sleeve vs bypass

What does your team advise?

Ultimately, there are a few differences between the surgeries, which means a pros/cons list for each. Every person has a little bit different medical picture going into the decision, and that many times makes the decision very easy.

I spent a lot of time worrying about which one I would have before I met with the surgeon and discussed it with my rheumatologist. I thought the RNY would be best for me, but the VSG has the appearance of being less severe with fewer anatomical changes.

When in fact, there was some compelling reasons in my medical history and current condition to choose the VSG over the RNY and in my medical team's opinion, there was no question that the VSG was the best solution for me. The time I spent worrying about it was of no use.

After talking with many people here and reading their stories, the RNY doesn't scare me as much as it did when I was pre-op. I believe now that if I didn't have the medical reasons compelling the VSG, the RNY would have been a slightly better option for me. That being said, I think that the VSG is a very good surgery, and I'm very happy with it and the results so far.

Given your excess weight and A1C, and not knowing anything else about your medical condition, my instinct would be to say RNY. But ultimately, you and your team need to look at the whole picture and decide.

The complication rate for both surgeries is essentially the same, and are VERY low. And your current health problems have so much higher risks of complications up to and including death, that there's no comparison. Go with what your team recommends, and try to quit worrying.

I'm a nurse, and my experience is ICU & ER so I don't know a lot about post-op, but I can tell you that I researched the complication rates of these surgeries, and they are both INCREDIBLY safe. No surgery is 100% of course, but this is as safe as having your gall bladder out or an appendectomy. Choose a good team that you trust, and then leave it in their hands. They know what they're doing, and they are good at what they do.

Thanks for your advice. I saw my PCP yesterday and he thinks the sleeve is probably better but my surgeon recommended RNY. RNY is considered the "gold standard" in wls because it has been around longer hence, performed way more times. My PCP wonders if that is the only reason the RNY was recommended. My surgeon is a well known, respected head of her department in a major hospital in a major city. My PCP is an extremely excellent doctor with a minor in chemistry and advanced bio, hes one of those guys that go out of their way to be the best he can be and tries to continue educating himself on all the newer studies, which he says newer studies show that the sleeve is less complicated for my blood pressure and those same studies show that after 2-3 years, weight loss for both surgeries are the same, the RNY you just lose faster. But I have to trust my surgeon to know what shes doing as well. Also my mom had RNY and had some type of complication and had to have tubes put in her belly cause she was losing too much weight, she went from 380# to 100# and that was scary but her surgery was along time ago and the surgery has made advancements since then

Wow. That's hard, then... having conflicting advice from two medical professionals you have confidence in. In my case, everyone on my health care team was in agreement, so there really wasn't any discussion once they laid it all out for me.

In your case, it seems like it truly is a fairly balanced case for either surgery. I'm sure you'll do great with either one then. I honestly would consider your mother's situation an anomaly. I'm sorry she had complications and hope she's OK now, but they really are rare. You shouldn't assume you'll have them because she had them.

If the case is that balanced, then it may come down strictly to how much alteration you are comfortable with being done to the digestive tract. Or if you like the thought that one surgery is potentially reversible while the other is not. (Though I doubt RNY gets reversed all that often, and I'd not expect the results to be fabulous, what with the residual stomach sitting unused all that time...)

While I think if I medically hadn't been pushed toward the VSG, the RNY might have been a better option for me, I do in fact like that my digestive tract functions pretty much as orginally designed, just with a smaller reservoir.

I have known people who chose the RNY specifically FOR the "feature" of dumping, however, because they know they cannot control themselves with sweets, and if they cannot tolerate the sugar post-op they're less likely to indulge. Of course, I've been informed that not all RNY'rs dump, so that's kind of a crap shoot. But it's something to consider, if sugar is a particular control issue for you.

Sugar has never been my problem, complex carbs are my addiction, fettucine alfredo and creamy garlic mashed potatoes smothered in butter oh my lol so maybe RNY would be better so I couldnt be tempted to over indulge?

You'd need more feedback from RNY'rs about what their tolerances are. The people I personally know who are RNY'rs don't dump with fatty/carby foods, it's sugar that does them in. And one became massively lactose intolerant post-op. I don't know if other RNY'rs dump with carbs or not.

The carb thing is something that we all have to deal with (VSG and RNY alike) through re-training ourselves to eat protein first. When you have limited space, you have to get the nutrients in that matter most, first. Protein is king, we have to have it for repair and weight loss, so we have to train ourselves to eat it first. The phrase I picked up here on OH is "protein-forward" eating. If you eat all the protein you should, there's not much space for a lot of carbs, especially if you're good about eating your veggies and other good stuff.

So do you just get full really fast? You're about 9 months out? What is a meal like and what portion sizes can I expect? If you dont mind me asking?

I don't eat to the point of "full," I measure out 4-6 ounces of food for my meals and that's all I eat. I do get the feeling of "okay, you've had enough" but it's nothing like pre-op full was for me.

I'm three years out now.

ARE you ever afraid you're going to get too thin? I already know that I have the capacity to lose weight, I just know that I cant keep it off by myself because I absolutely love food. I am nervous that if those food cravings are gone, I'll become too thin and once upon a time I was really thin and it wasn't pretty.

there are a few people who get too thin, but it's far more common that people don't get to their goal. Those last few pounds are really tough to take off (for both WLS people AND non-WLS people), and a lot of people can't/won't/don't want to do it. You have to be very committed, and some people are totally fine with being 20 or 30 lbs overweight and choose to stay there. Plus, you can always add calories once you fear you're getting too thin, which stops the weight loss.

My doc says I should weigh 142, i want to weigh 165-170, which is bout 65% my excess weight which is what the doc says most people lose so hopefully I should be good then. Thank you