that I didn't do well with the band. I wanted the restriction AND malabsorption. I have 150 cm of intestine bypassed. I also have a very tiny pouch (it was made less than 1 oz). I also originally started out with a BMI of 62.

I just want to make sure that everyone gets good information and reads as much as they can. I do stand by my statement that a person has to find the surgery that they feel the most comfortable with and feel will work best for them. I want everyone to be happy and healthy!

[MacMadame 81]

The bypass' pouch is NOT made from the greater curvature.

It's made from the fundus. That's the blob on top. (Well, it looks like a blob to me.)

[seajoan 0]

zsflower, I agree with you.

First the stomach can stretch even the sleeve remnant. There are a couple of people here posting well, very odd statistics. The sleeve has only been really studied the last 3 years. In fact it's being sanctioned by the ASMBS pending studies due out next year. We all have a vested interest in saying our surgery is/was the best. Well it might be the best for you, but not neccesarily for most people. Whats being left out of the sleeve debate is the surgical community does not know the long term issues particuliarily the discecting of the stomach and how it relates to hormones, What happens when you discect 75% of the patients stomach and how will that effect not haveing enough or at all needed stomach hormones. We know that there are at least 25 different hormones that reside in the gut besides guertin and leptin. What happens when they are absent or not enough? What happens if you get stomach ca, what happens 10 years post op in terms of weight loss. RNY is still considered the gold standard for obesity surgery. The RNY and the band can be reversed, not the .It was my choice to get a band. To each their own.

[MacMadame 81]

The sleeve has been done since around 2001, much longer than 3 years. LapSF is currently presenting their five year results. They have done over 1000 sleeves and have a cohort of 750 patients they have been following for five years. This is a bigger group than was used by the FDA to vet the lap band in the US.

You can see one of their presentations here:

http://www.ssat.com/video/2008/SSAT%2049th%20Annual%20Meeting(3)-Cirangle.htm

Plus partial gastrectomies have been done since the 70s and there is a ton of research into long-term complications. So we do know what happens if you dissect 75% of the stomach. In fact, there are people out there with no stomach at all who are living productive lives with no serious complications.

[WASaBubbleButt 41]

zsflower, I agree with you.

First the stomach can stretch even the sleeve remnant. There are a couple of people here posting well, very odd statistics. The sleeve has only been really studied the last 3 years. In fact it's being sanctioned by the ASMBS pending studies due out next year. We all have a vested interest in saying our surgery is/was the best. Well it might be the best for you, but not neccesarily for most people. Whats being left out of the sleeve debate is the surgical community does not know the long term issues particuliarily the discecting of the stomach and how it relates to hormones, What happens when you discect 75% of the patients stomach and how will that effect not haveing enough or at all needed stomach hormones. We know that there are at least 25 different hormones that reside in the gut besides guertin and leptin. What happens when they are absent or not enough? What happens if you get stomach ca, what happens 10 years post op in terms of weight loss. RNY is still considered the gold standard for obesity surgery. The RNY and the band can be reversed, not the .It was my choice to get a band. To each their own.

Seajoan... you need to get some updated information. Once again you are passing around old info.

[seajoan 0]

Hi, Obviously, gastrectomies rose out of bypasses. Dr. Cirangle may be or have done a retrospective study but.....

I doubt very much whether this will be a random or double bind study.

Right now ASMBS is awaiting studies and I think they will probably approve the sleeve next year.To say we know what happens with long term sleeve patients is disingenuous. We don't even know all the hormones that reside in the stomach and how important they are to everyday life. . They only recently found this year that the serotonin receptor which they thought was in the brain has one if not more of its receptors in the stomach.. It took years to find out the long term side effects of doing a extended distal bypass (high incidence of pancreatic cancer, bone loss with fractures etc.).

I'm just pointing out to be cautious about your surgery choice.

[WASaBubbleButt 41]

HAHAHA.. see Mac? Told you. ;o)

[MacMadame 81]

Hi, Obviously, gastrectomies rose out of bypasses.

Well no. They arose out of the Magenstrasse and Mill procedure which is a gastroplasty. It was the M&M procedure, and it's success, that prompted people to think "hey, maybe we can do that DS in two-parts."

They are nothing like a bypass and not really related at all, except that both are WLS. The band is the one that arose out of the bypass. It is designed to mimic the pouch of the bypass without actually cutting the stomach or re-routing the intestines.

Dr. Cirangle may be or have done a retrospective study but.....

I doubt very much whether this will be a random or double bind study.

99% of bariatric studies are retrospective. I've never seen a double-blind study. You have to tell the patients what operation they have so they can get proper post-op care and that cuts out double-blind right there. They will randomly assign a surgery type to the group sometimes, but that is very rare because there are ethical considerations to doing so. In fact, I personally think it is *unethical* because matching surgery type to a patient's issues is important for long-term success. But obvious the handful of people doing these sorts of studies don't agree with me.

To say we know what happens with long term sleeve patients is disingenuous.

To say we don't, is disingenuous, IMO. There is tons and tons of data on partial gastrectomies. There is at least 30 years worth of data. That data does not show any problems with malnutrition (with proper Calcium supplementation) and does show that sustained weight loss is a side-effect of those surgeries (which were done for other reasons so it's considered a side-effect).

I'm just pointing out to be cautious about your surgery choice.

Everyone should be cautious about all surgery choices. It's surgery. And, yes, if you want to see 50 studies of long-term results of the surgery done only for weight-loss reasons and not for ulcers or stomach cancer, then the VSG isn't for you.

That doesn't mean you have to spread misinformation about the sleeve though. You clearly haven't studied it much at all and have a lot of misconceptions and misinformation about it.