Bypass experts

I have a question for folks who had bypass surgery. Need some opinions. My daughter is 23, she has severe acid reflux, IBS and other gastro issues. She weighs in at approximately 250-260 lbs.  She saw a surgeon this morning to discuss removal of gall bladder, he wants to do bypass surgery. Says, it will cure her acid reflux, IBS and other gastro problems, her infertility (i do believe that one) and of course restore her self esteem as she was once a 110 lb girl before marriage and health issues. Now I have discussed weight loss surgery with her before as I am a sleeve girl of 5 years and I see her going down my road. Lost 169 lbs. I am just not sure she is ready for bypass...I think that is a big adjustment at just 23 years old. bypass can be very unforgiving if eating the wrong foods for some folks and others do just fine. I don't think the sleeve is right for her either given her severe acid reflux. I want to hear your opinions on having bypass at a young age, your thoughts on whether acid and IBS improve, long term complications, possible regain, etc.  He also told her it can be reversed whereas the sleeve can not...well my thoughts on that was there is not an insurance company around that is going to pay to reverse it unless there are complications. He is a young bariatric surgeon, he removed my gall bladder and I trust him but just wary that he is not pushing this because that is what he does. He made it a point to tall her it wasnt about money, he gets paid the same either surgery...not so sure about that one but again...please thoughts?

I am over 8 yrs post op RNY.    I did have acid reflux prior to my WLS and it has gone away.    Personally I had my RNY at 52 yrs, old.    Trust me....I would have loved to have had it at a young age.    As far as whether the sleeve can cure her issues I have no idea.    Personally how does your daughter feel about having WLS?   Trust me...the weight can be regained no matter which WLS you choose.    The regain is caused by your choices NOT what surgery you decide to have.    It takes lots of hard word and dedication on your part to make it a success.    Good luck to your daughter.

Hugs and blessings ~~~ Vivian

I would first strongly suggest a second opinion as far as gastric bypass curing IBS.  I do not believe that is true.  Many people do, however, get relief from reflux.  She would likely get some relief from reflux just by losing weight via ANY method, though.

As far as RNY being reversible... Well, yes, technically, it is, but it is an extremely complicated surgery that very few surgeons do, and will ONLY do if the pateint's health is in serious jeopardy, and therefore should be considered permanent.

FWIW, my personal opinion is that no one so young should get RNy or DS.  She will have to live her entire life with potential vitamin deficiency issues having over her head.  Some 23 year olds might be conscientious about taking vitamins three times a day every day, but most will not, and if she does not keep up with he vitamins, she will eventually have nutritional deficiencies, some of which can be serious.  The calcium supplements are very likely to not get taken as needed since the calcium is what needs to be taken in three doses.

There are number of red flags about what this surgeon is telling you about Roux-en-Y. I would strongly suggest getting a second opinion on the entire situation.

Lora

You're right that insurance isn't going to pay for a reversal unless there are complications, and I don't think you'd find a surgeon to do a reversal unless there were complications because it's a pretty complicated surgery.  But why would you want it reversed unless there were complications?  If it was working great, why would you want to undo it?

With severe reflux, she definitely shouldn't do the sleeve.  RNY usually does fix that, but I don't think anyone can guarantee it. 

I have no idea if your daughter is ready for RNY or not.  As far as getting it done at a young age, well, I think it's probably better to get healthy now instead of waiting a few more years.  I don't think 23  year olds are any more likely to lose weight and keep it off than older people and I think being morbidly obese for many years definitely takes a toll on the body.  If she's mature enough to commit to all that RNY entails, like taking vitamins regularly, then I think she should probably go for it.

Hi,

I am 33 and had gastric bypass 8 weeks ago largely because of the onset of pretty severe GI Issues.  I was not a candidate for sleeve because of the reflux problems since a sleeve will likely make that worse as some others have said.  I will be completely honest with you...I have had a smooth transition to my new normal because I did the research, met with several different surgeons over time, consulted with my primary physician, and most importantly, was mentally ready to make a change.  I also made changes in my personal life to control stress (I have a very high profile job) and make time to make myself the priority.  Bottom line - I was educated, had a strong support team in place, and was mentally prepared for this surgery.

It takes organization and time to prepare meals, take vitamins regularly, etc.  In some ways, especially related to physically healing and the skin's ability to snap back resulting in less loose skin, being younger helps.  Age has nothing to do with the success of the surgery overall though.  Anyone who doesn't take vitamins will develop deficiency.  Anyone who doesn't  "follow the rules" of food and maintain high lean protein, low carb, low fat, low sugar daily diet will regain weight.  Anyone who doesn't work out consistently won't maximize their weight loss or overall health.  Anyone who doesn't follow the pre and post operative instructions will have complications.

There are a lot of emotions and emotional issues that this surgery will stir up and I strongly recommend working with a counselor prior to surgery and ongoing afterwards to make sure that those are being positively addressed.  Just going to the psychological consult required for surgery clearance is not going to be enough to be successful long term.  As someone who work frequently with college age women, they are not always extremely self aware and that can heighten the emotional part of this.

Surgery did immediately stop all of my GI issues (reflux, gastritis, inflammation, etc.) because they bypassed the part of the stomach and small intestine that was causing me a problem.  I do not have any personal experience with IBS.  Just in understanding how the surgery works, I don't think the surgery itself would alleviate IBS, but sticking to the required nutrition plan absolutely could help because she would be eliminating many of the foods know to irritate IBS (fat, sugar, spicy foods, gluten, etc.).  If she struggles with IBS, I would definitely talk at length with the surgeon about how the change in diet could impact it positively and negatively.  Constipation is a side effect of bypass, particularly in the early months, because the foods you eat and fiber is limited to avoid "dumping syndrome."

I had my gallbladder removed 2 years ago because it got infected, but it is very common for bariatric surgeons to remove the gallbladder at the same time that they do bypass surgery because bypass patients are very susceptible to gallstones post surgery.  You are exactly right on the reversal of surgery - it is rare and not recommended unless necessary.  My doctor has only seen 1 his entire career and it was medically necessary for the patient because her body would not stop losing weight and she became dangerously thin putting her organs in jeopardy.

My surgeon was younger (mid-30s) as well, but he was phenomenal and doing surgery at a national Bariatric Center of Excellence.  Her relationship with the surgeon is critical to success.  My doctor and his staff have been amazing and so many people I have talked to did not have the holistic support that I had in working with him.

Obviously, I don't know your daughter or her personality, but the biggest thing I can say is that surgery is not the easy fix.  As you know, it is the hardest road to go down to lose weight.  I would recommend that she really do some soul searching to see if she is ready physically and emotionally to go through this life change and that she feels she has exhausted other options for losing weight (not just doing them, but really has given her all to try to get the weight off through other means).

Sorry for the length, but hope this helps!

Carrie

In addition to the other posts, I would add that I think she needs to be ready to look into surgery, and she will need to do the research for herself. I hear your concern and love, but she is an adult and needs to be responsible for herself in seeking something as major as irreversible permanent surgery- even though reversals can be done, the repairs leave permanent scarring. 

Also, as I'm sure you know, the hardest part of WLS is learning the necessary self management, particularly with maintenance. She won't be ready to take that on if she isn't seeking the surgery for herself.

So my response to your question about someone young- does she have the emotional maturity to handle it?

I'd encourage her to consider the sleeve instead, unless that won't help much with the reflex.  I had IBS before surgery.  I still have it.  I also now have severe reactive hypoglycemia.  RNY isn't that great for some people.  

I went to the Mayo Clinic in Jacksonville, Florida regarding severe GERD/regurgitation issues.  After a full week of tests, three specialists from different departments concurred that RNY was my best option, as nissen fundoplication was not an option if my BMI was greater than 30 because the procedure would fail.  My BMI was 37, but I had never considered WLS.  I really didn't know anything about it.  I went through the necessary counseling sessions and nutrition classes, and read everything I could get my hands on.   I had the surgery 08/20/13, and I have not had ANY GERD/regurgitation since that date.  I believe the RNY has added many years to my life.  Added bonus....I've lost 55 lbs. pre and post-surgery.  Best of luck to your daughter.

Sherell, my experience is so similar to yours- BMI 37, 35 at the time of RNY surgery , for me 3 ½ years ago. Pre surgery I had GERD severe enough to cause Barrett's Esophagus, which lucky for me was caught early on. I also had a huge hiatal hernia, which was repaired at the time of my surgery. But no GERD post surgery. What a blessing! And great work on your part!

Anne, I'm glad you've had relief.  Until someone has experienced recalcitrant GERD and spontaneous regurgitation, they have no idea the agony of it.  Warning TMI - I would regurgitate into my mouth during the day while I was working.  I never knew when it was going to happen.  It was obviously worse at night, and it caused my asthma condition to be uncontrolled.

I too have Barrett's, and I had a very large hiatal hernia which they repaired.  My gastro had referred me to a surgeon locally (Sarasota), but I was so scared of having the fundoplication, that I made an appointment with the Mayo to see if I would be a candidate for the newer procedures like the transoral, or the Linx.  I AM SO GLAD I DID!!!  This surgery has been a miracle for me.  I have not had any trouble or problems with eating by the guidelines.  I don't obsess with the scale, and I weigh when I feel like it.  I know I will reach a healthy BMI and stay there as long as I eat by the guidelines I was given.  Life is good!