RNY or LapBand?? Pros vs Cons of each?

I am so CONFUSED.. I don't know which surgery to get- here are the issues I have got most of pre-op tests done, I am going on vacation then when I get back my doctor starts fighting with my insurance company for coverage on the surgery. I have the co-morbidity of sleep apnea and arthritis. First my insurance supposedely only covers the RNY- but my doc says his staff with fight for the band if that's what I want. The band is reversible. My g.f had the RNY and misses her 'comfort' er- food. The LapBand doesn't have the absorption issues, so it obviously won't work as well, but the RNY does have the absorption issues.. and the whole vitamin deficiency issues. I just lost my father-in-law to a hospital acquried infection, which terrifies me away from ANY surgery,but I can't stand my weight any more.

I had open RNY. I had it on January 8th. Later that night I was walking around the hallways at the hospital. I was scared to death of many things. I weighed the options myself. I didn't want to be able to have those "comfort" food since that's what got me fat in the first place. I rather miss it, and not have. It's a small scarifice. I think yeah I love greasy and fried. However, those good old "comforts" of mine were also what probably gave me high cholesteral, and helped me gain weight in the first place. I'm only 12 days post op. I'm down 22 lbs so far. You're all ready looking at the band being reversible which worries me. Regardless of which procedure you have if you chose to, you need to look at it as a permanent change. My friend who had the bypass a year prior to me asked me a question when I was driving her nuts with questions. She asked me what I truly wanted. Did I want to live to eat? or Eat to live? I probably thought about that question for a good year while doing all my pre-op stuff. It's a tough decision either way. I do wish you much success either way you go.

No one can decide what surgery is best for you, but in consideration of your concern about losing your "comfort" foods, have you thought about the DS (duodenal switch)? If your insurance company pays for the RNY they will almost always pay for the DS. If not immediately upon the first request, almost always upon appeal. You can read about why I chose the DS over the RNY or lap band on my profile, but bottom line is this, you have to have the surgery that you think is best for you. Only you and your surgeon can make that determination. The lap band is removeable, but it takes an operation to remove it, and there are some instances where the removal of the lap band is very dangerous. On the DS forum (on OH) we have 2 DSers who were revisions from the lap band. In both cases the lap band was lodged in their livers, others on the DS forum that are revisions from the lap band, said that the lap band perferated their stomachs, and/or caused their esophogus to get extended. Yet another person threw up for years before her revision, because the lap band had slipped. The lap band is "best" for people who do not have a ton of weight to lose, and who can stick to a very strict diet for the rest of their life. It restricts food intake, yet can be "tricked" by food such as chips and candy, which go right past the band in almost unlimited quantities. I didn't want the RNY because i couldn't deal with the issues of a stoma: food getting stuck, pills getting stuck, and/or it getting stretched out and then needed a 2nd operation to fix it, or worse getting a stricture and needing a process to open it up. I didn't want to deal with dumping syndrome. Not every RNY gets dumping (only about 50 percent) and long term, most RNYers don't get it at all, but to those that do dump, they get the feeling that their heart is going to come through their chest, cold sweats, and the feeling of vomiting and passing out. I didn't think this was a benefit, nor did I want to get sick in public. I've read on the main forum where people carry around barf bags or barf cups (even years out), because they don't know what they will eat that will cause them to throw up. Every surgery has it's disadvantages, but it's up to you to decide which ones you can live with, personally I could not have lived with the lap band or the RNY. So I chose to have the DS. Scott

I won't get into which procedure is better, because some of what I've witnessed on the main board has gotten ugly at times.... but I WILL say this... given that you have arthritis, I would stay away from the RNY because with RNY, you can not take any NSAIDs such as aspirin, ibuprofen (Advil, Motrin, etc), Naproxen (Aleve), Excedrin, as well as a bunch of prescription drugs (Celebrex is one name that comes to mind.) NSAIDs are the most prescribed drugs for treating arthritis because of how they work... they have an analgesic (pain relief) effect, they reduce inflammation, thin blood and reduce fever..... yet they can cause gastrointestinal problems, especially with the regular use that comes with persistent joint pain. The main chemical function of most NSAIDs is what they call a COX inhibitor... COX is the shortened name of an enzyme in your body, and there are two types - COX-1 and COX-2, both of which are inhibited by NSAIDs. the problem is that COX-1 enzyme's main function is to protect the stomach lining from acids and digestive chemicals... inhibit COX-1 long enough, and you run the risk of perforations, ulcers, and other upper GI problems. under normal anatomy, a problem in the stomach/upper GI can be detected (and sometimes even repaired) by endoscopy... take a good look at one of the many drawings of the post-RNY configuration, and you'll see that endoscopic detection and repair is pretty much impossible. For the reason of your artiritis alone, I'd suggest either the Lap-Band or the Duodenal Switch. Best of luck.

my opinion personally is that if your going thru life threating surgery you want to try to get the maximum results there will be a lot of contreversy about this subject and again its a personal desicion .... my feeling about the lap band is that port that stays in you it kind of grosses me out but thats just me .... i have had a lot of success with the rny and thats because i was ready mentally and physically... i followed the docs rules and if you do that either surgery is infailable..... i gave up pasta for a 2 yrs i gave up rice ..... i followed to the t and had amazing results so like i said its a personal desicion... and whatever you decide i wish you the best of luck....... i look back and wouldnt change a thing...i went from 20/22 to a kids 16 slim so good luck to you ... Stacy

Joann: Hi KNOWLEDGE IS POWER, RESEARCH RESEARCH RESEARCH ALL YOU CAN to make the most educated and informed desision for you. There is no BEST surgery, people could attempt to debate that forever there is only the BEST surgery for YOU! We r individuals and luckily there are many surgical choices (Lap band, RNY open or lap, BPD/DS, sleeve gastrectomy, gastric pacer etc)...but they all carry risks, benefits, as well as each has good points or selling points.. aAlign the selling points and risks you are willing to accept and the surgery your able to get (insurance or private pay) as well as resources for which tool you get (not as many pacers or sleve gastrectomies or BPD/DS surgeons available etc). Put them in a pot, stir and make the best choice for you.. with that said surgery is not for everyone! It is a tool but only a tool and each can be defeated, so learn about the tool adn how to maximize its success. Read on i have posted this brefore... Deciding to have WLS is a major, life-changing event and shouldn't be made on impulse (I am not saying this is you I am saying this for anyone thinking about it!). I recommend anyone be 110% sure this is what you want to do because it is PERMANENT! Things to think about: · How long have you been researching WLS?**Hopefully at least a good 6 months or so****for many it is years! · Do you understand the procedure, I mean really understand the nitty gritty of what they are going to do to your intestinal system! Not just it will help me lose weight but *for instance w/ the Roux-En-Y gastric bypass* that they are going to cut your stomach in 2,make a small pouch, the old stomach hopefully is transected from pouch by staples and surgically cut in 2! Then the intestines are cut a few feet or so down and rerouted so you lose weight because the tummy is restrictive and bypassing the intestines decreases absorption....Know the risks involved with this!!!***(nutritional/metabolic/physical/psychosocial): ex B12 and vitamin deficiencies/protein deficiency/hernia/adhesions, risk of depression post op related to grief over loss of food and hormonal surge of estrogen/trauma of surgery, marital/relational difficulties/high divorce rate)... · Surgical risks: (not all inclusive.. ~Bleeding, ~Complications due to anesthesia and medications, ~Deep vein thrombosis/clots, ~Wound Dehiscence, ~Infections, ~Pulmonary problems, ~Spleen/Liver injury, ~Stenosis of new connections (stricture), ~Hernia, ~Death. · Depression possibly related to grieving the loss of food, decreased metabolism, and hormonal surges from estrogen being released into the body from rapid wt loss/fat breakdown.... · Gallstones....need for 2nd surgery to remove this. · Long-term osteoporosis (metabolic bone disease), severe vitamin./mineral deficiencies · Hair loss (temporary due to anesthesia, trauma of surgery but will continue if you are protien/vit and mineral deficient!) · Food intolerances (possibly meats, esp. red meat, lactose intolerance, sugar, fats, fried food) · Dumping syndrome (Nausea/vomiting/diarrhea/chestpain/palatations/sweating/tiredness for minutes/hours/days) *when eating highly concentrated fats or sugars (a desired behavioral response that ~ 50% of post-ops geet) · EXCESS SKIN....OK my philosophy is you fit in your skin or you don't...Do say you don't want to feel bad after, ask yourself do you feel bad now? If yes are you healthy now as a MO person? Yeah many insurance companies pay for some plastic surgeries if medically necessary it may be a fight, but you can get some of it removed possibly....If though this will deter you I say the chances are great you will have some amount of excess skin, no one knows how much...Age, gender, prior diet/weight changes, pregnancies all affect this and the best chance on has to control this is (although limited) exercise, water and protein....So if this is a huge issue don't have surgery.......Excess skin may be by far the most distressing side-effect for people as we already come with altered self-esteem/body image!!! · What type of research have you done? (Internet, in-person support group meetings, talking with others who have had surgery, surgeon consult, surgeon seminar, articles, books?????)***Knowledge is power and is the best tool we have for success and happiness afterwards**** · What are your present support systems? Friends, Family, co-workers.....**Although not 100% necessary if others are on board it sure as heck makes the ride all that much easier!!!*** · What are your current stressors? ***WLS is a time when you need to be as stable as possible, going through a divorce, bankruptcy, death of a close relative, job loss...well WLS may be a good option but pick the optimal time as it is stressful enough if everything is good, when you are going through something extra stressful you are hampering your success possibly and not having the old standby of food to rely on can be HELL!***This is not to say there ever is a right time and things can happen post-op but be kind to yourself and do what's best for you, waiting 3 months may make all the difference in the world! After all this is about forever!!! · What is your nutritional/obesity/diet history?***WLS is not for everyone, it is for the Morbidly obese (BMI above 40 or 35 with major comorbdities such as sleep apnea, Coronary disease, Diabetes....)This should be no ones first attempt at dieting (*I know this is not yours again just general guidelines)...Anyone who says this is the easy way out, KNOWS NOTHING about the surgery or the struggles you will endure and lifestyle changes necessary post-op for success! They are usually ignorant, jealous or both! Again your education and knowledge here goes a long way...Everyone seems to know someone who 'died' or had a 'terrible experience' with WLS...BUT no one seems to have a name or number to call that person!!! It is again based on hearsay alot of the time and their own fears and insecurities...You are doing this for you remember that, it is nice to have support, so educate friends and family, bring them to a support group!!! It can only help! Many programs require wt loss preop...I know many people disagree with this or don't understand why..IMHO I think it is a generally good idea to start instilling dietary, exercise and overall lifestyle changes preop, there is nothing magical about the surgery that makes u wake up and think like a thin person (*I WISH!!!!) So making small changes are helpful pre-op...EXERCISE is one of the biggest keys to success (IMHO again) and anything you can do preop will help you keep up with this and be healthier for surgery!! (and a better surgical risk!)...Start eating smaller portions, it is hard if you go from eating super sized fast food today to clear liquids for 2 weeks (*this is my equivalent of psychological hell/torture!!!) Start slowing down when you eat, put that fork down in-between bites, cut up your food to small pieces, stop drinking and eating at the same time (cant do it or shouldn't postop so start now!) Start taking in 64 ounces of fluid a day if u aren't already, will need to postop! Cut out carbonation, caffeine, sugar, alcohol and chocolate (these are 5 recommended things to avoid postop for many esp. in the first year) again make postop life easier on yourself not harder start ahead!!!!Try on new coping skills for size, they wont miraculously appear postop! Stock the house with clear liquids, crystal lite, diet kool-aid, broth, diet jello etc so u are ready when u get home!!!!Try and avoid the 'last supper syndrome' you will eat most everything again eventually, perhaps in smaller quantities, so don't have a feast each night of things u think u will never have again! · Ask yourself: What is my ability to make lifestyle changes? Be compliant with post-op recommendations??? This is only a tool....(*sorry can't say that enough!).... a. Need to exercise nearly daily for health/wt loss and help with excess skin b. Need to supplement with B12, multivitamin, folate, Iron, Zinc, Calcium citrate, protein shakes possibly give or take things. c. Need for LIFELONG FOLLOW UP!!!! If you're not taking care of self now you MUST postop or you may trade far worse illnesses for the Morbid obesity you have now malnutrition and vit/mineral def can be permanent and irreversible! · Know that extended release medications may not be as effective or absorbed well (**esp. birth control pills in woman of childbearing age use alternative form of BC) I could probably ramble on all day about this..I hope some of this helps you! Any specific ? email us or me offline! Take care and good luck it is an awesome journey!! *not perfect and a positive attitude helps! DO this for you and only you!!!!Start journaling now www.obesityhelp.com is a great site, start your own profile there! Also if you haven't seen this document (pouch rules) print and read! A good basic guide to things that will help you use the tool and be successful as possible (*for most of us!!!) http://www.digitalhorsewoman.com/pouchrules.htm The Bypass as well as the lapband, and BPD/DS, SG, pacer etc have all of the risks that come with having an operation, the lapband may involve shorter OR time and no rerouting of intestines. Both can lead to gallstones & excess skin r/t wt loss, None is "SAFE" any needs to be considered carefully and not taken lightly...it must be an informed decision and used only as a last resort for people who are 100lbs overweight or have a BMI of 40 or greater, unless their BMI is 35 and they have comorbidities (DM, HTN, sleep apnea...) The surgeon really should be going over all the risk/benefits with the patient, whichever procedure they the PERSON chooses. I would though encourage anyone who is contemplating this to educate him or her to make the best-informed decision possible. Weight loss surgery is not for everyone. I am glad there are different options, because not everyone can have a bypass...and the band is an option for those that cannot/do not (want to) have their GI system altered. I promote weightloss surgery (band or gastric bypass or any other BPD/DS, SG etc) to those that are informed and understand the risks/benefits and have weighed them heavily!. The bypass is what I know most about and have had. WHY? There is more research on this surgery (IN THE US), it has been around longer, perfected, esp. in regards to weight loss (depending what research you look at the band may only give the person a 38% wt. loss vs. 78% wt loss is a standard for GBP), NO DS around and ya know from a RNYer I would of gone w the BPD DS to tell u the truth w/ what I know now but I have a great tool that enabled ME to lose 100% excess and at 4+ yrs maintian w/in 10# +/- sp far!!! The band has only been used in this country since June/July 2001 (In Europe 10-15 years). and long-term complications still are not all known, Can the band stay in forever? Who knows, many do opt to get a bypass after ineffective wt. loss with the band, (So why go thru 2 operations if the bypass will be your final destination? IF your insurance will pay for a SECOND operation?!), many see the band the same in terms of wt. loss as the VGB (vertical gastric band, which has almost been abandoned or revised to bypasses in this country r/t ineffective wt loss (no malabsorption). With the band, there are risks such as: stomach perforation, pouch enlargement r/t band placement/slippage, band slippage, erosion of the band, erosion of band into the stomach, body rejects foreign object (the band), access port problems (flipping etc), saline evaporating from port requiring more f/up fills, more follow-up is needed for the fills.....Also the lapband is not done everywhere yet in this country, insurance companies are still reluctant to pay for it, insurance companies are paying for the bypass, without much issue. These are the reasons I chose what I chose... And th BPD DS wasnt offered in my area so I didnt consider going to NYC or spain etc for it... I am not implying Bypass is not without risks, It has many risks...more serious? Depends which side-effect/complication you get, depends who you talk to....I had a complication, but came through it fine, I had adhesions and scarring that caused a stricture on my small bowel, this could of happened if I had the lap band, our bodies make adhesions, it is a risk of abdominal surgery...mine were in the wrong place and caused a problem! Malabsorption...which in essence means lifelong follow-up with a clinical nutritionist, for labs... and supplements of: calcium, iron (maybe), B12, folate (maybe) and a multivitamin for life. Protein also needs to be a focus of the bypass persons diet, and sometimes supplementation is needed. Hair thinning at 3 months, r/t protein deficiency, but it grows back in full after a few months (not baldness mind you thinning) Dumping syndrome...now some say this is a benefit, sort of the ultimate behavior modification..if you eat sugar/fat you feel awful, tired, nausea, diarrhea..so you don't eat that food again! What is agreed on is careful screening medically, surgically, nutritionally as well as emotionally/psychologically. Eating disorders need to be looked at, esp. compulsive eating. A good aftercare plan is key, having a multidisciplinary team to follow you (Good PCP, Surgeon, Nutritionist, therapist, support group) are all factors shown in research to lead a person to the best outcome/wt. loss possible. THERE REALLY IS NO WAY TO OUTLINE EVERYTHING THAT IS GOOD/BAD/UGLY WITH EITHER PROCEDURE. FOR ME BYPASS WAS THE ANSWER, FOR SOMEONE ELSE IT MAY BE THE BAND or the DS etc. GOOD LUCK! From this site....VERY VERY INTERESTING!!!!(*Read all the way down to see how they select procedures based on type of eater you are and the risks you will accept and how much you want to lose!!!!) http://www.alagsa.com/Bariatric_Surgery.htm email me offlist I have a great documenton WLS sites of interest I compiled last yr! Take Care, Jamie 100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY 320(preop)/163 (lowest)/174 (current) 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com http://www.obesityhelp.com/member/jamiecatlady5/ "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"