Choice of surgery

Hi everyone,

So my orientation went very well@TWH. A great team and very helpful as well.

The only thing that's s bothering me is that the sleeve will only be done when clinically indicated. I really want the sleeve but maynot be clinically indicated.

I do not want the bypass. I heard that the sleeve has more success with hunger control and is less invasive.

What are my chances to get the sleeve over the bypass.

Thank you!

To get a Sleeve you do need to meet the criteria. Usually it has to do with steroids or NSAID requirements. Previous surgeries etc... You will really need to make your case for why they should do sleeve. When you reach your surgeon appointment you sign consent for both. RNY is first choice if they can't do it they would do a sleeve. Other option is to self pay

They'll only do the sleeve if they have to or if you pay for it. I'll say up front that I'm not a doctor or anything, but this is what I've found from my own research.

The impression that I got is that because a bypass is the gold standard (you lose more weight and are more likely to keep it off), the province doesn't want to waste money paying for a sleeve that won't be as effective and that some people end up having to get revised to a bypass ANYWAY, which costs them even more money.

Personally I wouldn't have wanted to get the sleeve at all, because with a bypass they don't actually REMOVE the part of the stomach that's separated from your pouch. It's still there doing it's thing for bile and whatnot, so if I ever get stomach cancer, or if I get in an accident that somehow damages my pouch, etc, they still have the rest of it to work with for any reconstructing.

I think the difference in invasiveness kind of depends on your definition of invasive?? They make the same laparoscopic incisions for both surgeries, so they're the same on the surface level.

Internally there will be more "cuts" made for a bypass, but it's really only the length of the surgery that changes, because a sleeve isn't as complicated. The recovery time and hospital stay is the same.

There is slightly more risk of complications from a bypass, BUT they both have the same survival rate, and the complications that become more likely with bypass are ones that are easily caught and treated.

For me it came down to a short term vs long term issue. Short term the sleeve can seem like the better option because it's simpler, but in the long term the bypass has better results and won't cause problems if I ever need that extra stomach tissue. I got mine in October and have no regrets.

So yeah, talk to them about it for sure, cuz they'll definitely be able to explain it better than I did, but I wouldn't count on being able to get the sleeve.

I've never heard the hunger control thing being better with the sleeve (I actually imagine it would be worse based on the sleeve leaves you with a bigger stomach than RNY does), but I can tell you as someone who is 6 months RNY post-op I DO NOT have hunger issues. I get full very easily. The fact that I am rarely hungry really helps me to not have to worry about cravings. Definitely look into how many people who have had the sleeve have it revised to RNY, I think this is a growing group.

Whatever you choose, I wish you the best. This tool is amazing!!

I always think it's funny about the less evasive part. You are permanent removing 80% of your stomach.

Hunger control is individual. I see both sleeve and rny report hunger and or lack of hunger.

For a higher bmi patient the sleeve has higher regain. Sleeve statistics indicate that sleeve has a better success rate for those with 100 lbs to lose. Many have issues post op with reflux

If you have diabetes and have had it a long time, rny had the best long term success

I have no choice but to get the gastric sleeve because of a mild case of Crohn's. The surgeon did say that the gastric sleeve might seem like a more simple surgery, but there is a long series of staples and there is a higher chance of leakage which can be very dangerous. He did say 25% of patients have issues with acid reflux especially if they continue drinking caffeinated drinks such as coffee and tea. If I had any issues with acid reflux at present, I wouldn't even qualify for the gastric sleeve.

The surgeon also did say that the stats/studies are not as extensive as those with RNY for weight gain, but there is definitely a slightly lower percentage of weight loss of excess weight than RNY (gold standard) and more of a chance for weight regain. The surgeon said I would have to work a little harder to keep it off, BUT both surgeries require you to change your lifestyle: healthy clean eating and regular exercise!!! You can be thin and NOT be healthy if you still make consistent bad food choices and are not active!!

I was given the choice by my surgeon... but only by my surgeon. It was the morning of surgery, and the first time I met him!!! I don't think all surgeons are as open as mine was, but he felt it's my body, my choice. I REALLY appreciated that.

I chose RNY, but we had a discussion about it. I had previously thought I would only want the sleeve, for the same reasons you stated. When I learned about both surgeries, I realized RNY was a better choice for me because of Diabetes and GERD.

Both surgeries are invasive. Both can have major complications, or none. Thankfully, I've had none. I also feel no hunger basically. Head hunger; that's something I'm learning to control. But physical hunger... no.

I'm so thrilled with my choice and tool.

Don't discount RNY just because you think you'd be hungry, or you think it's more invasive. Conversely, if you decide the sleeve is the right surgery for you, advocate for yourself (only with the surgeon though... no one else can influence that decision).

Good luck!!

Although I am still waiting on surgery, I have met with the Surgeon and we did have a discussion about which surgery I preferred.

We talked about both the RNY and VSG and Dr. Hong let me plead my case and I think if it had been "right" for me he would have done it.

My issue is GERD and since this was my big bug a boo RNY is definitely the way to go and, with my history of weight loss, weight gain etc., he felt that the best solution for me was RNY. I knew in my heart it was the way to go but the discussion did happen. Having said that, VSG may still happen as I've had several abdominal surgeries and scar tissue may not be facilitative of RNY. We will see.

I do know of someone that I met at a coffee chat a couple of months ago who convinced her surgeon to do VSG. She is quite young, wants to have children eventually and felt VSG was the way to go for her. Her surgeon did the VSG. She's lost lots and looks amazing one year later.

VSG is possible but it needs to be the right procedure for your situation.

another poster just posted a very good read:

https://www.vox.com/science-and-health/2017/12/7/16587316/bariatric-surgery-weight-loss-lap-band

part of it states:

"But an additional reason both the sleeve and gastric bypass surgeries lead to long-term weight loss is likely because of the changes in hormones that occur after these procedures. The sleeve, and especially the bypass, seems to suppress hormones that affect hunger and satiety, like the "hunger hormone" ghrelin -- something no diet will ever do."

So according to this article (and the research behind it) the bypass is better for hunger control.