Thank you for the good wishes and congratulations on your weight loss!

I appreciate the information very much!

Thank you for this information!

I had a VSG close to ten years ago, and went with that over the DS (as my primary alternate) as I didn't think that I needed the extra power that it offered. My wife had had a DS around six years before, and I had lost about a third of my excess weight "the old fashioned way" as she was going through that process, and I managed to keep that off over the next few years, but was not able to make additional progress, so the sleeve seemed to be a good for me (and it was/is).

My third choice would have been the bypass, but as it offers very similar weightloss performance to the sleeve, at a higher cost in limitations and potential complications, it didn't seem to make much sense.

Any of these procedures will be predisposed to some kind of potential complication or compromise, as you are changing the way your body evolved (or was created, if you're into that), so we always need to weigh those potential tradeoffs against the expected benefits of the procedure (as in, losing lots of weight and all that goes with that.) A predisposition simply means that a greater number of patients will see these effects than is seen in the general population, not that you will have a particular problem; it's just a risk calculation.

The VSG is predisposed toward GERD, as the stomach's volume is reduced much more than its' acid producing potential, and sometimes the body doesn't fully adapt to that change. If one has preexisting GERD that does not have an identifiable cause that can be corrected at time of surgery (such as a common hiatel hernia), then the VSG may not be the best choice, and the RNY may be preferred despite its greater limitations.

The RNY is predisposed to dumping and reactive hypogycemia due to rapid stomach emptying owing to removal of the pyloric valve from the active digestive system. It is also predisposed to marginal ulcers owing to the relationship of the stomach pouch to the intestinal bypass (this is the basis of the "no NSAID" rule in bariatrics.) This also applies to other medications that are known to cause gastric distress, so that, along with difficulty with some extended release meds, means that over the long term, one may run into more medication limitations as we get older. Another limitation that can get in the way as we get on in years is that there is a blind loop containing the bypassed stomach remnant, duodenum and upper intestine that can't be easily scoped for diagnostics or treatment - more invasive techniques must be used if something is suspected, which means that something serious may not be caught early enough to be treated successfully.

The RNY is also somewhat fussier when it comes to supplements owing to its malabsorption. This usually isn't a big problem as long as one keeps up with their needed supplements and lab tests, but it is an additional imposition, and can cause problems if one tends to be overly casual about such things. All things being equal, one will likely need to supplement more with an RNY than with a VSG, and in some cases that may not be enough - things like iron infusions are much more commonly needed with the RNY than with the VSG (if one needs any supplemental iron at all with that.)

The DS, in contrast, is similarly fussy on supplements and lab testing, probably somewhat more so, and likewise doesn't mix well with many extended release meds, but doesn't have the marginal ulcer problem, so like the VSG, is more tolerant of those meds that the RNY must avoid, and doesn't have the problem of the blind remnant stomach (though the duodenum is partially disrupted, so some of the newer endoscopic techniques in diagnosing bile or pancreatic duct problems are similarly off the table. However, in exchange, it offers better weight loss performance, better diabetes remission rates (typically 98-99%) and most importantly, better regain resistance than either the RNY or VSG, so there is some tangible value being provided for those additional costs.

It really all comes down to matching the right procedure for one's own cir****tances, and there is no one right answer for all.

If my relationship is not a 10... I'm not staying ;) I had a few relationships over the last years and it took me a long time until I've found a 'perfect' partner. Just then it was possible for the relationship to be a 10, we meet halfway every time. I admit I might have been the toxic one before because I couldn't get over jealousy. Before entering a relationship you have to think twice about it. It's not like buying a hamster, you literally choose a human to love and live with and that can be pretty hard sometimes. This is why you have to learn how to love and live with yourself before sharing it with someone else :) And this is how it'll be possible for your relationship to be a 10 as well.