VSG vs RNY

I am not terribly obese, but have been overweight for 20 years.  I am 5'5" and 220. I have T2DM and have been taking insulin for 8 years.  I was totally set on RNY until I had a relative with T1DM do VSG and have great results.  When I brought up my decision to change from VSG to RNY I got a skeptical response from my surgeon.  He said RNY would be better for me, but ... he could always convert the VSG to RNY if I didn't lose enough weight.

What are your thoughts?  I don't want to have more than one WLS so I need to make the right decision from the start.  My mother was a bariatric NP and suggested the VSG because I have a sweet tooth and would not do well with dumping syndrome.

If you have RNY and you sometimes cheat (by cheating I mean maybe a hershey kiss or 2 on occasion), how often do you get dumping syndrome?  Has anyone here had a VSG converted to RNY?

If you're already thinking about cheating, maybe you're not ready for surgery.

I am being realistic.  I realize that I will not give up chocolate for the rest of my life.

Also 2 Hershey Kisses = 44 calories.  

How much sugar causes dumping syndrome?

All RNYers don't dump.... the number I hear gets passed around is about 30% of RNYers dump.

That said, VSGers can dump just like a non WLS person can dump.

Both surgeries can work, the question becomes can the patient do the work?

The VSG is NOT a standardized procedure and all sleeves are not created equal.

A surgeon that says "he could always convert to an RNY if you didn't lose enough weight" doesn't do an effective VSG. The longer term results should be close between the two procedures and patient commitment and compliance is the difference. Strong aftercare helps a lot, the more you learn the more your effort becomes knowledge based. 

Most who convert from RNY to VSG do so to rectify GERD and improper VSG technique can cause GERD or make it worse than it needs to be.

If a patient really does need to convert from VSG to a more powerful surgery than the Duodenal Switch is the natural move..... similar sleeve stomach with a bypass.

Most 5'5'' 220lbs woman in my surgeons group get down to around 120-135lbs. with his VSG.

Hope this helps.... you said you wanted to keep it for reals !

frisco

I could eat about a pound of Hershey Kisses before I dumped.  If I ate two eventually I would eat more.  RNY does have a better track record of putting diabetes into remission and DS is even better.

I'm a dumper and can eat up to 12 grams of processed sugar before I start to feel the dumping symptoms.

 I will tell you that getting the head stuff right is far harder than going through surgery.  You really do have to change everything about how you relate to food.  If you are going into this thinking that you can still eat the things you loved, you will likely regain.  None of us became obese eating two Hershey's Kisses.  The problem is we don't know when to STOP.  Getting real about the food addiction is key to your success.  

Food does not equal happiness.  It's just fuel for the body.  You can lead a wonderful life without sweets.  When you stop eating them for a month or two,  they don't even taste good anymore.  The most successful people with WLS recognize their weakness where food is concerned and stay away from their trigger foods entirely.

Pick one surgery and go with it.  Revisions are complicated and there are very few surgeons that are good at them.  Most insurances will have a "one WLS per lifetime" clause.  If you have a revision you may have to pay for it out of pocket, unless you have a mechanical failure of your original surgery.  If you have GERD the RNY surgery will likely cure it where the VSG might make it worse.   RNY has a better track record for putting diabetes into remission.

Edited to add I know that I don't have the will power to keep myself from eating "two kisses" every few hours and making the excuse that, "It's only a few kisses and 44 calories".  You can eat two Hershey's Kisses every few hours and never dump.  That means you could eat the entire bag in a day. 

I was an insulin dependent Diabetic prior to WLS and VSG surgery on 11/19/14. I walked out of the hospital off all medications but one BP med and was off that within a month. I have done well thus far, but make a conscious effort to stay away from my previous vices, such as chocolate. I will eat a protein bar as it helps me fuel prior to working out, I think eating a protein bar helps to curb any cravings for sweets.

The numbers do show that RNY or DS has a higher success rate for putting diabetes into remission, while I am only 20 months out I feel that I am doing what I need to do to ensure I do not fall back into any old habits. I feel it would be dangerous to add the sweets. Once you go without the sweets it is much easier than you think to stay away.

Continue to do the research and pick the one that you feel will allow YOU to achieve success. The surgery is a tool, in the end it is up to you to determine how successful you will be.

Sadly we have no "easy" button, I am finding I struggle more now than I did the first year. Losing the weight was easy, maintaining is more of a challenge, but do able. I know it is on me and no one else. I also need this Forum to help keep me focused and to give me a kick in the A$$ when I need it.

Best of luck to you. Mike

If you've been on insulin for 8 years, your diabetes may not go into remission at all. But it's much more likely to go away with RNY than VSG. And even more likely to go away with the DS.

Some doctors like doing VSG. They are easier, and faster. More profitable. Yours sounds like he is trying to talk you into what works best fir him, not you.

Don't think revision. They are much more dangerous. Do one surgery, and be finished with it.

2 Hershey Kisses are 44 calories? That doesn't sound like much. But 44 extra calories every day is 5 pounds in a year. Those pounds add up. And not a single one of us, ever, could stop at 2 Hershey Kisses in a day.

If I knew my neighbor had a bag of Hershey Kisses in his kitchen, I would break in at 4 am and eat them all.