My Doctor is Trying to Talk Me Into RNY Instead of the Sleeve

I went in for my my initial consultation with the surgeon.  I was certain I wanted the sleeve, but he told me I wouldn't be happy with the sleeve.  He said only 2% of the people who have the sleeve lose 100 lbs. or more, and that I should have the rny.  He said a year from now, I will be upset because I will only lose around 60-70 lbs. with the sleeve, and I will come to him for another surgery because I will still be obese.  I am so confused right now.  Has anyone else been told this by their surgeon?  If so, what did you decide to do?  Thanks for your help!

When I first started researching WLS, I talked to my one friend who had the gastric bypass and told her I was considering the sleeve, she said something similar what your doctor is saying.  She also added that her cousin had the sleeve and in a couple of years was back to her pre-surgery weight plus had gained more.  So that kind of scared me away from the sleeve.  When I first met with my surgeon she said that only the bypass would work for me because I have PCOS, so she said I would not fully benefit from the sleeve.  I also did my own research in looking at medical journeys which all seemed to indicate the same thing.  My understanding is that the sleeve can be slower in loosing.  

You might want to pose this question on the sleeve forum, you may have some different responses there since this is the RNY forum most people will have only done the RNY.

Best of luck in finding the right WLS for you!

Thank you - I put this out on the sleeve forum as well to see what they had to say about it.

Jami 

I had the gastric sleeve in October, 2014.  I have lost 106 pounds and still losing.  I can only speak of my own personal experience, and I've always been slow to lose weight. 

Honestly, there is not enough information to say one way or the other for you and we are not doctors. As stated, this is a RNY zone and we are all pro RNY. The only thing I will add; if you have medical problems that you need to take a lot of medications post op and you do not mind heart burn issues (VSG issue heard frequently) = VSG, but I had GERD pre op and I wanted VSG at that point... my doctor told me my GERD would get better with RNY... it did and I do not suffer from it post op. I can eat the spiciest anything. Even with that said, I do have a lactose issue that I watch to keep it in check. I do not take meds post op. To help you understand better, with data, check this site for details on all forms of WLS. http://www.bariatric-surgery-source.com/types-of-bariatric-surgery.html  They all are serious operations and just getting non professional options is not doing you justice. BTW... I lost 175 pounds; HW=297, SW=252, TW=119.6   Best wishes.

Thank you for the website link - lots of good information is on there.   

Iv had no gerd... I thought I would've had more issues,but I didnt.

I had an RNY and love my surgery -- HOWEVER, I know tons of people on these boards and in real life who've lost more than a hundred pounds with the sleeve.  You can be successful with either surgery -- however, there are other reasons why one surgery may be better than another for individual people. 

Also, be sure to investigate the DS.  

I would (politely) ask your surgeon to cite the source for his statistics, because his "2%" statistic flies against EVERY research study I have seen (I work part time for a Bariatric surgery group, and when I have time to kill if a client doesn't show up or if I am staying late to meet with one of the surgeons, I read their medical journals and other literature).

Whether he's right about you losing only 60 to 70 pounds in a year with the sleeve really depends on two things: how much you need to lose, and how compliant you are with changing your eating habits. Based on the materials I have seen, on average RNYers will lose approximately 50% of their excess weight in the first 6 months while VSGers, on average, will lose 35-40% in the first 6 months. (The statistics on VSG vary more between studies tHan they do for RNY, but I'm not sure why.) Now, keep in mind that these numbers are a bit skewed by the fact that most people who are SMO (have a BMI over 50) opt for the RNY over the VSG, and those people lose MUCH faster early out than even RNYers with less to lose.

Here is the link to what the ASMBS says about weight loss with RNY, VSG, and banding.  It is very general (and it is obvious that they are greatly rounding their numbers), but they indicate that RNYers experience a 40% drop in BMI in one year, while VSGers get a 30% drop, and bandsters get only a 20% drop.  Sorry that I don't have links to any online study results on my iPad...

The reality is that people can lose just as much weight with the sleeve as with gastric bypass, but because they do not have the temporary caloric malabsorption of the RNY, VSGers usually lose more slowly during the first year.  By 2 years out, though, both groups have lost about the amount of weight.  (The most frequent cited statistic is that RNYers lose about 8% more.) At 5-7 years out, the degree to which individual patients are compliant with permanently changing their eating habits matters far more than which surgery they had.

Remember, your surgeon is not the one who will have vitamin malsorption the rest of his life... you are.  Your surgeon is not the one who 1) may develop reactive hypoglycemia, 2) will be at higher risk for kidney stones, 3) will have to take vitamins  four times a day, every day, for the rest of his/her life, and 4) cannot take NSAIDs and have to rely on Tylenol and narcotic pain killers (VSGers also should be cautious about using them, but the primary concern about NSAIDS is development of ulcers in the blind, remnant stomach... which doesn't apply to VSGers, of course).

Personally, I had RNY (VSG wasn't an option 8 years ago), and I don't regret it at all, but if I were doing it now, I would choose VSG.

You need to choose the surgery that you feel is right for you because you are the one who has to live with it.  If your surgeon does not want to do a sleeve on you, will not answer your question about his/her "2%" statistic, and/or is reluctant to accept your informed choice of surgeries, get another surgeon. Sadly, some surgeons -- and I don't know yours, obviously, so this is just a general statement -- really push RNY, and it can be for a variety of reasons, many of which (e.g., they can charge more for RNY) have nothing to do with what is best for the patient.

Lora

Thank you so much for taking the time to give me all of this information.  I really appreciate it!