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

Yes it does seem risky. What I read is that vsg increases gastric emptying, and since gastroparesis causes delayed emptying this is helpful for this disease process. Doc could be misinformed.

Anyhow I hope you are able to come to a decision with your surgeon! Keeping you in my thoughts and prayers.

The risk and "invasiveness" of RNY and VSG are as nearly identical as they can be. Both are about the same as gallbladder or appendix removal. From the surgical standpoint, there is no real difference.

But you've made your mind up there is. I have no doubt you can find a surgeon with an opening who would be glad to do a VSG on you. But you should listen to this surgeon and not have it done. With your medical issues it is just too risky. If you are dead set against RNY, you're better off doing nothing.

When I was your age, I thought I was healthy too. I could carry 300 pounds around ok. But I'd gain, lose a lot, gain back more, et****il I hit 475 pounds, had diabetes, circulatory problems, apnea, arthritis etc etc etc. Lots of pills, and started on injections. Then I had RNY. I wish I gad done it years before, and haven't regretted it for a single day.

I second everything everyone else has said. I would 100% urge you to reconsider. The RNY is no more invasive than VSG, and given your situation I would absolutely consider what your surgeon says and strongly consider bypass.

I did not have gastroparesis prior to my VSG in 2014. In fact, I had no contraindications. About 8 months post surgery I developed severe and debilitating reflux. I would reflux acid, food, liquid, etc., even though I did everything right (small portions, bite sized pieces, etc, no liquid with my food, etc.) As someone above said, the VSG is a closed high-pressure system that is the perfect breeding ground for reflux. Anyway, my reflux got so bad I was forced to convert to RNY in July 2016.

I understand your reluctance to have RNY, really I do. But I would urge you to reconsider. To me (and this is just my opinion) it makes no sense to push for a procedure that could make a condition you already have, worse, such that you may have to revise to RNY to alleviate your symptoms. There is no going back from VSG, once they remove your stomach, it's gone forever and if you end up with severe GERD/Reflux, the only cure is revision. Also, it doesn't make much sense to me to say you'd have RNY as a "life-saving treatment down the road." Have it now while it can make your life infinitely better. Again, as someone who has gone through it, this is only my opinion.

Good luck with whatever you decide!

Thank you all again for your feedback. Seems like the consensus around here is pretty clearly against me getting the VSG.

This has been so tough. I was so excited to get it. Now I'm kind of lost.

As it stands, there are clear risks with VSG, and my perceived risks with RNY.

With Kaiser, once you complete the 12 week program, you have up to a year to decide whether or not to get the surgery. I think I'm going to take this year attempting to change my lifestyle without the surgery. I know the odds are stacked against me, but hopefully I can overcome them with the knowledge that a risky surgery is my only other option.

If I am unable to succeed in making these lifestyle changes without the surgery over the next 6-8 months, I will just have to decide which is the best option for me then.

Thanks for your help and good luck to all of us on our weight loss journies!

both of these surgeries are on the very low end of the continuum of "risky surgeries". They're safer than hip replacements, and about the same as having your gall bladder out. Yes, 20 or 30 years ago WLS was risky, but it's just not anymore. Techniques have improved greatly, and it's become a routine surgery. RNY now has a 0.3% mortality rate, VSG is a bit lower. But still, that means 99.7% of us pull through RNY just fine. I'm thinking you're going by outdated perceptions or old research. Keep researching. As Grim said, the risk difference nowadays between the two surgeries is negligible.

To clarify further, I'm not worried about the procedure itself. I understand that it is very safe, and that complications directly related to the surgery are rare.

The risks I am worried about with the RNY are the potential long-term risks. Dumping, not being able to take NSAIDS, malnutrition, etc.

Yes, the benefits almost certainly outweigh the risks! But I'm still scared about it.

only about 30% of us dump - and NSAIDS are not recommended with VSG anymore, either...

Yes, dumping is not a given, and is often transitory, going away after a couple of years. The NSAID thing depends upon who is doing the recommending - it is a big NO-NO with the RNY due to that procedure's predisposition toward marginal ulcers, and given that most bariatric surgeons grew up on the RNY and probably had bad experiences with any patients that used NSAIDs, they tend to be very gunshy about them and carry over their aversion toward them to other procedures such as the VSG, which doesn't have the same level of sensitivity toward them. Surgeons who were early adopters of the sleeve based procedures and have more experience with those procedures tend to be a lot more flexible in their recommendations.

Dumping affects less than half of patients. And honestly, we shouldn't be eating sugar (which causes dumping) anyway!

NSAIDS are not advised for either surgery.

Malabsorption after RNY is not permanent.

Caloric malabsorption is not permanent with the RNY, dissipating after a year or two; vitaming/mineral malabsorption is a long term thing, so one still needs to supplement for it for life. With the DS, malabsorption in both cases is long term.