sleeve vs gastric bypass

I had RNY because My doc did not do VSG and I did not know it existed. ()

I probably would chose VSG if I could do it again. Malabsobtion of calories in RNY lasts only 18-24 months.. After that is just change in way we eat that helps with maintnace. But malabsorbtion if vitamins and minerals for RNY lasts forever and there is bigger chance to really get deficient as times goes by. 

Plus - post op RNY I developed some food allergies /intolerances ... That are most likely due to the RNY configuration ( no pyloric valve). Plus my body overproduces insulin in response to carbs so to be able to maintain my weight loss - I need really low carb diet for the rest of my life... 

What bothers me most is that I no longer can eat and digest most raw veggies without major discomfort.. (my body does not process that). 

But I may be one of rare cases... ...there are many very successful RNY who can eat normal food and are doing great.  

I got RNY because I was told that it will make sick of I eat sweets.. . it worked... But 7 years post op - I can eat them - if I want , and don't mind getting bit sick later.. I learned how to "eat around my surgery".

So it Is now my pure determination and choices that allows me to maintain my weight. 

I had my heart set on the sleeve for 3 years until my surgeon told me it was a bad fit with my GERD (sleeve usually makes GERD worse while RNY almost always makes it better). He said he'd do the sleeve if I wanted, but that there'd be a good chance I'd need to revise to an RNY down the line due to GERD, and since my insurance only covers one procedure lifetime, that made up my mind. I'm glad I changed course -- I haven't had a single GERD-related nausea spell since, and I used to have multiples per day, even on 40mg of Prilosec. On the other hand, my husband had no pre-existing GERD and has been really happy with his VSG, although he does have some GERD now. I would have had sleeve if not for the GERD.

I went into my surgeon's office wanting to get VSG, per my research. For me, the choice was clear for many reasons. I was worried about having to be on vitamins forever and possible mal-absorption issues - especially since I do plan on possibly getting pregnant one day. I also was not comfortable with the rerouting of my intestines. I also was worried about "dumping" and issues with tolerating food. 

You will need to be on vitamins forever with the VSG! And the VSG does in fact have some malabsorbtion issues to be aware of, particularly B12, and sometimes calcium and iron (if you're on PPIs due to acid reflux). 

All VSG patients should be taking multivitamins, calcium citrate, vitamin D, B12, and possibly other vitamins as needed.

What I was advised by my surgeon and his team is that vitamin absorption post-VSG is completely normal for most patients - especially once the sleeve "matures" and restriction allows for more food (in the form of veggies and healthy grains). The reason why vitamins are recommended is that we are eating so much less than before. Prior to my surgery, I had completely normal vitamin levels, and have had no nausea or vomiting, which, in excess, can also cause nutritional deficits. 

While I do take calcium, B12, and a multi-vitamin currently - and likely will continue to do so, I like knowing that if I do not, it's unlikely to lead to significant nutritional deficits. I am currently being monitored every 3 months to ensure nothing is wrong.

Here's just one article on the matter I quickly found:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784422/

Your surgeon did you a disservice. The ASBMS recommends vitamins for life.

We malabsorb vitamin B12. B12 is only absorbed using a substance called "intrinsic factor" which is produced in the wall of the stomach. Because we've removed 85% of the stomach, we don't absorb enough B12 on our own. It's why we can't take B12 pills, we have to either get shots or dissolve the tablets under our tongue, bypassing the stomach.

When it comes to calcium and iron, stomach acid is required to fully absorb them. We produce a lot less due to our smaller stomachs (that, and many of us are on PPIs for extended periods of time, possibly for life. These resolve acid reflux but cause problems for absorbing calcium and iron), and therefore absorb less calcium and iron. The scary thing is that blood tests won't tell you if you're calcium deficient, only a bone scan will. Your body will leach calcium from your bones to maintain a stable calcium level.

I had a very high BMI (over 50) but no other issues, so I could have had either surgery and my surgeon refused to recommend one over the other.  Statistically I should have chosen RNY due to the higher percentage of excess weight lost.  However, I decided to go with the sleeve because the lower rate of complications was important to me.  I don't get paid time off, and any extra time off of work would have been very hard on our household budget.

I lost 170 lbs in one year, so the sleeve definitely didn't slow my weight loss.  I went in to maintenance mode for a few months, because I just needed to slow things down (mentally more than physically, to be perfectly honest).  I'm now losing weight again and plan to lose another 20 lbs, which will put me into the normal BMI category.  At that point, I'll assess my weight loss/maintenance plan.