RNY VS VGS.. options and opinions please

Hi all,

My name is Brandi and I am currently going through my 6 month weight loss for the insurance approval. I am looking for more information about the surgeries. My Dr. thinks I would be a better candidate for the VGS due to my age and long term affects, however I am nervous it wont do what I need it to. I want to push for the RNY. I am Currently 320 lbs and 5.5. My BMI is over 50%. I just am so tired of living this way. I have tried like everyone else here just about every diet on the planet. I am looking for those who have these surgeries and what their experiences were. Did it work for you? What were the down falls. This is not about a bashing session .I need honest input and what you would do if you could do it over again.

Thanks

A very hopeful surgery candidate.

Brandi

Well why do you think it won't help you? What do you think the RNY can do different for you? I am just curious so I can help you more.

Either surgery is good for getting off about 100 pounds in the first year.

Both surgeries make it easy to be satisfied with small portions of food.  With RNY the initial weight loss is quicker and easier because you do not absorb all of the calories that you eat.  Both surgeries require you to eat according to a plan.  Long term maintenance is achieved by learning good eating habits and following them for life.

I had RNY because that is what was offered at the time.  My surgeon started doing VSG about a year later and tells me that I would have done just as well with VSG and not had the digestive side effects of RNY.  RNY is more likely to cause issues with dumping, loose stools, lactose intolerance and diarrhea.  Malabsorption goes away and then you absorb what you eat and your weight is determined by what you eat.

You didn't say how old you are, or if you have any health issues.  The restriction on taking NSAIDs with RNY can be a significant consideration when deciding on a surgery if you frequently take ibuprofen for arthritis or something. (Even if you don't take them now, you may need them in the future.  If you have knee pain now, for example, you may have arthritis rather than the joints just complaining about the weight they have to support, and the arthritis damage cannot be reversed (and anti-inflammatories are the best treatment.)

Your comment about worrying about the sleeve not doing what you need it to do concerns me a bit.  The surgery really is only a tool.  Your success, not only in getting the weight off, but -- more importantly -- in keeping it off depends far more on how much you truly change your eating and physical activity habits.

There are only 2 things that RNY offers that might be considered additional "help" with losing the weight.  Yes, the malabsorption of the RNY will help you lose more quickly, but since it is temporary, eventually you will absorb almost all of your calories again (so you end up with what is, essentially, just a restrictive surgery after 2 years anyway... But the lack of vitamin absorption with RNY is for life.)

If you are assuming that RNY will "keep" you from eating sweets because of dumping, be aware that only about 30% of RNYers dump, so the changes are pretty good that you won't be one of them.  (My surgeon said that not everyone dumped, but she gave no indication that the number was so low!)

RNY has some potential significant "side effects" that the sleeve does not: reactive hypoglycemia and increased incidence of kidney stones.

It is also VERY important to take vitamin supplements (4 times per day (since calcium has to be taken in 3 doses and cannot be taken at the same time as your iron) not just an extra multivitamin) with the RNY, so that may also be a consideration.  

I had RNY because sleeve was not an option 7 years ago, but not taking the NSAIDs was a bigger deal than I expected, and I have has problems with multiple incidences of kidney stones. I don't have reactive hypoglycemia, but now have regular hypoglycemia and must eat something every 3-4 hours.   If I were making the decision today, I would likely opt for the sleeve.

Good luck with your decision!  There are LOTS of old threads about this topic if you use the search function (the little magnifying glass) and type in "RNY vs VSG" or "bypass vs sleeve".

Lora

Well, we're similar heights and weights - I was 5'4" and 319lb.  I chose the VSG and I've been very happy with it.  I didn't want the function/process of my stomach and intestines changed, which made the VSG the correct option for me.  

It has been working well so far and I'm very happy with my choice.  :D

Do remember that any surgery is just a tool.  It won't work unless you do the work first.  

Okay, here's my opinion. (*grin*)

With a BMI of more than 50, you also need to be researching another procedure called the Duodenal Switch. I suspect your surgeon didn't mention this procedure to you because he doesn't DO it, and he wants to keep you as a customer. (Yes, customer---he's getting paid for this, remember?)

The DS has the same stomach as the Sleeve, plus an intestinal bypass similar to, but more effective than, that of the RNY. The DS has the very best long-term, maintained weight-loss stats for patients of any size, but especially so for those of us with a BMI greater than 50. It also has the best stats for resolving or preventing diabetes and high cholesterol. However, like the RNY, it will absolutely require you to take vitamins and minerals daily, for the rest of your life. Unlike the RNY, it will also give you permanent malabsorption of a significant per centage of the calories you eat. This makes maintaining your loss easier.

If you must choose between the RNY and the VSG, I'd take the VSG every time. Why? Several reasons. Long term, the RNY and the VSG have about the same maintained EWL, but the VSG retains the pylorus and all normal stomach function. This means you can still take NSAIDs and still absorb pretty much any medication you will ever need. You're less likely to have food intolerances, and you're less likely to develop reactive hypoglycemia, a potential long-term complication of losing your pylorus. Also, if the VSG doesn't give you all the help you need, it's relative simple to add the 'switch' for a complete DS. If your RNY doesn't do the trick, revising it to a true DS is VERY complicated, and only a handful of surgeons in the world can do this.

I would like to say thank you for all those who put in their opinions. I will add to my story so you can understand a bit about me.

I am 39,  happily married and have 6 children which  includes a set of triplets. I have been heavy all of my adult life and the majority of my youthful years. Basically I was 12 when weight started piling on. I have done the rounds of dieting like everyone else... seriously I would say a 90/10 split. I have lost significant amounts of weight only to stall and then regain. My largest lost has been 80 lbs. After each round I increase by 15-20lbs.

The reason I was worried about the VGS is that honestly I have had a hard time finding info, most sights I have seen limit how much info is there. The RNY seems to also have so much success, although it has been done a lot longer.

I am aware it is a life change. in all honestly it took a long time for me to get to this place where I was even willing to consider a surgery as many people have told me it is a losers way out, of the simple way to do this. However I have worked my arse off tying to lose permanently only to continue to get bigger. The last round was the worse, most lost...longest stall and finally crippling failure and depression as my weight climbed back up. I have been in this struggle so long I can stand it anymore.

As far as co-morbidities I have relatively few. Hypertensive, back issues and headaches. Yes I take a ton of NSAIDS which worries me about the after the surgery part, however I am also hopeful that my head and body aches will go away. 

I just need help. I am sick and tired of being sick and tired. I know now I can't do this on my own, I just need the help. I do like that with the VSG I wont need the daily vitamins and can still have the painkillers when needed.

I was also worried due to the fact that I have seen many others fail with the VSG. Well... maybe with many of the surgeries... including my brother in law. Overall I am just scared of failure. Of course who isn't right??

Thanks again, it is appreciated.

Brandi

FWIW, I would strongly caution you NOT to assume that your back issues will subside when you lose weight.  It may happen, but it may not, and then you will be hard pressed to find a substitute for the NSAIDs.

I had read so much about people having no knee pain after losing the weight that I decided that it wouldn't be too big a deal to have the RNY and not take any anti-inflammatories, especially since I was trying to limit them anyway because I take blood thinner.

I lost 190 pounds and my knees hurt almost as much as they did before the weight loss! It was very difficult living without the NSAIDs. It would be even harder now, since most states and physicians are cracking down on dispensing opiate pain killers like Vicodin.

Please do not underestimate the significance of not being able to take NSAIDs after RNY (not just because of the risk of pouch ulcers, but more because of the risk of ulcers in the blind, remnant stomach).

Lora

Well, I see some things in your post that sound familiar. The yoyo dieting and always bouncing back but higher, sounds like you have a very stubborn metabolism, which is one of the reason that the DS shines. I would also think long and hard about getting a surgery that would not allow NSAIDs for life, like RNY. Reread MsBatts post above, as you have some specific issues that I personally feel the DS is far and away the best way to resolve them.

I will weigh in here.  :) 

I had the Sleeve.  I am 7 months out and have lost a ton of weight.  (See my ticker).  My BMI at my highest weight was 84.5!!  I take specific medications that weren't compatible with having RNY.  But then again, I would not have considered the RNY anyway because I didn't want to lose my pyloric valve nor have my intestines re-routed.  But that is me. 

I have not had any issues with my sleeve.  It is a tool that I highly respect and work on maximizing its power to the fullest.  My life has improved 100 fold.  Downfalls....None.  But, I stay 100% on plan all the time.  For me, this is too important to screw up by thinking I can do better than what has been tried and true.

As far as if I considered the DS...Nope.  My insurance will not cover it under any cir****tances.  It is considered an exclusion under our policy regarding WL Surgery.  We have only the option of RNY or VSG. 

Good luck with whatever you decide.