Bypass vs Sleeve

on 2/15/21 4:45 am

I need some help deciding, help! I was looking closer into the sleeve but the Dr i went to said I would be better off with the bypass. Because of the inability to exercise due to back problems from a car accident. Yet I spoke with a different Dr and she said there is the same amount of weight loss for both surgeries. Please help I'm confused.

on 2/15/21 7:03 am
RNY on 06/03/15

if you have GERD, then I'd strongly consider going with the bypass. Although it doesn't happen to everyone (the statistic I've heard is about 30% of patients), the sleeve can make that worse. If you don't have GERD or some other medical condition that would make the bypass more appropriate for you, then it comes down to personal preference.

average excess weight loss with the bypass is 70%, and I believe sleeve is 65%, so there's not a huge difference. And besides, those are averages. You'll find people who fall on either side of that. You'll find people who are wildly successful with both surgeries, and others who have failed them. And lots of people in between. Your success is really more dependent on how committed you are and how closely you follow your program, not which surgery you had.

I had RNY because I had GERD prior to surgery. If it weren't for that, I probably still would have chosen RNY because at the time I had surgery, standalone sleeve surgery was still kind of new, and I was a little afraid of it becoming "Lapband 2". But it's been around long enough at this time that it's proven itself. Still, there seem to be enough people revising to RNY after having sleeve that I'd have to think about it long and hard. But then there are many people who are really happy with their sleeve, though, so...

they both have their pros and cons - and you'll find fans of both. And again, you can be successful with either if you're committed.

Janet P.
on 2/15/21 8:12 am

With the sleeve there is no malabsorption - it is 100% a restrictive procedure. With the bypass (RNY) you will have some level of malabsorption (depending on the type of RNY you get).

Janet in Leesburg
DS 2/25/03
Hazem Elariny

on 2/15/21 10:18 am - CA

It's really a toss up between the two, and mostly gets down to comorbidities or pre-existing conditions that you bring to the table, and personal preference, as overall weight loss and regain character are very similar between the two. As noted, if you have pre-existing GERD, the RNY is often preferred unless there is an identifiable cause that can be corrected during surgery (such as a hiatal hernia.) The RNY will be somewhat fussier on supplement need and on possible medication and future medical treatment limitations. The standard proximal RNY, which is what 95+ percent are, may lose weight a bit quicker owing to its mild malabsorption, but the caloric malabsorption dissipates after a year or two so most wind up at about the same weight as with a VSG, and no particular advantage on regain resistance; nutritional malabsorption remains for the long term. You may or may not be able to take enough oral iron with the RNY is be stable, resulting in a need for periodic iron infusions; that is rare with the VSG

I tend to prefer the VSG if there aren't any other issues driving you to the RNY for the above reasons of a bit simpler living style and that there are more options available in future should revision be necessary (hope for the best, plan for the worst...) as the RNY is something of a surgical dead end, as there are few viable options to address any significant regain problems and it is difficult to revise into something else; the VSG can readily be revised to an RNY if that is necessary, and can also be readily revised into a traditional DS (duodenal switch) or the newer SIPS/SADI/Loop DS, both of which use a sleeve as their basis and add a malabsorptive component.

I don't see the exercise problem as being much of an issue, as both have a similar metabolic strength - being a marathoner or a couch potato will yield similar results with either; what might be an issue is that the RNY is fussier about some medications - some time release meds don't work the same anymore, and it is more sensitive to meds that are known for stomach upset such as NSAIDs. Many surgeons don't recommend them for any of their WLS patients, but the sleeve is more tolerant of them, which can be useful (what GERD is to the sleeve, marginal ulcers are to the RNY, so that is the root of the difference on meds.)

As you have found, things can be a bit confusing, as outcomes are similar, but surgeon's opinions can differ - some are more experienced with one or the other. Keep digging and researching to find what fits you best. Good luck.

1st support group/seminar - 8/03 (has it been that long?)  

Wife's DS - 5/05 w Dr. Robert Rabkin   VSG on 5/9/11 by Dr. John Rabkin


on 2/18/21 4:45 pm

It's a lot like money & taxes. It's not how much you make, it's how much you keep.

The most important decision is choosing the right doctor. The right choice Dr. will advise you correctly and then perform an extremely well executed surgery. It sounds like you have not found a true expert yet. You need a Dr. that has extensive experience with the VSG, ByPass and DS. They will then recommend the right option and you'll see if you agree.

I had a variation of the DS called a SADi DS and it has been extremely effective for me over the past 6.5 years. Based on my eating habits, the VSG would have been too little and ByPass included dumping syndrome issues, while DS was overkill for my 40 bmi. The Dr. was extremely familiar with all the options which lead to an outcome I'm happy to live with.

Good luck!

on 2/19/21 12:51 pm

I chose bypass because I didn't want to risk the reflux issues because it seemed (at the time) whatever could go wrong did go wrong with whatever I did in life. I haven't really had any issues with my bypass, I'm pretty close to my personal goal. pretty happy so far

Good luck

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