Surgeon Suggesting Against VSG Due to Gastroparesis... Thoughts?

Hey everyone! Long time reader, first time poster here.

32 year old male, 5'11" 330 pounds.

Have yo-yo dieted all my life... have lost as many as 120 pounds, only to put them all back on . After a ton of consideration, reflection, conversations with loved ones, etc... I've decided that VSG is something that I'd like to have, to give me a tool to help me lose the weight again and keep it off this time!

Only one problem. I'm through 10 of 12 weeks of the Kaiser pre-surgery program, so am super close to the finish line! ...But in pre-consultation, I was told that my delayed gastric emptying (gastroparesis) made me a bad candidate for VSG, and that I would be steered away from the sleeve and pushed towards the RNY instead.

About my gastroparesis... I would say that I am very fortunate to only suffer from a very mild case of this disease. I don't have any issues at all with acid reflux; no foods are off limits, I never reflux up acid, and I never have heartburn. The one issue I do have is that complete bits of food will reflux back up if I eat I large meal. This happens when I don't chew well or eat a big meal. But it is never acidic or particularly uncomfortable. When I chew well and eat small portions, it doesn't come up.

Despite this mild case... as the pre-consult said... when I talked to the surgeon today he said that he would NOT suggest the VSG. He says that making the stomach smaller can make current reflux issues worse, and even if I don't have acid reflux now, I may get it later. When I told him that I don't want the RNY, he said I'd be better off getting no surgery at all than doing this and potentially regretting it.

Now... I don't know what to do. On the one hand, if I ignore him and decide to do it (is this even allowed?), I could turn what is currently a harmless condition into a much more severe one. On the other hand, I've battled obesity my whole life, and the idea of continuing this battle without surgery and with so many past failures under my belt crushes me.

Obviously no one here can make the decision for me... but I wanted to vent to a group that could at least sympathize and understand. Would love any and all feedback you have, from personal experience to just opinions!

To clarify from above... I do NOT want the RNY, regardless of if it is a "better option" for people with reflux. In a nutshell, I am very fortunate that despite my weight, I don't have any comorbidities or other issues... I'm quite healthy! I know this won't last forever, but for now it is the case. While I wouldn't balk at RNY as a life-saving treatment down the road, I simply don't feel comfortable having such an extreme and risky procedure done when I am still young and healthy. The VSG makes a lot more sense to me (smaller stomach, less ghrelin).

Both the RNY and VSG are "extreme and risky." When I was pursuing WLS, I also had it set in my mind that VSG was what I wanted and that was that. Now, after 4+ years of being in these forums, I know that RNY is also an AWESOME surgery and that people do really well with it. I would go back in time to past-Gwen and say, "Hey, RNY is a really good option too. Don't be close minded to it."

I think it boils down to whether or not you trust your medical provider. If you do, then be guided by his wisdom, experience, and expertise - those are the things you're paying him for after all. If you don't, then perhaps you shouldn't allow him to do any surgery on you and you should find a surgeon you do trust.

Having read what you've written and, again, having spend 4+ years reading many of the posts that get posted to the VSG, RNY, and main forums here, I would not have VSG in your situation.

Yes, it definitely sucks to find out that what you had planned on might not be an option, but better to learn this prior to surgery than after surgery when you're left to deal with the fall out of the wrong surgery.

I would probably go have a consult with a different bariatric surgeon to hear another opinion. I had RNY and am happy with my choice. My father died from esophageal cancer caused by acid reflux. It is not something I would risk, but we all get to make our own decisions.

As you said you are healthy now at your weight, but may not be for long.

Nursing homes that accept morbidly obese patients are now few and far between. They do not have the equipment necessary to care for MO patients. I think we all need to keep that in mind as we look towards the future.

you certainly can have the vsg , against this surgeons advice, but you will likely have to find another surgeon.

If you sre having trouble with refluxing bits of food now, with a normal stomach , under normal amounts of pressure, you are surely going to have even more trouble with that with a smaller dtomach , with even greater pressure as is created with a sleeve.

Noth surgeries are extreme and risky, it is major surgery. Those of us who are morbidly obese require extreme measures.

Mid you are worried about the extreme and risky nature of one WLS, you surely don't want to have to go through it twice, if you choose a surgery that is not right for the issues you are already dealing with.

Sound to me like your surgeon is trying to do you a solid here. I would listen to him.

Hi!

I was just wondering do you have diabetes? Gastroparesis is often secondary to uncontrolled blood sugars. If you were diabetic and could get blood sugars under control maybe you could get the gastroparesis under control.

If this is not the case then this would not apply, and you should follow your doctors instructions. Don't count RNY out. It's also a great surgery. I know it's disappointing, but people have had great success with the RNY. My mother has had it. She is over a decade out with no complications, no vitamin deficiencies, and she has kept her weight off.

Best of luck to you!

The VSG permanently removes 80% of your stomach. That's pretty darn "extreme" IMO.

Thank you all very much for taking the time to reply!

Want to try to clarify again... I did not mean to downplay the seriousness of the VSG or villify the RNY. I know that these are both major surgeries that both have their own risks and pros and cons, with the pros of both usually outweighing the cons when it comes to the benefits that come with the weight loss.

In the research that I've done, and in what I've been taught during the Kaiser program and told by my surgeon, the RNY is a more invasive and riskier surgery. That is just my understanding, I could be wrong. And perhaps the difference in risk is quite negligible.

This is just a personal preference for me. The RNY makes me feel uncomfortable. That doesn't make it bad or inferior. I have read many success stories on here with the RNY and am happy for all of them!

To answer the other question about diabetes, no, I do not have it and it is not the cause of my delayed emptying. It is apparently idiopathic.

Oh yes, I can relate, as I was also uncomfortable with the RNY for the very same reasons you state. I in no way felt you were vilifying the RNY. Just offering you some comfort in regards to the RNY based on my personal experience.

I was was hoping there was a root cause for your gastroparesis. Every patient I've ever had, admitted for this particular disease process, was a diabetic. Sounds like your case is more complicated. Still wishing you the best in your decision making process.

I have to say you've peaked my curiosity and I did a search on gastroparesis and VSG. A few articles came up that state the VSG can actually correct gastroparesis. Maybe if you did your own research and presented your findings to your doc he/she would reconsider.

I have read those studies as well! Isn't that interesting? Seems to be very little consensus on the matter. Which makes sense, because 1. Gastroparesis is fairly rare and 2. As you said, it is far more common as a symptom of diabetes. Which in these instances I'm sure virtually every doctor would recommend the RNY as one of it's great benefits is its relief of diabetes!

I feel like smaller meals and less consumption would be GOOD for gastroparesis as these studies suggest... but then what my surgeon and many in this thread have said makes sense too, that less stomach = more backup. Wish I had a crystal ball!