New Patient Consult-Dr wants RNY I want VSG. Help!

Hello to all,

I just had my 1^st consult with the doc that will be doing my WLS. I have done my research, I thought going into the consult that VSG would be the best option for me. The Dr. recommended RNY. The reason he gave is that looking at early long term studies (5yr-10yr) a significant portion of people are gaining some weight back. He thinks in the long term VSG won't be as effective for keeping the weight off. He likes the fact that RNY has 30,40,50 yrs of research behind it, but he performs both procedures. My best friend had VSG done by him last yr, though she had less weight to lose than me. This surgeon/bariatric hospital program is highly regarded. It is a teaching hospital and probably one of the best bariatric programs in Northern CA. I have a high BMI and a lot of weight to lose 180-200lbs, but I'm still young early 30's, and I only have borderline hypertension. In fact when doing my review of systems the surgeon joked that I was making it easy for him because I had no major issues besides the BP. Is there any reason why I can't get the sleeve? I am weighing the pros/cons now and I would like some thoughts and opinions from the community. Below are some reasons why I was considering VSG.

Reasons I was leaning towards VSG:

Monthly menstrual cramps that require Advil for pain relief( Tylenol does nothing for me).

No re-rout of internal organs/lower chance of absorption issues (this freaks me out).

Lower chance of "dumping" syndrome, I will be following the same diet as a RNY, so do I really need an unwanted side effect to keep me on the straight and narrow?

lower risk of complications/lower surgery time.

If I fail and push comes to shove VSG can be converted to RNY with the stomach I have left.

If there is anything else I should be considering please help, all comments are appreciated.

Obviously you need to do your own research and make the best decision for yourself. I had 100 pounds to lose and did it quite successfully with VSG. My reasons for choosing it were very similar to yours. So far I'm extremely happy with my choice.

Have you ever had an issue with acid reflux?

Many surgeons are now recommending no NSAIDs for VSG as well. Mine did, and I even have it on my med alert bracelet, so wouldn't count on that one.

Correct! And the newest ASMBS recommendations also say no NSAIDs for VSG. (The old recommendations didn't say this.)

I didn't know that. Well that alleviates one concern for me. Thank you.

No,I have never had issues with acid reflux.

I know the doctor is completely competent he's done hundreds of sleeves and thousands of RNYs. I just went to my first nutrition consult and I'm scared out of my mind now. Worried about the vitamin and mineral absorption issues I just got my labs back and found that I am slightly anemic so that will have to be addressed with iron supplementation. I met another woman during my nutrition console who had RNY and has problems digesting chicken 15 years after her surgery!!!! I'm so scared about complications I'm thinking about backing out of the whole surgery. :(

Obviously everyone is different, and complication are always a possibility (albeit severe ones are rare). That being said, my surgeon has repeatedly told me that with the current method of RNY he sees almost no issues with vitamin and mineral absorption aside from Iron. He acknowledges that Iron can be a real issue and you need to stay on top of that. Any other long term vitamin/mineral absorption issue is rare in his practice. I only take 2 adult Centrum everyday, plus a B12 supplement (my B12 was just low-normal so he added, and it is sky high now) and an iron tablet. I take those every morning and all is good so far (17 months post-op).

According to the doc, they used to see more of this as they used to take out a larger portion of the small intestine to increase malabsorption in order to enhance the effectiveness of the procedure.. Then they realized that the malabsorption portion of the RNY actually has very little to do with the weight loss, so they have changed their methods and remove less of the intestine. The surgery remains as effective as it was in the past, and vitamin/mineral deficiencies are pretty rare if you follow the plan.

My surgeon is also a huge advocate of consuming a ton of vegetables as well as several portions of fruit a day. I have no scientific evidence to back this, just my own personal opinion, but I do believe this may also contribute to the fact that he doesn't see a lot of vitamin/mineral deficiencies in his practice. I consume a lot more phytonutrients from my food everyday than a most WLS patients who focus that majority of their diet on animal/dairy proteins. Not judging anyone, and everyone should do what works for them, just my unqualified medical opinion ;-)

Both VSG and RNY patients are at risk of deficiencies, and they're recommended to take the same supplement regimens.