Michael_A

Sleevers -- Why the sleeve??

25 posts in this topic

Just looking for honest feedback on why you chose the sleeve.

If you originally considered RNY, why did you switch?

I know that sleevers lose more slowly, and I wouldn't have an issue with that myself. But do you feel (or has experience shown you) that the sleeve will let you lose just as much weight as you could, potentially, with RNY? For some reason I have it in my head that sleevers "don't lose as much" as those having RNY.

If you have a sleeve, is it guaranteed that you will suffer from GERD? 

I've been lurking here for about a year and been a member for 5 months, and in that time it seems like there are more folks having sleeves done than RNY. Also I've recently begun researching WLS in Mexico, and was very surprised to learn that 2 of the "top" surgeons there are no longer doing RNY (although they've not updated their websites to reflect that), only the sleeve.

Thanks in advance for sharing your thoughts.

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My surgeon now does more sleeve than RNY, which suits me fine. I've never wanted RNY and was glad to have sleeve as an option.

Why not bypass: I didn't want to dump, and i wanted the freedom to eat anything i choose when all is said and done. I also didn't want the malabsorbtion.

Why the sleeve: I wanted a permenant solution, and it seemed logical. My biggest stumbling block was the removal of 80% of my stomach from my body. Because the stomach is gone, it is truly irreversible. If I were to have problems, my only real option would be to convert to RNY, the procedure I wanted to avoid.

Speed of weight loss was inconsequential to me. I have successfully lost all of my excess body weight three times. I even kept it off for about a year the third time. I don't need the surgery to help me lose weight; I can do that on my own. My end game is to have a tool that gives me a fighting chance of keeping the weight off permenantly, and I felt the sleeve is the right tool for me to help me do that.

My next point is speculation. It seemed to me that if the stomach produces ghrelin (hunger hormone) and most of the stomach is gone, I could end up with improved control over physical hunger (although as many have pointed out, head hunger is a different beast).

The next point has scientific basis. A formerly obese person requires fewer calories to maintain a healthy weight than someone who has never been obese. My sincere hope is that with a smaller stomach, I will continue to be satisfied eating the smaller amount of food that my body will require to maintain my weight loss.

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Oh, and I didn't answer your GERD question. I went into VSG knowing I had GERD. I will continue to take the acid reducers as needed to maintain control of the reflux. I may grow out of it; I may not. Only time will tell on that one.

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My surgeons have done studies comparing RNY and Sleeve patients, and at 2 years out the weight loss was exactly the same, although RNY lost a bit faster in the initial 6 months or so. As for why, my surgeon stressed to me that long term, sleeve is a safer procedure. There are just some long term side effects of RNY that don't happen with sleeve, including chronic ulcers, internal hernias (life threatening), hypoglycemia, anemia, and osteoporosis. Now the anemia and osteoporosis CAN happen with sleeve but generally don't. The internal hernias and hypoglycemia are RNY issues only. So if I could lose the same amount of weight and avoid those complications, that seemed better. He told me if his mother was having weight loss surgery, he'd advise her to get the sleeve. 

Also, he said that if it doesn't work or you have problems you can convert to a DS or an RNY, but if you have RNY first there isn't much you can do after that. No plan B, as it were. 

I did have GERD before surgery, so I went in thinking RNY, but he talked me into the sleeve. I still have GERD, but it's better now that he fixed my hiatal hernia and I'm lsosing weight. He thinks that when I hit goal weight the reflux will be gone. But if I have to trade taking a nexium a day I still wont' regret my surgery. Also, I can still take NSAIDs as needed, if I'm careful, which isn't really true with RNY. 

That said, I am sure there are good reasons to choose RNY, and heck, if my reflux ever got really bad maybe I'd switch to that. But I do have that option,and for now I don't have to worry about internal hernias, having a stoma stretch or scar down, etc. 

teacupnosaucer likes this

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I did not want malabsorption and all the malnutrition issues that can come with it.  I did not want the other complications listed above, including intestinal blockages which I've seen.  I have a couple friends that had bypass 8 years ago and I see first hand all the problems they have with malnutrition and not being able to eat certain things.  One of them actually has very bad GERD.  Had it preop and bypass did not help.  Another friend had RNY two months before me and she continues to have issues eating due to discomfort and is already having nutritional deficiencies.  Still another friends was banded 10 years ago.  She vomits and slimes all the time, has never reached goal weight and has gained back about 1/2 of what she lost.  

i did not have GERD preop and don't have it postop.  I only have mild gastritis/heartburn when I drink coffee or alcohol which didn't happen before.  Other than that I'd never know I had surgery which is exactly what I was hoping for.  Just smaller portions but with no problems eating anything (except carbonation....it's the only thing my sleeve won't tolerate).  My bloodwork is perfect and I feel fabulous.

I Didn't care about the rate of loss since I knew this was a lifelong change and commitment anyways.  Honestly, If lapband and bypass had been my only options I would not have had WLS.  Thank goodness for VSG!  It's been a perfect tool.

AdrianVV likes this

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I wanted the sleeve because I wasn't particularly interested in the malabsorption aspect of bypass. I didn't feel it was something I needed. I don't suffer from any eating disorders, and wanted to more easily avoid any issues with nutritional deficiencies and glycemic problems. The loss averages were so similar as to be irrelevant. I didn't have GERD before surgery and don't have it now.

Yesterday was my one year surgiversary and I couldn't be more pleased with my choice and progress. Either surgery will get you where you need to go though, you just have to make your choice based on a honest consideration of your lifestyle and reasons you are obese in the first place. 

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The internal hernias and hypoglycemia are RNY issues only.

This is an untrue statement.  Anyone with abdominal surgery is at a higher risk for hernias because your stomach/abdominal wall/muscles are now weaker at the point of entry.  Because I had my appendix out I am more prone to hernia in that area.  Because I had the sleeve, I am not more prone to hernia in that area.   Because I had my gallbladder out using most the same holes that were used for my sleeve, I'm even more prone to hernia in that area.    If you have a hernia you are even more prone to getting them again....  cause everytime all that stuff is punched through it makes it a little bit more weak.   Also I do have hypoglycemic episodes as sleeve if I go too long without eating, it is not all that uncommon with sleeve.

Sleeve was the only thing I wanted and if it wasn't available I wouldn't have had WLS at all.  I did not want my stuff re-routed is the bottom line.  I also did not have any co-morbidities which was a big factor as well (I was pre-diabetic but not on any meds for it).  

Statistically bypass loses more and loses faster, that is simply fact.  But statistics are just that.....statistics.  I've seen fast sleever losers and I have seen really slow bypass losers.  I averaged 13lbs a month loss with is considered fast for sleeve, but I was also 400lbs.   I have seen sleevers lose all their weight in less then a year, I have seen bypassers never reach goal weight.   I have seen sleevers gain weight back, I have seen bypassers gain weight back.  I have gained weight back as sleeve myself - but it isn't my sleeves fault, its mine.    I very very likely would have lost more with bypass and lost it faster -   but keeping it all off is still up to me in the end and the type of surgery has very little to do in regards to that long term.

As for GERD - its a crap shoot.  No you are not gauranteed -  PapaG and Clickin have never had acid issues since his sleeve to give you someone here as an example.  I had issues for the first 10-11 months but after that pretty rare and I'm approaching 3 years out now.  I do takes Tums on occasion for mild heartburn and there is no rhyme or reason to it.  Acid issues usually resolve in 2-4 months once the sleeve is healed.  We have seen folks here needing revision to bypass though because their GERD was so severe; not very common but it certainly happens. 

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I should have clarified, I meant that internal hernias aren't a problem with the sleeve...you can still have the regular kind. But there is a certain kind, in the Peterson's space, that is much more likely with RNY or any surgery involving the intestines. 

As for hypoglycemia, I meant the kind that some (but only a few) RNY patients get, where no matter how often they eat or what they eat they can't control their blood sugar. It's a rare but serious complication of RNY that isn't well understood. 

Cue likes this

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Ditto on everything others have said regarding choosing VGS over RNY.  The primary point I will add to this is with the sleeve, the pyloric valve is preserved.  BIG DEAL!  It's function regulates the emptying of the stomach.  It reconizes fluid and solids....with RNY a stoma is created.  Over time, with many pts it will stretch out....then the stomach becomes essentially the size of intestines.  Anyone would have non-stop hunger then.  The treatment for this is named the Apollo stitch.  This was explained to me pre-op by a physician assistant..  He had been exposed to bariatric surgery since the 1980s.  There are just way too many areas that are rearranged with RNY FOR ME.  Lots of folks have success and great outcomes.  Yeah!!!  But, FOR ME, I just did not wish to chance that many anastomoses.  

Losing weight rapidly was not my goal.  Quality of life, one without malabsorption, ulcers, multiple staple sites that create problems....not so much.  Do what you feel best about.  Ask physicians many questions.  Checkout lots of bariatric websites.  This surgery is about changing your life.  It is a big decision!

Best of luck on your journey!

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sleeve for me because of all the reasons stated above, especially the malabsorption issues.

i disagree with the hypoglycemia happening in RNY only.

i was not diabetic before or after my sleeve but on occasion I have had hypoglycemic events, usually from not eating often enough. To prevent this I have a small bit of protein every 3 to 4 hours.

i lost 100% of my excess body weight in about 9 months.

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sleeve for me because of all the reasons stated above, especially the malabsorption issues.

i disagree with the hypoglycemia happening in RNY only.

i was not diabetic before or after my sleeve but on occasion I have had hypoglycemic events, usually from not eating often enough. To prevent this I have a small bit of protein every 3 to 4 hours.

i lost 100% of my excess body weight in about 9 months.

The type of hypogycemia thing I'm talking about with RNY is not from not eating enough. It's not a sometimes thing. It's a life altering type of reactive hypoglycemia where no matter what they eat and how often, they get low blood sugar to the point of passing out. They can't drive. They can't work. They can't have  a normal life. And there is no known cure at this point. It's rare, but it happens. Anyone, surgery or not, can have regular hypoglycemia, I had it from time to time even before surgery. This sis something different. Some people even have to have the bypass reversed because of it. 

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ktgrok, both of the complications you mentioned are rare. But given the size of this community, members we encounter people who have experienced them. Bugdocmom has the hypoglycemia problem you mentioned, and the wife of one of our members had the issue with the Peterson's space. They rarely happen, but they do happen.

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Thanks for these replies so far everyone, it really helps. When I first crossed that line mentally and decided that I need WLS, I can't tell you why but bypass was what I was stuck on. Being a part of this community though over these last many months, has really helped somehow to open my mind to the possibility of getting sleeved. 

What do you guys feel about the "newness" of the sleeve procedure versus bypass? Bypass has been around so much longer and is pretty much a known quantity. Vertical sleeve though, from the research I've done thus far, it seems like there's still some unknowns- for example, there's not a lot of info yet on what removing that much of the stomach from the body, does to the body long-term.

Was that an issue or consideration for any of you?  What do you guys in general feel about that statement, that there are more long-term unknowns with sleeve than bypass?

Again I'm not making this a pro- or con- sleeve vs bypass, just picking your collective brains. 

Edited by Michael_A

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The type of hypogycemia thing I'm talking about with RNY is not from not eating enough. It's not a sometimes thing. It's a life altering type of reactive hypoglycemia where no matter what they eat and how often, they get low blood sugar to the point of passing out. They can't drive. They can't work. They can't have  a normal life. And there is no known cure at this point. It's rare, but it happens. Anyone, surgery or not, can have regular hypoglycemia, I had it from time to time even before surgery. This sis something different. Some people even have to have the bypass reversed because of it. 

Ugh, sorry to hear that there are people here having this. And you are right, it's rare enough that for some it is still worth the risk, given other health factors. There is no one right surgery for everyone. For me, those were things I was more afraid of than say, the reflux issues or slow weight gain. But, other people may have other factors they are calculating into their surgery decisions. Praying we all stay healthy!

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As to the newness, as a weight loss procedure on it's own it is pretty new. But the DS has been around in various forms longer, which utilizes a sleeve, and even before that the same surgery as the sleeve was use don patients with certain ulcers or stomach cancer. So the surgery has actually been around a long time, just not for this particular purpose. 

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I was concerned about the newness and unknowns as well.  However, they have been doing total and partial gastrectomies for cancer and ulcer patients for over 100 years.  I did a lot of research on the surgery side effects for these patients.  There's plenty of long term gastrectomy studies, just not weight-loss specific data.  In general, the gastrectomy patients don't have any specific long term problems other than certain nutritional deficiencies.  But these are all preventable with proper supplementation and regular bloodwork.

as for the weight loss success vs bypass, like any WLS, long term loss and maintenance is entirely in the hands of the patient, not the type of surgery they had.

50zann likes this

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My surgeon now does more sleeve than RNY, which suits me fine. I've never wanted RNY and was glad to have sleeve as an option.

Why not bypass: I didn't want to dump, and i wanted the freedom to eat anything i choose when all is said and done. I also didn't want the malabsorbtion.

Why the sleeve: I wanted a permenant solution, and it seemed logical. My biggest stumbling block was the removal of 80% of my stomach from my body. Because the stomach is gone, it is truly irreversible. If I were to have problems, my only real option would be to convert to RNY, the procedure I wanted to avoid.

Speed of weight loss was inconsequential to me. I have successfully lost all of my excess body weight three times. I even kept it off for about a year the third time. I don't need the surgery to help me lose weight; I can do that on my own. My end game is to have a tool that gives me a fighting chance of keeping the weight off permenantly, and I felt the sleeve is the right tool for me to help me do that.

My next point is speculation. It seemed to me that if the stomach produces ghrelin (hunger hormone) and most of the stomach is gone, I could end up with improved control over physical hunger (although as many have pointed out, head hunger is a different beast).

The next point has scientific basis. A formerly obese person requires fewer calories to maintain a healthy weight than someone who has never been obese. My sincere hope is that with a smaller stomach, I will continue to be satisfied eating the smaller amount of food that my body will require to maintain my weight loss.

This is pretty much why I chose the Sleeve over RNY. Additionally, I liked the idea of my Pylorus being preserved with the Sleeve, and the Sleeve is a surgically safer procedure than the RNY. As far as GERD is concerned; I've heard that some surgeons prefer the RNY over Sleeve for patients who have serious reflux issues prior to surgery. I had occasional reflux before my sleeve but it's actually less frequent now and nothing that isn't resolved with antacids or a Prilosec.

Edited by Jabsie
50zann likes this

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I went sleeve because it seemed like a more simple procedure with less that could go wrong. I also didn't want to worry about vitamin deficiency the rest of my life. If I had more weight to lose I would have considered RNY more, but since I'm a relative "lightweight" sleeve was good enough. Mainly I didn't want my lifestyle to have to change too much--if I want to eat some pasta or rice every now and then I want to be able to do that. If that means that in the long run I only lose 70# instead of 90# (or whatever) I'm fine with that.

I had heartburn before surgery, but I wouldn't call it GERD. After surgery I have heartburn more often, but it's far less intense. I take an over the counter antacid now, but I did before too. I'm very fresh though--so my heartburn may get worse or it may get better.

As far as the "newness" I think that's off-set by how much less is going on with sleeve versus RNY. Fewer spots for rupture, less trauma to the digestive system, future surgeries in that area would be more simple because I don't have a twin stomach floating around inside.

Good luck!

 

teacupnosaucer likes this

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Newness wasn't and issue for me. While it's only a 12 year old stand alone procedure, it's been done for far longer for other reasons. And since all it is doing is cutting off the excess blown-out portion of the stomach; in theory there shouldn't be anything long term that should cause an issue.  Little changes digestively or in how things work. 

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I initially wanted RNY. Partially because "Bypass" was the only term I'd heard outside the band until I actually started researching things for myself, partially because I thought I'd fail and the malabsorbtion seemed like a plus. However, for my doctor consultation he immediately shot down the idea. He said I was too young and that the potential complications from a bypass weren't worth it for someone like me. I was worried about the GERD, but I've been extremely lucky throughout this whole process and it didn't show up.

I became diabetic right as my 6 month check ins were over, so I ended up spending an extra 5 months getting that under control and keeping it there. It forced me to reevaluate my diet and while I wasn't perfect, it gave me a confidence in myself that I'd never had before. Plus, now that the hunger hormone is mostly gone things have been considerably easier.

Do I still get cravings? Absolutely. But the second I consider eating the thing I'm craving I get grossed out because of how not hungry I am. Of course, I'm still pretty early out and things could change, but so far I've lost almost 40 pounds in less than a month with the sleeve. You just never know for certain how your body is going to react. So I'd say go with what you think is best and then don't look back. Either option is a huge step forward, no matter the initial outcome.

WendyH likes this

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this post is great! thanks so much for sharing, everybody! I know it's super old, but for those of you who posted here, mind giving an update? has anything changed since the last time you commented here? :)

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Still doing well--minor heartburn still lingers. No other complaints though!

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4 hours ago, teacupnosaucer said:

this post is great! thanks so much for sharing, everybody! I know it's super old, but for those of you who posted here, mind giving an update? has anything changed since the last time you commented here? :)

Still lovin my sleeve.  Still gives all the restriction I need WHEN I eat the way I'm supposed to.  No restriction when I eat crap..... pretty much what I expected.  I can't stress enough that the psychological component and lifestyle changes you make play a bigger role in long term success than the surgery itself.  With good choices I continue to maintain within a couple pounds of my lowest weight and annual bloodwork still perfect with my daily vitamin regimen.  I am pain free, have lots of energy, and look hot!

The biggest change for me since I posted in Nov 2015 is that I actually started dating someone 2 months ago.  Despite swearing off relationships and embracing the freedom of being single for the last 20 years, I now find myself having a great time with a guy that makes me laugh and feel good about myself.

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I'm still doing well. Blood work is good, no issues with reflux or any other Sleeve related complications.

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Doing well and loving the life I live now. 

Almost 3yrs out and my sleeve is still doing its job. Put the right stuff in it and reap the rewards. It's work and it is hard don't get me wrong. It's not a magic tool, it's a day to day keep making the right decisions helper. 

Edited by Clickin
teacupnosaucer likes this

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