What is better -- Lap Band Revision to Bypass or Sleeve?

Question
Hello...  I am a 46 y/o woman. I am 5'2" and had lapband surgery in March 2009.  My pre-op weight was 233 lbs.  The weight loss has been slow but steady until this year.  I got down to 158 lbs but due to a slip I was able to eat more portions and gained back to 169 lbs.  Due to the slip and lots of reflux I have begun to talk to my surgeon about a revision surgery.  I am confused about whether I should go with a sleeve or a bypass.  Can you tell me which one is more effective after a band?  I've heard that with a sleeve you don't lose all your weight but with a bypass you will. I have worked my band, I think, pretty well.  I exercise consistently, but I did fall into some bad habits of eating slider foods and junk foods.  I'm thinking the bypass would be better because it would prohibit me from eating sugar, but then I like the idea of the sleeve being restrictive only like the band.  I would like to get down to 130 lbs so I feel like I am so close and if I am going to have another surgery I want to make sure it is a surgery that will ensure that I will get to my goal.  I don't want to go to a sleeve only to never hit my goal.  I'm so confused.  Please tell me which option is better after a band.

Answer
Lisa,
I am going to give you some general thoughts and I will end up expressing a mild preference for one of the procedures, but I want to begin by saying that this is a very personal decision and that both the sleeve and the bypass are good operations.  I recommend you approach this decision as a choice between two good options - not "one is right, one is wrong."  In the end, you are the one who is putting this surgical tool to work, so it is very important that you feel a positive sense of conviction about the procedure you have done.

Most of my patients who are having their Band removed choose the Sleeve, and they are very happy with their choice.  Having said that, my patients who have undergone conversion to gastric bypass are also very happy with their decision, and I have a slight lean toward the gastric bypass.  I lean toward the gastric bypass vs. the sleeve for two main reasons:
1) the gastric bypass has slightly better results in terms of weight loss and in health outcomes (for revision patients as well as for 'primary' operations)

2) the gastric bypass has been around since the early 80's, whereas the Sleeve has been around since about 2005.  In other works, we know all the 'ins and outs' of the gastric bypass, but in the case of the sleeve there is probably still some information that has not been learned.

Best wishes!
Dr JP

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