BP II and bypass vs. sleeve

Hi all,

I've got an appointment with a surgeon I really like this week for a "let's talk about your specific situation and see what kind of surgery might be best for you." (I chatted with the doc briefly at an info seminar a few weeks ago.) I'm trying to do my homework and get my questions down in advance.

One thing I'm trying to research are the pro's and con's of the sleeve versus the bypass for someone whose weight gain has been caused by psych meds. From what I've seen, the sleeve has a much greater reduction in ghrelin than the bypass-- but does that affect drug weight?

If anyone has any resources or experiences, I'd love to hear them. Thanks so much! :)

I am in the same dilemma, interested to see what the posts say 

I chatted with the surgeon today, and he said that grehlin is probably not what causes the weight gain from psych meds; it's probably some other hormonal interaction that "we don't know about yet" and that will need more research to figure out.

That being said, though, he said that the sleeve would be the best choice for psych-med-related weight issues because of the greater reduction in hunger compared to the bypass, which can be a side-effect from meds. There's also less concern about how antidepressants would be absorbed after surgery, which is important, too.

Looks like I'm getting a sleeve, then!

I saw my surgeon at the beginning of September and he is doing the sleeve on me as well ...mostly so my meds absorb properly 

I am in the beginning stages of my surgery quest. From the research I done I also came to the conclusion that the sleeve is the best option for me. There is no way I'd mess with med absorption. My current combo has kept me stable, with minor adjustments, for 2+ years. I'm encouraged to hear other people have surgeons who agree with my conclusion.

Hi Gabby, just saw your post!

I had my sleeve done about 2 months ago, and I'm happy to report no issues with meds so far! My psychiatrist had me bump up the lamictal a bit a couple of weeks ago since I was getting a touch manic, but that's been the only change. That one makes sense, because a hormone dump is common as you start losing weight, and lamictal apparently becomes somewhat less effective with increased estrogen (like when you start birth control). But I'm feeling really good, and the weight loss is coming along, so all is well so far!

Hope your research is going well! :)

Hey there I am having surgery soon and am having the same concerns about my bipolar meds. I wonder if I can lose enough weight with the sleeve (100#) then there's the heartburn issue. I don't have any support and I would love your thoughts. Thank you

Statistically speaking, it's possible to lose the same amount of weight with sleeve and bypass. Both surgeries are tools and it's up to you to work hard to lose all of the weight.

If you have any history of heartburn, you should definitely avoid the VSG. There are a lot of people who, like me, have needed to revise to RNY due to GERD. Might as well get the right surgery the first time around.

If you have a proximal RNY, which is the standard procedure, my doc said there should be no trouble absorbing psych meds. I haven't had any trouble with mine so far, which is really good news.

Meds are also the reason I want the sleeve. There is a non XR version of Effexor but I don't want to switch because I've been fairly stable on it. Also, in the future I don't want potential meds limited due to the RNY. I'm lucky that I've been able to find a med combo which has not caused weight gain. My weight has been stable for 10+ years, with brief periods of purposeful weight loss and the regain was due to bad eating habits rearing their ugly head.

I can't really answer your specific question....but the one thing my surgeon stressed was the difference in procedures and your body's ability to absorb meds post op.  Because the rny results in malabsorption often times people with psych meds struggle....the meds need adjusted more frequently and the dosages may need to be higher b/c your system isn't absorbing everything right.  with the sleeve there are no malabsorption that results from the surgery...its a restrictive procedure.  As a result people have a tendency to be more stable with their drugs.  When i had my chat with my surgeon...she indicated that she wouldn't do the rny b/c of my bipolar situations and my use of psych drugs.... and with either...if you're taking anything with extended release those will need to be reevaluated.....sooo....can't really comment on your exact question but thought i'd throw in what i've learned so far......best of luck with your research and on your decision!! 

stephanie