Unsure, bypass vs sleeve?

[sunshineeyes]

Hi all. Thought I'd introduce myself. My story is similar to most of yours. Have yo yo dieted for years and now due to pcos and another medical illness Ive decided to go done the barbaric route to finally shift my weight!
I've been to see my surgeon for a consult 6 weeks ago and I had all my pre op tests (bloods, endoscopy, ultrasound etc) on thursday. The surgeon actually performed my endoscopy so I briefly spoke to him after and he said all is ok so I have my next meeting with him in 2 weeks to decide which surgery I wanted and from that he will set a date for op. I'm hoping in next 6 weeks.
I have my psychologist assessment tomorrow,! Can I ask, what do they want to hear from me....I'm hoping to have this surgery covered in part my insurance comp so I want to make sure that I say all the right reasons for needing it!

Also....my biggest conundrum is I'm undecided about which surgery to have. I have about 5 stone to lose and I don't know which surgery would be the better suited to me.
I'm veering towards sleeve myself as I feel it's maybe better for someone with my amount to lose and also because they don't dissect and resect the bowel and as I'm 30 and hopefully kids are in my future, I was thinking from a "plumbing" point of view that the less needs doing the better.
On the other hand, I have heard that the sleeve is bigger than the pouch left after a bypass and I am aware that over time either will stretch somewhat so I then think maybe I should just have the full bypass.
I briefly asked doc on thursday and he told me its 6of 1 etc but that he prefer bypass...but admittedly he did say its because it's been around longer and has more long term statistics to back it up but I have read that sleeve is really coming into its own especially in the USA !

Any thoughts please would be such great help.
Thanks
S

 

[chrisa]

Well i can't really say a lot because i don't really know a lot bout the sleeve, i know if the surgeon couldnt stretch the bowel up enough then i would have had a sleeve instead of a bypass but he managed and i had the bypass so i could recommend that but there are a lot of people who have had the sleeve and are really happy with it and am sure will come on and let you know what they think and feel good luck with your decision. xx

 

[minxie]

'barbaric'. Lol, that's one way of looking at it! Sorry, only teasing but it did make me smile

I went for bypass after discussion with surgeon. I felt that I could only afford to do this once and I wanted to maximise my chance of success by adding in the malabsorption aspect of bypass. Also with a strong family history of diabetes my surgeon thought that bypass would minimise my risks of developing this - not sure whether sleeve has similar benefit but maybe someone else can enlighten us.

Might be worth a separate posting re. Babies after WLS, and see what others have experienced. Good luck, it is not easy reaching a decision.

 

[wannabeminime]

Definately Michael!! Yes please

I understand resolution of type II Diabetes is often more quick - (and sometimes more effective) following Bypass than sleeve....but it depends how long the diabetes has been present...the longer the patient has been diabetic, the more "exhausted" the beta cells in the pancreas become and the less likely they will recover and the diabetes will resolve.

Aside from diabetes, it is to some extent what your surgeon feels most comfortable/experienced with. VSG doesn't involve anastemosis of the small intestine & malabsorption, but it is still quite complex surgery, and better done by a very experienced surgeon! The question of a bypass being "better" for weight loss is a bit of a red herring. Likewise worries about sleeve being more able to be stretched than the bypass pouch. Raw food into the small intestine with bypass from the little pouch, but both pouch and the first part of the small intestine can be stretched.

One plus point of sleeve is that Ghrelin is 90% produced in the fundus of the stomach. The fundus, although "bypassed" in a bypass" remains in the abdominal cavity, and Ghrelin production is not seriously cut. With sleeve it is VERY much reduced ..if the sleeve is small enough. Same (almost) effect can be inferred...though not clinically proven, with Greater Curvature Plication (Gastric Wrap). Ghrelin is the most significant hormone signalling hunger signals to the brain, and sleeve patients tend not to feel physical hunger much.

A long & complicated post, but, I hope, helpful. Maybe I should do a thread on the pros & cons of various surgeries? Anyone interested??

 

[Sharonimo]

Also....my biggest conundrum is I'm undecided about which surgery to have. I have about 5 stone to lose and I don't know which surgery would be the better suited to me.

My non-expert opinion (but based on having read lots of research about the sleeve) is that it is often considered "ideal" for people with around 100 lbs (or less) to lose and 5 stone is just 70 lbs.

For people with between 100 lbs and 150 lbs to lose the difference between sleeve and bypass is a more difficult consideration, those sort of weight losses (120 lbs, 140 lbs etc) can be achieved with the sleeve but may take a little more effort on the part of the patient and adherence to the diet (as they won't have the malabsorption that the bypass offers).

A lot of super morbidly obese peeps (like me)with more than 150 lbs to lose are more often advised to go for the bypass ...... however even though I fall within that camp I chose for my own personal reasons to go for the sleeve and work with it to the best of my ability.


If you use the "Search" facility on this site (on one of the two menu rows at the top) you can also find many other threads with headings "sleeve v bypass" where other forum members have previously also been trying to weigh up exactly the same question !!

 

[stuckinafatsuit]

I have living proof next door to me, she lost 168lbs with her sleeve and her best mate lost the same with the bypass. Both were similar starting weights, they both work really well, its your call.

Kim

 

[sunshineeyes]

I understand resolution of type II Diabetes is often more quick - (and sometimes more effective) following Bypass than sleeve....but it depends how long the diabetes has been present...the longer the patient has been diabetic, the more "exhausted" the beta cells in the pancreas become and the less likely they will recover and the diabetes will resolve.

Aside from diabetes, it is to some extent what your surgeon feels most comfortable/experienced with. VSG doesn't involve anastemosis of the small intestine & malabsorption, but it is still quite complex surgery, and better done by a very experienced surgeon! The question of a bypass being "better" for weight loss is a bit of a red herring. Likewise worries about sleeve being more able to be stretched than the bypass pouch. Raw food into the small intestine with bypass from the little pouch, but both pouch and the first part of the small intestine can be stretched.

One plus point of sleeve is that Ghrelin is 90% produced in the fundus of the stomach. The fundus, although "bypassed" in a bypass" remains in the abdominal cavity, and Ghrelin production is not seriously cut. With sleeve it is VERY much reduced ..if the sleeve is small enough. Same (almost) effect can be inferred...though not clinically proven, with Greater Curvature Plication (Gastric Wrap). Ghrelin is the most significant hormone signalling hunger signals to the brain, and sleeve patients tend not to feel physical hunger much.

A long & complicated post, but, I hope, helpful. Maybe I should do a thread on the pros & cons of various surgeries? Anyone interested??

Fantastic post...thank you so much, and yes pros and cons page would be abfab!

 

[Sharonimo]

I have living proof next door to me, she lost 168lbs with her sleeve and her best mate lost the same with the bypass. Both were similar starting weights, they both work really well, its your call.

Wow !!

I wish I knew someone in real life who had had either, but other than people I have met online (one of whom so far I have met up with) I really didn't know anybody personally who had had either op before I went under the knife.

Oh there was a lady at work who had a cousin who had had the sleeve (a young lady in her 20's) and gone down from approx 19 st to somewhere between 11 st and 12 st, but the cousin was just anecdotal evidence (if you know what I mean -- someone I heard about second hand, not someone I ever met personally).


Most people at work have also said to me I am the only person that they know personally who has had bariatric surgery !!

I will be their guinea pig (!) ...... and if it works, I'm sure in a year's time their might be a few more of them signing up for WLS !!!

 

[stuckinafatsuit]

Thats why i decided on the sleeve, seeing her lose so much weight over a year and a half, i knew the sleeve was for me.

Kim