Having a gastric bypass this summer and have some questions. Thank you !

I was considering both the VSG & the bypass but my doctor recommended bypass because of diabetes. How do I know what is right for me and if the bypass will help my diabetes?

what are your experiences with the surgery?

This question has been asked and answered several times in the past few weeks.

This should help:

Diabetes and WLS

Bypass is considered by surgeons to be the "gold standard" for bariatric procedures.

VSG is newer and it's a bit like "bypass lite" Bigger pouch and no malabsorption.

Diabetes is the most serious co-morbidity. Your surgeon is just suggesting the solution that gives you the best possible chance of reversing your condition. Not saying VSG won't cure you but bypass offers greater % of weight loss. Bypass also offers the benefit of "dumping syndrome" where sugary/carb laden food can make you feel ill. That's considered a benefit not a side effect

As someone who has had both a sleeve and RNY (due to severe GERD, and not lack of success with my sleeve), I have a lot to say about this post. And I apologize in advance, but I want to share my experience. VSG is NOT bypass lite. A sleeve is not simply a bigger pouch. In fact, it is not a pouch at all. RNY is a pouch, VSG is a sleeve with a functioning pyloric valve. According to my surgeon, and the diagram I have sitting on my desk, the capacity of both at maturity is comparable (within 5 cc's of each other) The weight loss %, all other things being equal (adherence to the program, etc.) is practically the same at the 2 year mark. The poster is correct that there is no malabsorption of calories with a sleeve. I reached goal with my sleeve and was quite happy until the acid tried to kill me.

As far as dumping syndrome . . . as someone who has it, I would NEVER consider it a benefit of my surgery. It is most definitely a side effect, and a miserable one. I can dump off of straight protein and, in my case, the syndrome does not only occur with "sugary/carb laden food." Therefore it is no deterrent (other than to eating on a regular basis) On the bright side, only about 30% of patients dump, so I wouldn't let dumping syndrome sway me one way or another.

I do believe (as does my surgeon who I trust implicitly) that RNY offers the best option for putting you in remission. Because I was not diabetic and did not have GERD prior to my sleeve, I felt that VSG was the best option for ME. I likely would have felt otherwise if I was dealing with either of those two conditions.

If a RNYer and a VSGer eat and burn the same number of calories, the RNYer will lose more weight. That's not my opinion.

Dumping may not seem like a benefit when you're laying there feeling nauseous but the idea is that the unpleasant physical reaction is supposed to deter cravings for the food causing it which is pretty much universally believed to be sugar and carbohydrates

VSG is a simpler procedure and offers less time under anasthesia and lower risk of complications. I think most people when faced with the decision of having their intestines re-wired or having their intestines remain intact choose the latter. I certainly wanted the sleeve. But, I had been taking omeprazole for ages already and I had no hiatal hernia so it really wasn't a good idea.

Perhaps I could have chose a better phrase than "bypass lite" but I wasn't trying to take anything away from folks that got the sleeve. I very much wanted to be one. I was just trying to demonstrate the difference in the procedures and why RNY could be more beneficial to a diabetic patient.

I'm not here to argue, because frankly I don't care that much, but I'd like to know where your statistic comes from, because a friend and I had the same starting weight and followed the same diet plan and I, with my sleeve, at the 2 year mark had lost more than she in the same period of time. The surgery type itself is not determinative and I will stand by my statement that at the 2 year mark, weight loss % is virtually identical with the 2 procedures.

As far as dumping, at the risk of repeating myself, I would never count on it to be a deterrent, because chances are you won't dump. Also, I would never count on it as a benefit of the surgery. It is miserable and not always tied to eating off plan.

I agree with you 100% that anyone who has heartburn issues should never be sleeved, and in my opinion any surgeon who agrees to sleeve someone with pre-existing GERD is doing a disservice to his/her patient. I also agree 100% that RNY is preferable for patients with diabetes. Sorry if I came off harsh, but as a sleever, I got pretty tired of the RNY is gold standard, you got the sub par surgery, etc. All things being equal (and for those without contraindications for the sleeve, things like weight loss percentage ARE equal) the sleeve is an amazing tool.

Well anecdotal evidence aside, RNYers absorb less calories. That's the whole point of bypassing the duodenum. Unfortunately along with those calories, RNYers also don't absorb as much of the good stuff found in food. The nutrients. The surgical community call RNY the gold standard because it's been around for a long time and studied more and it's what all the subsequent bariatric procedures get compared to. It doesn't mean the sleeve is subpar. Like I said, I wanted one. My long history with GERD prevented it. Hopefully my new anatomy will cure that condition but I won't know for sometime as I'll remain on omeprazole for at least a year.

I truly don't think the two procedures are better or worse than each other. They're just different. RNY provides a secondary tool. If you want subpar we can probably point to the lap band. That wasn't even an option for me. My surgeon won't even do it and I think that position is gaining strong support

Malabsorption of calories for RNYers is fairly small, and very temporary. It gives a little boost to weightloss over VSG during the first year, but then the advantage is gone.

Id be interested in seeing the science that supports that claim. Not much out there but I did find this. It says malabsorption was a tick higher at 14 post surgery months than it was at 5 months.

http://m.ajcn.nutrition.org/content/92/4/704.long

http://m.jn.nutrition.org/content/133/11/3703.full

https://link.springer.com/article/10.1007%2FBF01655386

http://onlinelibrary.wiley.com/doi/10.1111/j.0954-6820.1977. tb19356.x/abstract

http://emedicine.medscape.com/article/193391-overview

Here is what the article says about the adaptation (that up to 90% of the malabsorption is overcome in 12-18 months (phase two).

Note the reason for RNYers being encouraged to drink, drink. drink during the first few months (phase one)!

"Macronutrients and micronutrients are absorbed along the length of the small intestine. However, as described by Clarke, the jejunum has taller villi, deeper crypts, and greater enzyme activity compared to the ileum. Therefore, under normal conditions, about 90% of digestion and absorption of significant macronutrients and micronutrients are accomplished in the proximal 100-150 cm of the jejunum according to work conducted by Borgstrom and colleagues and by Johansson. This includes absorption of proteins; carbohydrates; fats; vitamins B, C, and folic acid; and the fat-soluble vitamins A, D, E, and K.

However, if a significant portion or all of the jejunum is resected, the absorption of proteins, carbohydrates, and most vitamins and minerals can be unaffected because of adaptation in the ileum.

The physiologic changes and adaptation of patients with short-bowel syndrome can be viewed in 3 phases.

The acute phase occurs immediately after massive bowel resection and may last up to 3-4 months. The acute phase is associated with malnutrition and fluid and electrolyte loss through the gastrointestinal tract. Fluid and electrolyte loss through the gastrointestinal tract may be as high as 6-8 L/d. Patients will have abnormal liver function test results and transient hyperbilirubinemia. Enteral feedings may also be initiated, but it should be relatively slow. Patients with less than 100 cm of small intestine will require total parenteral nutrition. The presence of ileocecal valve or colon may play a significant role in the outcome of these patients.

The adaptation phase generally begins 2-4 days after bowel resection and may last up to 12-18 months. During this second phase, up to 90% of the bowel adaptation may occur. Villous hyperplasia, increased crypt depth, and intestinal dilatation occur. Early continuous feedings with a high viscosity elemental diet may reduce the duration of total parenteral nutrition.

In the maintenance phase, the absorptive capacity of the gastrointestinal tract is at its maximum. Some patients may still require total parenteral nutrition. In other patients, nutritional and metabolic homeostasis can be achieved by small meals and supplemental nutritional support for life. These patients will also require vitamins and mineral supplements, including vitamins A, B-12, and D, magnesium, and zinc."