sleeve vs bypass

2 1/2 weeks from surgery. am having 2nd thoughts about the sleeve and worried that i won't lose enough wait with that. surgeon prefers the sleeve since my bmi is under 40. everyone tells me the "gold standard" is roux-en-y and they tell me to do that one )another m.d., too) anyone had those dilemmas? HELP! from Hollywood, FL

Hi Karen, Are you a sweet eater? Have diabetes? If yes, I would lean towards the RNY. The RNY *is* the gold standard when comparing it with other restrictive *and* malabsorptive surgeries. But the sleeve gastrectomy is restrictive only - so not really fair to compare the two. If I had to do it again, I would probably choose the sleeve since studies are showing that - of the RNY, sleeve and band - the sleeve by far reduces Grehlin (a hormone that increases food intake and is thought to play a role in long-term regulation of body weight). The sleeve has been reported to produce a 50% or higher excess weight loss. How much weight do you have to lose? You may want to schedule another consult with your surgeon to work out *together* what is best for you. Take care, Kristen

thanks for your informative reply. i am an eater, sweet, salt, carbs. i'm prediabetic, and have a couple of comorbid med problems. my doc tells me that my bmi is not high enough for the roux en y. mind you last year he said it was. i am concerned about the sleeve because there is no long term studies and i would hate to go through the procedure and not be as successful as i could be. it's almost impossible to get to him, though, i will persist. much thanks again.

Ethically, surgeons are guided by NIH standards with regards to BMI and type of surgery. Without any co-morbidities, NIH says that you should have a BMI of 40. If you have documented co-morbid conditions, that qualification goes down to 35. Whereas no one in their right mind would ever advise someone to gain weight to qualify for surgery, definitely re-verify your height. Men, for example, routinely misrepresent (accidentally?) their height, which completely messes with the BMI. You may want to see if you are shorter than you think. Seriously. HTH, Kristen

Karen- Have you looked into the DS. The DS combines the sleeve gastrectomy with a reconfiguration of the intestines (similar to what is done with RNY -- but definitely not the same as RNY) for malabsorbtion. It is a myth that the DS is only for people with higher BMI's. Red

ummm, what's a DS...