New member - waiting for insurance approval trying to decide on a procedure

Hi everyone. I'm brand new here and need advice.

I know I want a surgery, but I am having a difficult time choosing between the sleeve and bypass.

I've read and researched and read some more, and I keep going back and forth.

I have about 120lbs to lose. I'm 44 and 5'6.5". I've tried all the diets, meal delivery programs, everything. I've had success before, and I've been thin, but I am now on a ton of thyroid meds for hypo and I have a 2 year old and I can't seem to lose anything anymore. I'm tired of fighting tooth and nail for a one pound loss.

My surgeon had no strong opinion on which surgery I should have until yesterday.

I just had my upper endoscopy yesterday. I have some small abrasions (that's not the right word) due to heartburn that I never really thought was that bad. I would have categorized it as mild, really. Based on that, he thinks the bypass is a better fit, though he will do whatever I choose.

I have no other comorbidities. I'm a little more scared of the bypass. My surgeon treats them as if they're very nearly the same, aside from the affects on diabetes and gerd.

I can't keep changing my mind. I need to make a decision. I'll be all in, whichever way I go. But I have to pick a direction.

What made you choose one over the other?

If you had gerd prior to a sleeve, is it worse? I know everyone is different, but my surgeon's comment was that it could get better or worse.

Does bypass really require that much more in the way of vitamins long term? Do you not have to take lots of vitamins long term after a sleeve?

I'm not sure what else to ask, really. Any insight would be helpful. Thanks in advance!

yes, I had herd before and it got worse after VSG.

Many ppl are having to revise their sleeves to the bypass after a few tests so do give that some thought.

some insurance companies are starting a p e was surgery in a lifetime, so there is that too.

I didn't find one to be any more radical than the other, really. Cutting out 80% of your stomach and throwing it away sounds pretty darn radical, too.

both surgeries are good surgeries - we have some great success stories here on OH with both VSG and RNY people.

however, if you have GERD, I would go with bypass. Although it's not inevitable, there's a decent chance it's going to get worse if you go with the sleeve. You'll find several people on here who have had to revise to bypass because of severe GERD.

I also had GERD pre-surgery, which made up my mind for me - bypass. If that weren't the case, I'm not sure which I'd go with -- like I said, they are both really good surgeries.

also, sleeve patients also have to take vitamins for the rest of their lives. In my clinic, they have the sleeve people on the same vitamin regimen as the bypass people. That may not be true universally (some surgeons may not have you on quite as many vitamins as the bypass patients), but yes - you will have to take vitamins for life regardless of which surgery you go with.

I did not have GERD prior to surgery, but developed it after and had to convert to RNY. My surgeon will not perform VSG on someone who has been diagnosed with GERD, let alone someone who has esophageal lesions due to acid reflux. In my opinion, I would go with bypass.

I appreciate your thoughts.

I had almost gotten comfortable with the bypass option and I think reading these things just reinforced that it will be best for me.

Just waiting for my biopsy to come back from pathology so they can get everything submitted.

What are your experiences with insurance approval? How long did it take once everything was submitted? Did they deny on the first try? I'm pretty nervous about this part, too.

GERD aside, if you have already dieted like a champ (several times I suspect) to fight for that one pound loss, then you will likely do better with more than the sleeve, which makes dieting much easier with that huge reduction in stomach capacity. The RNY gives the one-two combination of reduced capacity and changes how you metabolize what you eat.

There is a third procedure (but your surgeon probably doesn't do it) which is the duodenal switch (DS). It has a sleeve stomach with added malabsorption similar but more aggressive than the RNY. There are hybrids of the DS, too, SADI, LoopDS, and SIPS (all similar to each other).

My surgeon does do the DS, but said he doesn't consider me a candidate for that because my BMI isn't high enough.

I think I've finally accepted I need the RNY.

RNY is not an extreme surgery . The effects last forever including some of the malabsorption of fat calories ( based on my personal experience 9 yrs post op ) sleeves on the other hand stretch out and chronic GERD is a huge issue w the sleeve .

I would SO choose RNY . Hugs