sleeve vs bypass

Bypass vs sleeve, please help, surgery is a scary word, please help make it less scarier. I think I'm so scared of the surgery itself and risk of complications that I may give myself a stoke worrying. My bp is way way way toooooo high and even with the few meds I tolerate, it's still high. Bypass is the most recommended type of surgery, But sleeve has less complications? easier recovery? My highest weight ever was 8 yrs ago, 420#. I did Atkins, lost 150# over 9 months, plateaued and couldn't lose more. I maintained that weight until about 7 months ago, my blood pressure was too high, I was told my AIC was too high, got sleep apnea, so my solution was to quit smoking and diet. I quit smoking and have since gained another 50#. Of course my health issues just got worse and now I'm older and not smoking, I've finally decided to do the surgery, but I've never ever had surgery before and am scared too death. So, bypass vs. sleeve?

To me, RNY is a no-brainer for you because of the high A1C.

I had RNY nine years ago when I was 59. It took me several days to recover. I had surgery on Tuesday, was home and on the treadmill on Thursday, doing light housework and cooking on the weekend and back to work on Monday.

I have had no complications. After RNY, I followed an Atkins type diet, but ate way less than on Atkins. An ounce of meat can sometimes fill me up, even now.

For me it is easy to "diet" when I am never hungry and can only eat a small amount when I do eat. Plus for the first year or two, there is malabsorption with RNY so you do not absorb all of the calories that you do eat.

The main reason I would recommend it for you is that RNY often results in instant remission of Type 2 diabetes. Patients go home from the hospital off their diabetes meds and may have normal A1C's from that point forward.

Recovery time, complications and weight loss are almost identical with the sleeve and bypass.

I second what White Dove wrote. And I disagree that the sleeve has fewer complications. It's a much newer procedure, but even now there are more and more examples of people developing really bad gerd from VSG. More and more are needing to revise to RNY to get rid of the reflux.

Thanks for the reply. I have really bad GERD already that I control with Prilosec. Do you think the sleeve could possibly make it worse or the prilosec will just continue to control it? How could the RNY help GERD? Would it get rid of my pre-existing GERD?

Most surgeons feel that GERD is a contraindication for VSG as VSG will make it worse. (Plus, long term PPI use isn't healthy.) The sleeve might make it worse because it will create a higher pressure environment. (Boyle's Law - decrease volume/increase pressure.)

Is there a chance that the GERD is due to a hernia? Have you had an endsocopy to check that?

I'm not quite sure why the RNY alleviates GERD, perhaps because the pyloric sphincter is removed this allows for better pressure release? I do know that if I had GERD there is no way I'd opt for the VSG.

Thank You! That is definitely something for me to look at and ask my doctor, maybe thats why she recommended RNY and my PCP was thinking sleeve, like he said tho, thats not his field of expertise so maybe she knew something he didnt which she just didnt feel the need to share with me lol GERD runs in my family, even my very thin barbie doll looking daughter has had it her whole life just like me

I'd definitely give more weight to the advice of a specialist I trust than a PCP I trust - PCPs just don't have the time to specialize in everything :)

GERD is definitely a good reason to consider RNY instead. I have a history of mild reflux, always controllable with antacids and occasionally PPI. We think it was due to obesity, and my team and I decided given the other reasons the VSG was the best choice, we'd take a chance. I have to be on PPI anyway because of the treatments for my rheumatoid disease. I lucked out, no reflux since. But my surgeon said that a history of reflux will most times have her recommending RNY instead because the VSG can increase reflux/GERD.

I had reflux before VSG and I took PPIs for years. Now (almost six months post-op) I don't have reflux (at all) and I also DON'T take PPIs.

So my advice for the OP is to discuss the matter with the surgeon, and not let The Internet decide for her.

I want you to take this as well intended advice, because it is. If it sounds harsh, I'm just trying to emphasize the point. I think it's that important.

I think that anyone with bad gerd who chooses VSG is insane. It's a really bad, really horrible choice. All the other factors and issues between the two surgeries can be discussed and debated, and I have no problem with that. VSG is a fine surgery, and a fine choice for many people.

But not if you have gerd. It's the ace of trumps. The last word.

A great many people who never had gerd come down with a horrible case after VSG. Those that have it already can make it much worse. Many take their PPIs for a few years after VSG with "controlled" gerd. Then it starts to get much worse.

Gerd often leads to esophogeal cancer. Barretts esophagus. Researchers are just beginning to discover all of the horrible things that can happen with long term PPI use. And none of that is worth the risk.

Search around OH and you will find stories from an increasing number of VSGers who needed to revise to RNY because of reflux. None of them wanted to, but they were ecstatic when they got rid of the gerd. You may not think that being able to lay flat in a bed at night can be something worth celebrating, but they all do.

Nothing else matters. After a year or so both surgeries eat the same things, the same amounts, and you'd never tell the difference. Weight loss is nearly identical. There is practically no difference in vitamins and supplements.

Gerd, for you, is all that matters. If someone I loved told me they had bad gerd and were getting VSG, I'd chain them to a radiator in my basement until they changed their mind. That's how big a deal I think it is.