KansasDelta

How did you choose?

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Hi everyone! I'm in the pre-op stage and still about 4.5 months away from being "on the table". I feel like I've watched every YouTube video out there on gastric bypass and gastric sleeve but I keep bouncing back and forth between the two! So since I don't personally know anyone who has had either, I wanted your input. Why did you choose the route you did? My surgeon recommended the sleeve due to the fact that I'm young-ish (30) with no co-morbidities. But I could tell just by talking to him that he had a preference for the sleeve over gastric bypass in general, so I'm not sure if he just has an overall tendency to recommend that more regardless. Thanks in advance! 

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I'm young-ish, no co-morbidities and I chose gastric bypass. My main reason was, when I looked, I couldn't find any long term (like 5-10 year) studies about the effectiveness of the sleeve, but there were plenty for gastric bypass. Additionally, gastric bypass is considered the "gold standard" and people who have gastryc bypass usually lose more weight overall and faster than people who have the sleeve. The other thing that reaffirmed that I'd made the right choice for me was when, at my 1 year check-up, my surgeon ( while congratulating me on reaching my goal weight) remarked, "aren't you glad you chose bypass? My sleeve patients aren't nearly as successful as my bypass patients." Now, that could just be her experience but it confirmed for me that I made the right choice for myself. I know some people take issue with having their intestines rerouted or worry about dumping or malabsorption or choose the sleeve for other reasons and I totally respect that this is a personal decision where there isn't necessarily a wrong answer, but for me, bypass was 100% the right choice.

Hopefully Res Ipsa will chime in with his amazing list of reasons why he chose bypass and some of the sleevers will post their reasons. Whatever you end up deciding we're here to support you and try to answer any questions you have. Welcome to TT!

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Just a warning, I find this board heavily slanted toward bypass. I feel really good about my decision to go with the sleeve (My surgeon talked me into it), but I rarely participate in answering this question here for fear offending those who chose or needed to go the other way. I'm part of the problem of sleeve being underrepresented, I guess! I'd be happy to PM with you about it if you end up really being on the fence. I'm very early out, so you may be more interested in someone who has has more experience under their belt. Bottom line, most people are happy with whatever they chose and you can make either tool really work for you.

Edited by Gretta

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2 hours ago, KansasDelta said:

Hi everyone! I'm in the pre-op stage and still about 4.5 months away from being "on the table". I feel like I've watched every YouTube video out there on gastric bypass and gastric sleeve but I keep bouncing back and forth between the two! So since I don't personally know anyone who has had either, I wanted your input. Why did you choose the route you did? My surgeon recommended the sleeve due to the fact that I'm young-ish (30) with no co-morbidities. But I could tell just by talking to him that he had a preference for the sleeve over gastric bypass in general, so I'm not sure if he just has an overall tendency to recommend that more regardless. Thanks in advance! 

I'm about two months away from my surgery date.  I chose gastric bypass because I have type 2 diabetes, and gastric bypass usually instantly corrects this, even before you leave the hospital. 

Gastric bypass also provides 2 mechanisms for weight loss- restriction, and malabsorbtion. I definitely want the restriction, as do most of us that pursue WLS. But the malabsorbtion part also appealed to me as it gets the weight off quicker. Also there are no potentially massive heartburn issues with bypass, as there can be with sleeve. Because bypass does malabsorb you, you must be committed to taking vitamins daily, for life. But I'm fine with that.

It's not for everyone though, and I'm sure some sleevers will give you a good counter-point to us bypassers.

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20 minutes ago, Gretta said:

Just a warning, I find this board heavily slanted toward bypass. I feel really good about my decision to go with the sleeve (My surgeon talked me into it), but I rarely participate in answering this question here for fear offending those who chose or needed to go the other way. I'm part of the problem of sleeve being underrepresented, I guess! I'd be happy to PM with you about it if you end up really being on the fence. I'm very early out, so you may be more interested in someone who has has more experience under their belt. Bottom line, most people are happy with whatever they chose and you can make either tool really work for you.

Gretta, this is what this board is about-- sharing the info and helping others who need it. I hope you don't relegate your conversation to a PM.

I'm not sure who may have said what to you about your choice of sleeve, but I'm sorry someone made you feel as if it wasn't the way to go. All of us have to make that choice for ourselves and hopefully we make it based on good research or good counsel.

My own personal opinion is that there are several very strong and successful sleevers on here, and I definitely don't feel like the place is heavily slanted toward bypass, but that is just me :-). Also don't forget that while the sleeve is becoming very popular (and for generally very good reasons), it hasn't been done nearly as long as gastric bypass. So there is bound to be much more familiarity with bypass, and maybe even a preference for it by some due to no long-term data on the success or issues with it.

But notice that the OP asked why each of us chose what we chose. You should definitely feel like you can speak freely about your journey and experience, that's what we're here for! 

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Here is my latest post on this topic:

 

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Just wanted to welcome you to Thinner Times KansasDelta.

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6 hours ago, Gretta said:

Just a warning, I find this board heavily slanted toward bypass. I feel really good about my decision to go with the sleeve (My surgeon talked me into it), but I rarely participate in answering this question here for fear offending those who chose or needed to go the other way. I'm part of the problem of sleeve being underrepresented, I guess! I'd be happy to PM with you about it if you end up really being on the fence. I'm very early out, so you may be more interested in someone who has has more experience under their belt. Bottom line, most people are happy with whatever they chose and you can make either tool really work for you.

I've never found this to be the case. When I first joined this forum there were some very prolific long term posters who'd had sleeve surgery. Sadly they've disappeared for now, no doubt due to other priorities at the moment. I suspect your perception is more about the mix of members posting since you joined.

Welcome to Thinner Times @KansasDelta. If you suspect your surgeon might be serving his own wishes rather than recommending what's best for you, you can always visit a different surgeon and get a second opinion.

Edited by Aussie H

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8 hours ago, Gretta said:

Just a warning, I find this board heavily slanted toward bypass. I feel really good about my decision to go with the sleeve (My surgeon talked me into it), but I rarely participate in answering this question here for fear offending those who chose or needed to go the other way. I'm part of the problem of sleeve being underrepresented, I guess! I'd be happy to PM with you about it if you end up really being on the fence. I'm very early out, so you may be more interested in someone who has has more experience under their belt. Bottom line, most people are happy with whatever they chose and you can make either tool really work for you.

I have felt this way as well. Not necessarily as a major negative, but I do feel that the "gold standard" of the bypass gives off the perception that us sleevers got the lesser of the surgeries. I chose the sleeve because I knew successful people who've had it, I'm on the lower end of the spectrum and the thought of malabsorption scared me.

 

I couldn't be happier with my choice. I am 1/2 way to goal weight at 3 months out. I know that the balance 50lbs won't come off nearly as fast, but I'm having a blast working out and learning to live a new life.

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I chose the sleeve because I didn't want my intestines re-routed. I knew I was less likely to dump with a sleeve and I still wanted to drink alcohol. The drs tell us all not to drink but I knew I was going to. My personal opinion is if you enjoying drinking from time to time and you do NOT want to stop drinking forever. Educate yourself on alcohol and WLS. Post by-pass, even a little bit of booze can make you sick or drunk very fast. 

Edited by Stephtay

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11 hours ago, Gretta said:

Just a warning, I find this board heavily slanted toward bypass. I feel really good about my decision to go with the sleeve (My surgeon talked me into it), but I rarely participate in answering this question here for fear offending those who chose or needed to go the other way. I'm part of the problem of sleeve being underrepresented, I guess! I'd be happy to PM with you about it if you end up really being on the fence. I'm very early out, so you may be more interested in someone who has has more experience under their belt. Bottom line, most people are happy with whatever they chose and you can make either tool really work for you.

It ebbs and flows. Lots of active posters with by-pass right now but there have been more active sleeve posters in the past. I agree - most people are happy with the one they chose.

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Welcome KansasDelta! 

I got the RNY, for reasons well explained by others here, but I think I probably would have been happy with either. I communicate with a group of women who all had our surgeries done the same day, about half sleeve and half bypass. So far our experiences seem pretty similar, and all of the women are pleased with whichever surgery they got. 

Ultimately, I think there are very legitimate reasons to choose either surgery (plus the probably not so legitimate gut feeling that some of us have), and if you don't have any big indicators that show you should have one over the other, they're probably both fine in your case. Psychologists have observed that there is a thing we do called "choice-supportive bias" - whichever choice we make, we usually make mental adjustments (rationalizations) to make ourselves pleased with that choice later. So, whichever one you choose, you will probably be happy with later ;) 

At the moment, there seem to be more bypass people active here than sleevers, but I do hope that the sleeve people (I'm talking to you, @Gretta! As well as others, including @Stephtay and @Raddy) chime in to walk you through their decision making process. (OK, Stephtay answered while I was typing this!)

In the end, the important decision is whether to do WLS, and you've already decided that! Congrats and best of luck on your journey!

Edited by Jen581791

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Just now, Stephtay said:

It ebbs and flows. Lots of active posters with by-pass right now but there have been more active sleeve posters in the past. I agree - most people are happy with the one they chose.

I totally agree with both Stephtay and Jen581791 (as usual). 

Each of the two weight loss surgeries have relative advantages and disadvantages. You, as an informed consumer and in consultation with your surgeon (and insurer), need to make the decision about what is best for you. 

We are here to support you on your weight loss surgery journey. 

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The things I do feel comfortable posting publicly about my choice of the sleeve are:

-Did NOT want to give up NSAID pain relievers. Boy, this past week makes me so glad I can have those.

-Wanted the unused portion of my stomach removed, not left in there. My weight gain issues seem to have a lot to do with hormones. And I didn't want an always-empty stomach sending any messages to my brain.

-Did not want to mess with my intestines.

-Did not want malabsorption, because I have no idea what obstacles I'll face in my hopefully long life, and what nutrition and medication I'll require and need to be able to absorb.

-Sleeve has far fewer complications both immediate and long term.

-Didn't want dumping.

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WLS is pretty rare in India. A friend of mine got the sleeve and she's had phenomenal success with it, so her example got me thinking about getting WLS myself. I researched a lot online, and the sleeve seemed less invasive and scary while enabling adequate weight loss, so I decided to go with it. However, the first surgeon I approached felt that the gastric bypass was a better fit since I was a "light weight" and yet diabetic. He wasn't sure I'd be able to reverse my diabetes with the sleeve. But I had my heart set on the sleeve, so sought a second opinion. This doctor felt I would be able to both lose the weight and be diabetes free with the sleeve, so I took the gamble. So far so good! Diabetes seems to be in remission since surgery and I recently was taken off blood pressure medication as well. So I'm happy I chose the less invasive procedure...

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Remembering that I had my WLS just short of 10 years ago, I chose the RNY because at the time, it was marginally more successful than the VSG.  And I also wanted to retain my remnant stomach.

Having said that, regardless of what bariatric surgery we have, it's just a tool and unless we follow a programme of sensible eating and exercise, our long term goals of a slimmer and healthier life will not be met/maintained.

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35 minutes ago, Raddy said:

Diabetes seems to be in remission since surgery and I recently was taken off blood pressure medication as well.

This is great news, @Raddy! You've been on my mind. Good to see you!

Edited by Gretta

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Thanks Gretta! :)

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Hi KansasDelta, we're practically neighbors lol,

Here are my reasons for choosing sleeve over bypass:

*Didn't want intestines re-routed.  During my preop period, Al Roker publically shared his story about having uncontrollable diarrhea while at a State dinner at the White House and having to change pants.  That made an impression on me, even though I understand it is not typical lol.

*Wanted to be able to take NSAIDS.  Although with the weight off I have much less need of them.

*Wanted the benefit of having the unused portion of stomach removed so that some of those hunger hormones weren't being secreted and yelling at me to eat all the time.  Retaining normal function was more important to me than retaining a portion of something I wasn't going to be using.  I WANT this to be permanent lol

*I didn't have significant heartburn issues which is a big reason to choose bypass instead of sleeve.  Also not diabetic which many cite as a reason for choosing bypass, although sleevers with Type II diabetes also gain blood sugar control.

*I don't have numbers but I got the impression from my reading that pouches tend to develop strictures more frequently than sleeves do and tend to be more stretchable than sleeves.  Of course you have control over the stretching part, that can totally be avoided by eating proper portion sizes.

I agree that most people on here are very satisfied with the surgery that they chose, probably because in the long run it really doesn't make that much difference for most.  Your success will always primarily depend upon what and how much you choose to eat; either surgery is just a tool to help you make better choices.  So, do your research, decide what your priorities are and make the best decision for you.  I know I consider this the best decision I have ever made for myself.  Good luck!

 

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1 hour ago, msmarymac said:

Wanted to be able to take NSAIDS

This reason alone would have me doing sleeve instead of bypass, but for my diabetes. And absolutely, type 2 diabetics do regain better control as they lose the weight. But my Dr. was fairly insistent on bypass for the quick remission of diabetes. I don't feel like I'm not free to choose, but he had some sound reasoning why it made better sense for me.

But man that NSAIDS issue is a tough one for me to accept.  :-(

Edited by Michael_A

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Hi @KansasDelta 

I started with a BMI of 38-40, the habit of exercise, and was without diabetes. I also had a very bad back, an arthritic hip, bad knees, and obstructive sleep apnea (OSA). I did not have overt gastric reflux. For my purposes the reduction in weight that either a sleeve or bypass would likely achieve would do the trick for me when it came to my back, joints, and OSA.  While bypass surgery leads to statistically higher weight loss than a sleeve gastrectomy, the results are closely similar. In doing my due diligence I ran into the literature that shows that weight loss strategies that included exercise after WLS were significantly superior to those without exercise ... and I exercise. My feeling was that I could probably achieve substantially the same weight loss as a person who had a bypass by having a sleeve and continuing to exercise, as I have done most of my life. 

I chose a sleeve gastrectomy over a bypass, because, in my view:

- I did not want to run the life-long risks associated with malabsorption and mineral/vitamin deficiencies. I am of course taking my vitamins and calcium supplements, but my underlying risks with a sleeve rather than the bypass are much lower.

- The surgical risks for a bypass are higher than for a sleeve. They are low for either procedure now compared to the past but they are not zero. This is one of those things where most everyone does fine ... but on this Forum there are plenty of people who have had complications of surgery (after all the different flavors of surgery). Sleeves are technically easier to do than bypasses and the risks of a leak or stricture are lower. If you have complications it is a very big deal. If you look at quoted numbers you will see that the risks of death or a serious complication are perhaps double to three times higher for a bypass compared to a sleeve. The risks are clearly quite acceptable for a bypass, no question, but they remain higher than for a sleeve gastrectomy. 

- Sleevers rarely have problems with dumping syndrome. For most people with bypass it is not a major problem but there are people who have a lot of problems with it. 

- I didn't have diabetes (though was a "pre-diabetic.") - which I attribute to good luck and in part to frequent exercise. If I had been an insulin requiring diabetic I might well have weighed the benefits of a bypass differently. Having a bypass does not guarantee you will be cured of diabetes forever either - but it does increase your odds substantially. For a person with pre-diabetes it appears a sleeve works as well as a bypass. Having said this, long-term data for sleeves is not as abundant as for bypasses. To summarize, this common reason to choose a bypass over a sleeve was not present in my case. 

- People with bypasses have been shown to be more affected by alcohol, e.g. after a drink blood alcohol levels go higher, sooner, faster. This has not been shown in persons with sleeves. I don't want to have a drink and be worried I can't drive safely. I belong to food and wine societies and my hope is to continue to participate in these over the long haul (enjoying good food and wine but lesser amounts going forward). 

I'm satisfied with my choice. My surgeon did a hiatal hernia repair at the same time as my gastrectomy and have not been bothered by GERD. I had no surgical complications. I am nearly at the 3 month mark, and have lost about 60 lbs from my pre-surgery weight, and just under 50 pounds from my day of surgery. If the 3 month weight loss is (on average) about half of what is eventually achieved, I will most likely lose 100-110 lbs and be at a normal BMI of 22-25 in 1-2 years. 

 

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Hello and welcome!

I went with the sleeve because my surgeon performed it laproscopically instead of open. I really liked the surgeon and didn't want the infection risk of a traditional open surgery.

I also was uncomfortable with rerouting my intestines and felt better about leaving things in the original order and removing a portion of the stomach. It amuses me to see that choice written down, but that's how I felt.

Right now, I am maintaining a 170+ pound loss, not at goal, but feel pretty good! 

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1 hour ago, Michael_A said:

This reason alone would have me doing sleeve instead of bypass, but for my diabetes. And absolutely, type 2 diabetics do regain better control as they lose the weight. But my Dr. was fairly insistent on bypass for the quick remission of diabetes. I don't feel like I'm not free to choose, but he had some sound reasoning why it made better sense for me.

But man that NSAIDS issue is a tough one for me to accept.  :-(

Here is my two cents on NSAIDS. I took them all the time for years. Foot pain, elbow pain for my tendonitis and most days I had a low grade headache. I was happy to learn with a sleeve I'd still be able to take them but here is the interesting thing. I rarely take them anymore. Maybe 2x a year. My foot pain went away once I lost weight. I still have tendonitis - I had surgery for it right after my WLS but it still bothers me. I think (I could be wrong though) that since I'm not overusing my elbows in the ways I used to when I was fat that my tendonitis is better. And, I'm thrilled to report I rarely have a low grade headache. Maybe once every other month. For years pre-opt I wouldn't leave home without Advil. Now, I don't even know if we have any at home.  

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48 minutes ago, KMFL28 said:

Right now, I am maintaining a 170+ pound loss, not at goal, but feel pretty good! 

Booyah girl!!!

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So, in summary, both surgeries can allow you to lose lots of excess weight and keep it off.  You need to research each of them and make the decision that feels right for you. :)

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