Bypass or Sleeve?

Question Below Submitted By:  

Shauna (a patient from Indiana)

I am scheduled for gastric bypass surgery in 8 days and am on day 7 of my liquid diet. I came into this wanting gastric bypass, because I do not want to have to look at doing surgery again.

My initial thought was to do the “big one” and not look back. I see many say that they would do it again if they had to.

However, I am starting change my mind and here is why…

I started at 310 lbs and since I started the 6 month program, I am down to 285. I never had diabetes or GERD. I do have mild sleep apnea, which they expect to go away once surgery is done. I do have higher blood pressure, that is managed with medication.

My doctor said that if there was an ideal candidate, I would be it, since there was not a long list of health issues to go through. I have had surgery on my knee, and have early onset arthritis.

My eating habits are, loving the pasta and breads. I know that these are carbs and create more trouble than they are worth. It brings me to my indecisiveness of the surgery…

Bypass will give me more of the dumping syndrome that is usually related to sweets and sugars and perhaps more long term on those.
Wouldn’t the sleeve work just fine as giving me the full feeling I need without so much sickness?

I wonder about the malabsorption now and when I am a senior (I am 40) and what that will look like with the bypass.

I know that both have a chance of gaining and stretching the stomach and if I am not mistaken, the bypass has longer term success for keeping weight off (though slower and steady) than sleeve, and sleeve is more rapid, but weight gain can occur faster.

Is this because the bypass still makes you have so much dumping later? It just sounds like the bypass takes enjoyment out of any eating, because you never know what is going to happen, rather than the sleeve which curbs the quantity but lets you enjoy…please help.



Expert Responses to the Question Above

Surgeon response to "Gastric Bypass or Gastric Sleeve?"

by: John Rabkin, MD


You outline very well some of the relative risks and benefits of the Roux-en-Y Gastric Bypass (RNY) and the Vertical Sleeve Gastrectomy (VG). Each of these two weight loss surgery (WLS) procedures has their own 'issues' and you need to carefully weigh (pardon the pun!) these differences from YOUR PERSONAL PERSPECTIVE and decide for YOURSELF which procedure YOU PREFER.

In addition, remember that there are two other standard accepted WLS procedures deserving of your consideration: the Adjustable Gastric Band (AGB or "LapBand") and the Duodenal Switch (DS), a less commonly performed procedure which has the best associated weight loss and durability of the weight loss while still allowing patients to 'enjoy' food without being at risk for dumping symptoms.

The weight loss you can expect as well as its durability are only two of the considerations in making your decision of which WLS option is the right one for you. Lifestyle considerations as well as the opportunity to reverse or prevent obesity related comorbiditites (health problems) which you outline also are very important to review when making your decision.

My own opinion is that for many patients, a VG will adequately provide the needed weight loss with reasonable durability without creating the difficulties some patients may experience after undergoing the RNY. However, the medical literature clearly demonstrates the more durable weight loss patients enjoy after the RNY compared to patients who undergo the VG.

The dumping physiology that some patients experience after the RNY is only one of the potential reasons why the weight loss is more durable; the changes in the enterohormones (intestinal or 'gut' hormones) from the bypass also likely contributes.

However, keep in mind that these are statistical outcomes of groups of patients undergoing these procedures. Whether or not the more durable weight loss would occur in your specific situation is unknown: your weight loss and its durability may be as good or better with the VG as with the RNY.

The choice is YOURS!

John Rabkin, M.D.
Pacific Laparoscopy

(click here for Dr. Rabkin's full bio & contact info)

DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

Related Page:
- Comparing All Types of Weight Loss Surgery

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