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mikef

Why did you choose Bypass over Sleeve?

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Curious for some feedback. Why did you choose RNY vs VSG?  

Which surgery is more invasive and more painful?  Which has a longer recovery time?  

Is one a bigger surgery than the other?  I think that's the word I'm looking for  

Which has more complications?  

Thank you. 

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Both surgeries are usually done laparoscopically these days and the surgeon will generally use the same amount of port sites (where they insert the laparoscopic instruments) so there can't be much if any difference in pain level between the RNY and sleeve, recovery time or complications.

The gastric bypass is a more complicated surgery and has a slightly higher overall risk profile but it generally produces more weight loss.

ETA:  In the RNY, the stomach remains making a reversible possible if necessary but in the VSG, it is removed.

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My doctor recommended sleeve because of my age. He said the more years you live the higher the risk of blockage from scar tissue with bypass. I also felt personally that sleeve was a more "permanent" solution. It also seemed somehow less intrusive to me because it only involved the stomach and no rerouted intestine.  By the way, I have zero regrets. I'm 2 1/2 yrs out down about 150 lbs and love it! 277 to 125.

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I choose sleeve because I thought I'd be less likely to dump with a sleeve. I knew I wanted to still eat sugar and carbs on occasion. I didn't like the idea of have my intestines re-routed. I knew I wanted to still drink alcohol. For me the effects of alcohol are exactly the same with a sleeve as they were pre-op. Everything I've read said a by pass causes you to process alcohol differently. A little bit gets you drunk or makes you sick very quick. 

 

Both surgeries are effective if you follow your plan. Lots of people on this site are very happy with their decision whether they chose by pass or a sleeve. My sense is the recovery time is about the same for both.

 

Good Luck with your decision!

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My surgeon said I was not eligible for the sleeve because I had esophageal reflux. He said the sleeve would act like an acid cannon and burn my throat, whereas the bypass is actually the surgery done for GERD that doesn't respond well to medications. BTW, the reflux is totally gone.

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I really wasn't given a choice.  Because I had uncontrolled diabetes.  But I would have chosen bypass.  I didn't like the idea of removing the unused portion of my stomach or possibility of reflux.  I felt great after surgery and wanted to o home the next day but couldn't because my blood sugars weren't good.  

I returned to wok full time on my feet without a break at nine days post op.  No complications, no regrets at this time...best thing I've ever done for myself..

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My surgeon said either one was fine for me, but ultimately I decided RNY because:

  • it's been around a long time, so there's lots of data on its success rate and long term outcomes
  • it's statistically more likely to lose more weight (keeping in mind that statistics to not determine individual outcomes) 
  • no risk of reflux increasing (I didn't have it before, don't want it after)
  • it's at least technically reversible (nothing is removed)
  • the hormones involved with the digestive process appear to be more greatly regulated with RNY than VSG
  • fear of dumping might motivate me to avoid sweets (I don't have a big sweet tooth, but anything helps)

That said, if the surgeon had firmly said VSG, I would have been happy to go with that recommendation. So many people are happy with their sleeves and have enjoyed a lot of success with them. The most important thing to me was just getting one or the other done ASAP so I could start to address my problems. 

WLS is a huge decision. The choice between the procedures is a big decision, but to me less of a big thing than deciding to go ahead in the first place. Barring some sort of complication, most people post-op seem to think that they made the right decision as to which one to get, so I have the feeling that if one doesn't jump out as the "right one" to you for whatever reason, probably either one is OK, and you'll think afterwards that it was the right one for you. We tend to like the decisions we've made.

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mikef, 

I chose VSG because there is a slightly lower rate of immediate complications and the difference between VSG and RNY is small in terms of weight reduction. (Small but real, so if you want the procedure with the highest % of success, RNY just noses out VSG). There also appears to be fewer longer term complications like nutrient deficiency and post-surgical hypoglycemia. having said that, if my surgeon had urged me to go for RNY I probably would have been persuaded. 

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On ‎5‎/‎10‎/‎2017 at 8:58 PM, slars04 said:

My surgeon said I was not eligible for the sleeve because I had esophageal reflux. He said the sleeve would act like an acid cannon and burn my throat, whereas the bypass is actually the surgery done for GERD that doesn't respond well to medications. BTW, the reflux is totally gone.

Reflux is very serious. It can erode your throat to the point of irreversible damage. It isn't something to take lightly or hope will go away. Ask your surgeon to show you the numbers. My dad ultimately died of reflux. He messed around, wouldn't take medication, and got esophageal cancer. It was ugly, painful, and not something I would wish on my worst enemy. His doc told us that the likely cause was reflux, alcohol consumption, and smoking. (BTW, he had quit smoking and drinking alcohol 13 years before he died. He popped antacids like candy, but didn't see a gastro until it was too late.)

Edited by slars04

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I also chose RNY because I have reflux - and was recently diagnosed with Barrett's esophagus - without cellular changes, but cellular changes could be the next step if I don't address it.  I went in to my surgeon's office asking for RNY, and he asked why I chose that over the sleeve - and when I told him, he totally agreed.

He also pointed out that if I were to ever develop cancer of the esophagus (very minimal chance, especially after bypass), the organ of choice with which to repair the esophagus is the stomach.  With bypass it's still there to be used if needed - with sleeves, it isn't, so they use less optimal tissue (like colon tissue!)

I do like the fact that the sleeve seems like a less complex operation, and I'm pretty scared of surgery in general.  But if I'm going to do it - RNY is just the best, most logical option for me.

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