vertical sleeve v. gastric bypass

 I plan on having weight loss surgery in Seattle after the first of the year.  I am having trouble deciding between the vertical sleeve procedure and gastric bypass.  I am a patient with Type I diabetes, sleep apnea, high blood pressure. You name it.  Does anyone have any suggestions on which one I should go for?

I'd really appreciate any feedback if people have the time.  Thanks so very muc.

Christopher in Seattle

Chistopher....

If you having Dr Thirlby do your surgery  - he only does Open RNY.  No surgeons at  Virginia Mason do vertical sleeve. 

Helen

Quite honestly, as my husband's employer chose not to include any type of weight loss treatment regardless of co-morbidities or BMI (except discounts to Jenny Craig and Bally's - like I haven't tried just eating better and exercising - who'd of thunk it could all be so easy?!?!?!?) price was a major concern since I have been out-of work (terminated when FMLA ran out - thanks for all of your hard work and I guess that recent promotion didn't really mean anything in terms of your professional attributes or commitment to the company) since mid-March 2008.  I thought Lap-Band was my only option as a cash pay patient until I attended the required seminar by my chosen surgeon in early October 2008. 

When I had my consult I asked my surgeon if I was a good candidate for VSG.  After a thorough review of my medical records (10 page health history survey plus long interview during the consult) he stated that I was.  He knows that this surgery, whatever I chose, was going to be my "last shot" at successful weight loss (although to be fair I have to admit that the fact that it can later be converted to the Duodenal Switch, even if I have no intention of every doing it, does give me some comfort).  I trust Dr. Srikanth (located in Federal Way http://stfrancisweightforlife.org/st-francis-hospital-weight-loss-DrSrikanth.htm ); partly due to his congenial demeanor but more importantly because he's the best in WA (IMHO) and is very thorough in his pre-op testing and has a great follow-up program that lasts for life.  For example, due to my medical history he's required pre-op 4 outside consults, 25 lab tests, and 10 procedural tests (woo-hoo for me, only the stress test and PFT’s are left).

When I researched VSG on my own I came to the conclusion that it was not only successful as a stand-alone WLS, but also the best choice out of any WLS for me because:

-          immediate restriction meaning the possibility of faster weight loss

-          no complications, short or long term, from permanent device implantation like with Lap-Band

-          no need for expensive adjustments on a regular basis for life like with Lap-Band

-          better overall surgical risk/complication rate than other WLS's given my BMI and co-morbidities

-          no rerouting of my intestines thus less likelihood of malabsorption issues or dumping syndrome

 

 

 

I say good for you for asking the types of questions that should be asked before making one of the most important decisions of your life.  I have put together a list of research articles available online thanks to other members of the VSG forum who were willing to share their research.  If you’d like a copy of my list, please send me a PM.

In the end, please realize that it's up to you to choose the right procedure for you and you alone.

 

 

Good luck on your journey,

 

 

Amy

 

 

Hi Christopher! Luck of the draw, you ended up with two VSG preops here tonight and not many RNYs. Usually we are outnumbered.

I am choosing to pay for my sleeve rather than go through the insurance hoops for the bypass. As you can see from when I joined OH, I could easily have done the six month diet thing for my insurance three times already, so I guess I am strongly committed to the sleeve being best for me.

I think if you lurk on the RNY and VSG forums for a couple weeks, you are going to get a good idea of what you are in for with either proceedure.

Keep in mind that there are a lot more bypass patients than sleevers so the absolute numbers of complications are going to be higher for the bypass. However, one of my coworkers used to be a proceedure and OR nurse for the local bariatric center of excellence. She was so glad to hear that I wanted the sleeve. She said they were 'constantly' scoping RNYs for stuck food, looking for marginal ulcers, working up bowel obstructions etc.

I am also confident I can do vitamins twice a day for life (due to limited calories and variety) but I am honest enough to know that I will not do vitamins every 2-4 hours every day for life.

I think it depends really on what kind of eater you are and what kind of risks you are willing to take on in the long term.  Every thing you have can be helped by weight loss. 

You can learn to eat around any surgery.  Do you think that you are the kind of person who once they take off the weight they can keep it off?  Do you like protein??  We malabsorb so you need to eat protein at pretty much every meal.  Are you a sweet eater?  Not all Rny peeps dump (40%) I don't dump but sugar does make me feel icky. 

Vitamins are big for a Rny patient, I don't take them every 2 -4  hours though.  I take mine morning, noon, evening and before bed if I need, not all day!  After Rny you have to be committed to having blood draws every 6 - 12 months for the rest of your life to monitor your levels.  And "you" need to monitor them too, not just your Dr.   Its your body, if you are looking you can notice trends, like the fact that you iron has been slowly dropping, you might now still be in normal readings but would you rather add an iron to stabilize things or wait till you've bottomed out??

I chose Rny because I wanted to lose as much as I could as quickly as possible. I wanted the posibility of dumping.  I've lost 85% of my excess body weight in 9 months (127 lbs) and I am still losing.

I feel great, I still have great restriction, and no complications.

I think both surgeries are great, it just depends on what risks you are willing to take to get your life back. And how hard you are willing to work for it.

Hi Christopher,

Best of luck on your decision to improve your health!  The best thing I can recommend for you in making this surgical choice is not in thinking of how each surgery affects your body post-op but rather in what your overeating patterns are like NOW.  Because unless you are the type of person who can say, "Today I am going to eat completely healthy and never go back to old habits" then you are going to be faced with those same bad habits creeping back after your surgery too.  And that is where your chosen surgery type may or may not affect your chances for long term success.  Besides, if you can make that kind of choice for yourself you don't need surgery anyway.

I had VBG in '99 and soon after knew the restriction alone was not going to do it.  I'd fooled myself into thinking I didn't have a problem relationship with food and that merely cutting back on the amount of food I ate was going to be enough.  I am a food-self-medicater and EASILY out-ate the VBG.  So what if only a small amount of food goes in?  You merely wait awhile and then eat again.  Voila!  I never lost more than 50% of my weight with the VBG an then regained all but 10#.  Annnd...my health suffered in the process.

My RNY is much more of a built-in food police and is serving me well.  But it isn't a free ride; I have to NOT put in the wrong foods and it helps me in that way.  I don't consistently dump on sugars but then I don't 'test' either.  I've given up fried foods, most 'white' foods and everything made with high fructose corn syrup.  Some so-called natural and healthy sugars work fine for me and some don't.  Most all foods with fats over 4 or 5 grams will make me dump and I need that. Taking vitamins is no big deal for me.  (Four chewables a day...big deal.)   I'm never going to be cured of my food problems and will always fight my weight. 

From my lowest weight after revision surgery I have regained 10-15# and am staying at or under my surgeon's goal.  I exercise regularly but grudgingly.  But I'm no longer a stroke waiting to happen, my cancer risks are reduced and if the family spectre of Type 2 Diabete****s...it will be much later in life. 

Something else important you should consider...for many people in the future there will be no such thing as revision surgery unless you pay for it yourself.  Many insurance companies are adopting a 'once in a lifetime' exclusion policy meaning that even if you self-paid for your first wls the very fact that you've had one gives them the right to deny you coverage for a second.   I never could have afforded either of my surgeries without insurance so that would have been devastating for me. 

Do as thorough a study of your current eating/overeating habits now as you can.  Be brutally honest with yourself to help you make this very important choice.

Very best wishes to you!

Molly

I had the RNY, but from what I understand, the sleeve is not as helpful for diabetics, as you are not losing part of your duodenum, with is the main help for diabetics. good luck on what ever you choose

Vertical Sleeve Gastrectomy (VSG) is helpful for diabetics. The only advantage to diabetics with a Roux-en-Y (RNY) is that dumping syndrome is associated with the consumption of sugars.   However, it is still possible to eat high carb/low fat foods with RNY so diabetics still have to watch their intake of all carbs, as does every WLS patient regardless of procedure.  Additionally, for patients with high risks and high BMI's, VSG offers lower complication rates than any bypass option [(RNY or Duodenal Switch (DS) ]due to quicker OR time and no intestinal bypass (see http://www.ncbi.nlm.nih.gov/pubmed/18560961?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum). Both the VSG and RNY offer similar percentages of excess weight loss (EWL) at 70%, especially with the newer lower sleeve sizes (2 -4 ounces) created with VSG's.  The best percentage of any WLS for EWL is DS at 80% (see http://www.lapsf.com/weight-loss-surgeries.html ).

In the end, it is the responsibility of each patient to make an informed decision based on research, both empirical and anecdotal, and the recommendation of his/her surgeon.  All WLS's can be eaten around and "fail" if the person does not commit to following nutrition and exercise guidelines post-op.

Amy

Hi,

I've been to quite a few seminars now, have read about 10 books on all the different weight loss surgeries, and have searched the web extensively to learn all I can, plus have been going to different support groups to learn because I want to learn all I can so I can choose what is best for me. 

Many insurance companies don't cover the vertical sleeve because the weight loss is lower and slower with it, and a higher percentage of people gain weight back with it.  It's good for people that don't have that much weight to loose and who have good will power......definitely not for me.  Low complication percentage.  Good for people with a lower BMI or as a first step proceedure for people with a very high BMI for getting some weight off before having a second surgery such as a RNY or DS.  You don't have the dumping problem with this method.

Gastric Bypass RNY - Proximal has a bit higher weight loss and a better proven record for keeping the weight off long term - also with a low percentage of complications.

I have not had surgery yet, but I have decided on having the RNY- Medial surgery.  It has a higher percentage of weight loss than the proximal RNY, and the track record for keeping weight off permanently is a little higher than the proximal.  "Dumping" can be a problem with the RNY's which is caused by eating sugar and some other foods.  Me - I'm a sugar addict so the dumping will be a good thing to help me keep the weight off. 

There's so much more to all this - I just gave a really short brief breakdown.  You need to read about all the surgeries - all the pro's and con's, go to seminar's and ask questions, and keep asking questions like you are here.  Learn all you can and then choose the surgery which is best for you, your eating habit, and your personality. 

Hope this helps,

ragadolly

Wow, another person with a MEDIAL  RNY - sometimes it feels like I'm the only one!

Good luck with it!

You live in Maple Valley..... any chance you might be going to the support group at St Francis tonight at 6pm?