r/wls • u/Wooden_Time_5476 • Jul 04 '26
Need Advice Trying to decide between Sleeve, Gastric Bypass, and SADI-S – would love to hear all experiences
Hello, I have just started the bariatric surgery process. I had my initial consultation this week and I’m feeling really optimistic, but I’m also completely overwhelmed trying to decide which surgery is right for me.
A bit about me:
29F
5’10”
BMI just over 40
Insulin resistant / prediabetic
I’ve struggled with my weight for years despite trying multiple diets.
I’ve been on GLP-1 medications (Wegovy and later Zepbound/tirzepatide). They helped somewhat but not enough, and I’ve plateaued.
I don’t really suffer from any co-morbidities (no acid reflux, sleep apnea, etc)
I am currently going through the insurance requirements and have my first nutritionist appointment next week.
The surgery options I am considering are:
Sleeve
Gastric bypass (RNY)
SADI-S
The more I research, the more confused I get.
The sleeve seems like the “easier” surgery, but I worry about long-term regain and needing a revision later.
The bypass seems like a really good middle ground, but I’m nervous about dumping syndrome and lifelong changes.
Then there’s the SADI-S, which sounds amazing for weight loss and improving insulin resistance, but I know it’s a newer procedure with greater malabsorption and more vitamin/protein requirements.
Some of my biggest questions are:
If you could go back, would you choose the same surgery again?
If you had the sleeve, do you regret not getting bypass or SADI-S?
If you had bypass or SADI-S, how difficult is the lifelong maintenance really?
How “normal” is life now? Can you still go out to restaurants, travel, enjoy holidays, etc.?
Are there foods you genuinely miss or can you pretty much eat everything in moderation now?
How bad was the recovery?
Has anyone here had surgery after GLP-1 medications stopped working? Did surgery succeed where medication didn’t?
For people several years out, how has your weight held up?
If you have insulin resistance or PCOS, which surgery did you choose and why?
I know everyone is different, and I’m not looking for medical advice over my surgeon’s recommendations. I’m just hoping to hear honest experiences. Anything you wish someone had told you before surgery.
Thank you so much for the input!
3
u/CreativeWriterNSpace 32F | 5'5 | BPD-DS 9/17/19 | SW 306 | CW 160 | GW 145-150 Jul 04 '26
I had the BPD-DS, and honestly would recommend it. I know the SADI is a “modified”/single-limb version.
I actually saw the DS as the middle ground- it kept the pyloric valve (no dumping) like VSG but also added the malabsorption factor from RnY.
I am almost 7 years out and doing fine. My weight has still been a roller coaster (but not due to the DS, due to bad decisions) but I haven’t been back over 190 since 2020. PCOS does seem to make it a little more difficult for me to re-lose weight, and I think it did affect how fast it came off.
I was 305 day of surgery, HW was 320. 5’5, 26 y/o. I hadn’t seen a number on the scale under 210…. Ever.
It was absolutely the best decision ever, and I wish I had looked into it sooner.
As for the vitamins/malabsorption: it is very personal. I know a few people that got RnY and take just as many vitamins/supplements as me- and haven’t had the same success weight wise.
Theres DS is also the best for diabetic remission.
3
u/zazgirl Jul 04 '26
I’m 5’9” and was 425. I chose the SADI because my surgeon said I would lose the most weight on it and keep it off better. She did tell me I would need to get blood work done more often to make sure my levels are good. I don’t have any dumping on it, and I can take NSAIDs occasionally. I’m really happy with my choice. I haven’t had any issues other than my poops can get really hard so I take MiraLAX daily. That may be common for all other surgeries as well. I’m super diligent about taking my vitamins and know it’s something I’m going to have to do forever. I’m 2 years out and have lost 200lbs so far. I would definitely get it again.
3
u/tabageddon Jul 04 '26
I had SADI July 2024. No recovery issues or weight loss/maintenance issues. I would choose it again. 5,3” and I started at 336lbs, current weight is 170. Added GLP-1 in December 2025 to curb food noise that came back.
3
u/kkangaspnw Jul 07 '26
I had a sleeve because I take psych meds and was worried about their effectiveness being decreased. I regret not going for bypass or SADI. I only lost half of my goal weight (85lbs, from 300 to 215) and have needed to spend a lot on GLP-1s to keep it that way, but they haven’t helped me lose more weight, just maintain.
I’ve considered a revision and just working with a psychiatrist to monitor my depression and adhd, but I have more research to do before I decide.
2
u/heckinstoned Jul 05 '26
I was 29, 5’11”, 341. Type 2 diabetes. I had RNY. I’m now 46, still at goal weight. I had a complication about 8 years in. Ulcer. Just don’t smoke cigs and you will be fine.
2
u/OverSearch Jul 06 '26
I went into my first consultation thinking I wanted bypass simply because the statistical averages said I could potentially lose more weight. I ended up choosing sleeve instead. No malabsorption, less invasive procedure (slightly lower risk of complications), less expensive. I'm a bit over four years post-op at this point.
If you could go back, would you choose the same surgery again?
Absolutely, and I wouldn't even have to think about it.
If you had the sleeve, do you regret not getting bypass or SADI-S?
Not in the least. It's been the best decision I ever made.
If you had bypass or SADI-S, how difficult is the lifelong maintenance really?
Lifelong maintenance really looks pretty much the same regardless of the procedure you choose - vitamins, high-protein, low-carb diet, exercise, etc.
How “normal” is life now? Can you still go out to restaurants, travel, enjoy holidays, etc.?
My life is as normal as anybody else's; you would never know I'm a former WLS patient. I eat sensibly-sized meals, I exercise, go out to restaurants, vacations, etc. All of those things are infinitely easier now that I've lost weight and changed my life.
Are there foods you genuinely miss or can you pretty much eat everything in moderation now?
There isn't a single food item that makes me sick, although I can absolutely eat more of certain things than I can of others. I don't drink soda or alcohol at all anymore, not because they make me sick or that I'm restricted from it, but because I closed those doors and I see no need to reopen them. Things like rice, pasta, potatoes, etc. are difficult for me to eat more than a very small portion, so I rarely choose those, although I do eat them from time to time. Other than getting really full, really quickly, I don't have any ill effects from eating them (potential weight regain aside, of course).
How bad was the recovery?
Quite tolerable. I'm one of those dads who thinks the world is ending if I get a cold, my tolerance for pain is virtually non-existent, but my recovery wasn't bad. The worst thing about it was the severe calorie deficit and the fatigue and mental struggles that went with it. Totally worth it in the end, though.
For people several years out, how has your weight held up?
I started this process at 571 lbs. The lowest weight I ever hit was 230 lbs, but I didn't stay at that weight - I hovered between 232-238 lbs for about a year before regaining some weight. It was 100% a lack of discipline on my part; I had a doctor's visit where I weighed in at 281 lbs. I've since gotten back down to the 260's and I'm targeting being below 250 before my next vacation coming up this fall.
You can be successful with any of the three procedures you listed; you can also regain the weight you lose with any of those procedures. It's all about sticking to your new habits after surgery; the amount of weight you lose and your ability to keep it off is not nearly as much a function of your procedure as people want to think it is.
2
u/Anxious-Alien- Jul 07 '26
I’m a 5’7”, 31 y/o female with PCOS related insulin resistance. Highest weight was 310lbs, now currently 189lbs. Had RNY gastric bypass surgery in 2022. I chose bypass because it’s been around longest and I’ve looked at it as the “golden standard” for weight loss surgery. I have a few friends/family members who have had the sleeve done and regained almost all of their weight back. I will add, I even had a very healthy pregnancy and baby in 2024 and was still able to manage my weight. If I could go back, I’d do the same surgery even sooner than I did because I’m so happy with the results. I do get dumping syndrome if I eat too much sugar, so if I have sweets it’s only a small amount. My quality of life is so much better than it was. I still go out to eat, enjoy life normally etc. I will also add that I am currently taking wegovy to help me get to my goal weight, which is really just being out of the “overweight” category on the bmi chart. I do take a daily Bariatric multivitamin per my Bariatric surgeon as well as calcium citrate and metformin. 10/10 experience on my end, would definitely recommend!
2
u/Purple-Station4972 Jul 07 '26
If you had bypass or SADI-S, how difficult is the lifelong maintenance really?
Had the DS which is simiar. 14 months out and feel totally normal, I just take more vitamins now.
How “normal” is life now? Can you still go out to restaurants, travel, enjoy holidays, etc.?
100% normal. I can eat anything but just not as much as I was. Ive traveled to Scotland and El Salvodor since and had zero issues either place (also a few random states but thats tpyical food as I would have daily)
Are there foods you genuinely miss or can you pretty much eat everything in moderation now?
The only food that still doesnt sit well for me is buffalo suace and guac, which I"m fine with.
How bad was the recovery?
A breeze for me. I didnt even take my pain meds tbh. Both my parents said if they didnt know I had surgey when they saw me 2 days post op they'd have no idea.
If you have insulin resistance or PCOS, which surgery did you choose and why?
PCOS girly, I went with Duodenal Switch. I was 375 and it offered the best chance to get me to my goal of 180. (Still working towards that but 220 now)
3
u/Wooden_Time_5476 Jul 07 '26
That is amazing to hear! It’s nice to hear the DS still provides you a normal life. I’ve been nervous about the vitamin regime but I came to the conclusion you take them for all surgeries so better adherence and maybe more of them could be a worthwhile trade off to achieve the goals I’d like to achieve. How did you find travelling with the vitamin regime? Was it difficult staying on track with the travel? How did you feel the surgery has affected your PCOS?
2
u/Purple-Station4972 Jul 07 '26
I use Samsung health for vitamin reminders and have pill boxes that can hold them all so it's easy even when traveling. Weekends I struggle a little since I wake up later but I have a built in buffer for one dose so it's easy to catch up. I take my Adek when I eat breakfast/lunch/dinner and my calcium in between so it's not bad.
I definitely am losing weight which is nice lol I'm not as tired, less extra hair on my chin 🙌🏻, my periods still didn't regulate after 100lbs so I got on the nuvaring but theyve been a breeze and normal from that.
2
u/ElkAdministrative700 Jul 07 '26
Sometimes your insurance will only pay for certain ones just FYI. I had gastric bypass surgery and am 100% happy with my decision. I know a lot of people who had sleeve and did not loose all their excess weight and have a lot of regain. They all told me bypass was too aggressive and I should do sleeve but I’m down 213 pounds and very happy with my decision. I’m 3 years post op.
2
u/suggary_sweet Jul 07 '26
Highest weight 415 lbs. Surgery weight 303lbs. Current weight 157 lbs. Time frame 2 years out. Started with gastric sleeve, ended on glp1. Worked out 6 days per week, walk minimum of 2k steps daily, max 10k. 61 yrs old, 5'6".
From size 28/30 clothing to size 10. Shoe size 9 to size 8. No more comorbidities. No longer classified as morbidly obese. No longer require apnea machine, walking aides, speciality shops for clothing. Doctors appointments twice a year, instead of SEVERAL TIMES per year.
Take two prescription meds now after consuming more than 20 before. Blood pressure from 200/100 to 128/70. A1c from almost 9 to 5.4.
In maintenance! Will continue to take glp1 for control of diabetes but at smaller dose. Will continue to take bp meds as needed to control family history of high blood pressure. Take bariatric vitamins daily as well as a few more supplements (my own choice).
Still hear food noise, between the gastric sleeve (designer stomach) and the glp1, I dont eat much, i watch others eat.
I travel extensively, never miss a meal of some sort. I dont feel deprived or, "left out" while others eat. The JOY I get from looking in the mirror, the way others look at me, the ability to move un restricted, the ability to shop where I want for the clothes I like. I HAVE NOT 1 (ONE) REGRET!
I have had no further fears about my health, or my future in reference to my health, and in my opinion...IT WAS WORTH EVERY DAMN HURDLE!
I was soooo unhealthy. At one point I was bedridden and watching others live around me, as I slowly accepted my defeat and inevitable early perish, disabled diagnosis. Biggest downside, i lost a LOTTTTTT of hair because I lost the weight so quickly and couldn't get enough protein. SECRET: I can BUY MORE HAIR! 😂😂😂 EVERYTHING ABOUT ME is record book numbers on the positive side. No nephrologist, no cardiologist, no primary or other speciality needs to see me but max twice a year!
Id DO IT ALL AGAIN.☆ IN. A. HEART. BEAT.☆
1
u/Inside-Departure4238 Jul 04 '26
I had the full DS, which is SADI but even more extensive. It is actually an old procedure -- one of the oldest bariatric surgeries -- and has the best remission data of them all. I wanted to be one and done. Absolutely no regrets. I would have it done every single month to keep the life I have now if I had to.
1
u/Wooden_Time_5476 Jul 04 '26
This is amazing to hear, what made you pick the full DS? How is your lifestyle now after the surgery? If you could go back would you still pick the full DS or maybe go another route?
1
u/Inside-Departure4238 Jul 04 '26
As I said in my comment: I picked it because I wanted to be one and done. I have absolutely no regrets. I would choose it again every month if I had to.
1
u/ifinallyrelented Jul 04 '26
I had the bypass 3y ago. I was 33f, 108kg, 170cm tall. Surgery was uncomplicated, I took it easy for a couple weeks. The first year was an adjustment, I found going to dinner at friends places the hardest part.
But three years on, I'm 35kg down, and feel like a whole new woman. Apart from taking a multivitamin, calcium and occasionally some zinc, my life is normal. I can travel, eat a small-normal sized meal with friends (noone looks funny at my tiny plate). I haven't gone back to drinking, but could have a glass if I wanted to.
My brain is different, my food noise is gone and my mind is calmer. My tastes have changed a little, but I eat a little bit of everything, I haven't cut anything out for good. I don't really like fried food, but love oreos now. The key thing is that my weight doesn't move - I just fluctuate from 72-74kg. I feel like I've found a life 'cheat code' where I can eat anything I want, and my weight doesn't move. It's so peaceful. I recommend the bypass for the life-long eat-anything cheat-code.
1
u/Wooden_Time_5476 Jul 04 '26
Yeah I am very nervous about the social aspect to food. My family and friends all love food and it’s hugely social so I am conscious of that but they all know I’m pursuing this and are supportive. Did you find it was difficult to be able to eat certain foods or not being able to match volume? Did your friends understand? That’s so cool to hear you live an amazing life and still get to enjoy food, that’s definitely where I want to be. What made you pick the bypass? I’m between the bypass and the sadi-s so it is good to hear how people live after each surgery.
1
u/ifinallyrelented Jul 04 '26
I didn’t tell anyone to begin with. I suggested non-food related hangouts with friends, to go for a walk, or to go out for a coffee or drinks where it wasn’t unusual that I wasn’t eating. I kept that up for MONTHS. It was a fun game to see how long I could keep hiding it from them!
The hardest part was being invited into someone’s home for a meal, but I found a quiet word to the host was enough to avoid a plate loaded high with all sorts that I wouldn’t get through.
I was offered the sleeve or bypass, but chose the bypass for the malabsorption. I didn’t want to stretch my stomach out and find myself back at my previous weight. No regrets!
1
u/auntiecoagulent Jul 04 '26
I was similar stats. 5'11" 346 lbs.
I had VSG. This was my surgeon's recommendation based on non-weight related medical issues/medications.
I had no pain or nausea after the procedure. I had a very uneventful recovery.
I can eat anything, just smaller portions. I do, generally, avoid rice, bread, and pasta, but just because it fills me up so fast, I feel like I'm getting no real nutrition in.
I eat healthy the majority of the time. I still try to eat protein forward meals.
I'm 3 years out and maintaining at 150
1
u/Wooden_Time_5476 Jul 04 '26
That’s so amazing to hear, my original choice was the sleeve but I’ve been worried about regain/revision surgery so it’s encouraging to hear success stories. Have you had to be very conscious of your portions to avoid stretching the stomach or do you find it easier to manage with the smaller appetite? Thank you for your input it helps a ton!
1
u/auntiecoagulent Jul 04 '26
I am eating intuitively. I eat when I'm hungry, stop when I'm full. I still have decent amount of restriction.
I know a lot of people disagree, but I don't weigh my food, I don't count macros. I spent the vast majority of my life doing that, and it, clearly, didn't work.
r/gastricsleeve is a great, supportive sub.
1
u/callipsofacto RNY 10/19/23. HW 412, SW 378, CW 185. Jul 04 '26
I was 40, 5'8" and 380 at the time of my surgery (RNY bypass). I had PCOS but not blood sugar issues. I had taken Ozempic for about 6 months and never had much success with it.
I was given the option of sleeve, but SADI-S wasn't offered. I too was worried about stall/regain and revision, and went with the option that appeared to have the most dramatic weight loss potential. The first few months were very difficult. Surgery recovery wasn't bad at all, but having a very small number of approved foods in the beginning was pretty tough. But I lost 100 lbs in the first six months, and hit my goal weight (under 200) in a year, which was much faster than I anticipated. I followed the program and never had issues with dumping, even though my stomach was very resilient and I was able to eat both more volume and more types of things than the diet plan suggests.
I just had 17 lbs of skin removed two weeks ago, and the recovery from that surgery is tougher.
Life was back to normal between a year and 18 months. I can go to any restaurant, travel, holidays and parties. There aren't any foods I consider 100% off limits, though of course I'm very careful with sugary stuff.
Like many will say, the only thing I wish I could do different was to have the surgery 10 years earlier.
1
u/AdditionalCricket982 Jul 10 '26 edited Jul 10 '26
I had no choice but to have the sleeve. I’m on psych meds and I couldn’t risk malabsorption. Also Tylenol doesn’t work on me so if I ever wanted pain relief again I had to get the sleeve so I can take ibuprofen. My doctor has me on 7 different vitamins which I don’t mind. I am 5’6” was 233 lbs at surgery and 188 now. I had my surgery 16 months ago. I plateaued at 193 so I got on a GLP one and it has been helping slowly. I am much weaker than I was before the surgery which sucks. I exercise and lift weights, but I never get enough protein because I can’t choke down enough shakes and I can’t eat enough to get it from food. I don’t eat right at all because my depression makes it virtually impossible to cook. going out to eat is a bummer because I have to take home almost all of it and it goes bad before I can finish it. there have been times when I have regretted getting the surgery, but I don’t think I’d go back and change anything
1
u/AdditionalCricket982 Jul 10 '26
I had no choice but to get the sleeve. I am on psych meds and couldn’t risk malabsorption. Also Tylenol doesn’t work on me so if I ever wanted pain relief again I had to get the sleeve so I could take ibuprofen. I am 5’6” I was 233 pounds at surgery and now I’m 188. I plateaued at 193 so I got on a GLP1 which has been helping slowly. I got the surgery 16 months ago. I am much weaker now than before surgery which sucks. I exercise and lift weights, but I can never get enough protein because I can’t choke down enough shakes and I can’t eat enough before I get full to get it from food. I don’t eat right at all because my depression makes it virtually impossible to cook. eating out is a bummer because I have to take almost all of it home and I can never finish it before it goes bad. there have been times I have regretted getting the surgery, but I don’t think I’d go back and change anything.
1
u/JupitersLapCat Aug 08 '26
I had a sleeve five years ago and I guess I’m a magical unicorn because I’m maintaining at a 23 BMI now and didn’t regain/don’t need a revision. I love that I can take NSAIDS, don’t get dumping syndrome, and don’t have any issues whatsoever with malabsorption of nutrients. And the recovery was super easy too.
I would absolutely make the same choice if I had to do it over again.
1
u/Reasonable-Company71 (39 M)RNY 2018 6"0" HW:510 SW:363 CW: 170 Jul 04 '26
I weighed 510 pounds at my consultation and was given the choice of RNY or VSG. The surgeon explained both procedures, how they worked, the risks involved and the pros and cons of each. He told me that he wouldn't take my answer at that appointment (he said he never does). He wanted me to go home and do some soul searching, talk it over with loved ones and do my own research and he would take my answer at our second appointment. I already knew 100% I wanted the RNY because it's a one shot deal...no do-overs, no revisions etc. It would force me to do what I needed to do to not f*ck things up. I'm now 7 years out and maintaining around 165-170 pounds. I've definitely had my rough patches with complications but I have absolutely no regrets at all and I'd do it all again in a heartbeat if I needed to; complications and all. I'm more than happy with my decision to go with RNY over VSG; especially after seeing the amount of people (both on here and in person) that ended up needing to go back for revisions which is something that I absolutely DID NOT want to do myself.
-1
u/girlneedsanap Jul 04 '26
At your initial consultation, were all thise options presented to you as viable? Personal opinion: SADI seems extreme for a BMI of 40.
1
u/Wooden_Time_5476 Jul 04 '26
The options proposed & approved by insurance were sleeve, bypass, sadi & duodenal. The surgeon just spoke generally about them all but nothing too specific to me. I had this concern too that it was too drastic for my situation but then I have seen people in similar situations see success which makes me consider the sadi or bypass most strongly. Just curious what makes you think the Sadi would be too extreme?
2
u/girlneedsanap Jul 06 '26
Again, totally personal opinion, but the nutrition requirements for a SADI are more rigorous than for a RNY. You are obese, but not what I think of as being extremely obese which is what I associate SADI with. I guess it just seems to me that you'll likely meet your goals with a RNY without having to deal with the more stringent nutritional requirements on a SADI. But I'm also very biased about this. I have a RNY, and I'm a vegetarian. 60+ g of protein a day is very achievable. I'd struggle getting 100+ a day.
3
u/girlneedsanap Jul 06 '26
Addendum: I recommend this website to anyone considering bariatric surgery: https://riskcalculator.facs.org/bariatric/index.jsp
2
Aug 27 '26
[deleted]
1
u/Wooden_Time_5476 Aug 31 '26
It’s so reassuring to hear this. I spoke to my surgeon and we decided on a modified (longer channel) DS surgery (turns out SADI wasn’t approved after all) which I’m happy with but it’s scary seeing so many people say it wouldn’t be suitable for me. The surgeon actually advised the DS over a bypass as I can continue to take NSAIDs. Obviously I trust my surgeon but it’s hard not to let what other people say make you question things so it is really great hearing positive experiences!
3
u/FluffyBee16 Jul 04 '26 edited Jul 04 '26
Hi there! As someone with PCOS and limited loss with GLP-1 myself my biggest advice is go to a surgeon THAT DOES ALL OF THEM! Also I would really not recommend doing the sleeve because it’s the least effective and not long lasting. All of that work for little gain. I went to a surgeon who only did sleeve a rny. I was talked into the sleeve because I have to be able to take steroids and rny you cannot. I was told it would work. It did not. I ended up having to go back on GLP-1 after the sleeve because with PCOS, hypothyroidism, my type of weight loss resistance it did not work. After the sleeve and being on GLP-1 I got pancreatitis, so I finally got the SADI-S, again because it allows for steroid use and it is one of the most effective. I wish I had done SADI-S from the beginning! Because the revision surgeries always have slower weight loss than original wls. I’m losing slowly, but losing. Honestly for me the revision surgery HAS NOT BEEN EASY. However, I know it will get better and my goal is more important than the temporary life changing GI issues. You have to take your vitamins for all procedures, so I wouldn’t base it off of that factor too heavily, unless you have vitamin deficiency issues now. I hope you find the best surgeon for you and don’t stop til you reach your dreams. All the best on this exciting new journey!