Newbie Here and Curious

Hi! I am battling back and forth between having the VGS and the RNY. I am meeting with my surgeon next week and am a bit confused. What were the deciding factors for some of you? Why did you choose one over the other? I was set on the RNY - then I started reading about the nutrition deficiencies and got nervous. Do you run that risk with both? Is there greater weight loss with one or the other? 

Thanks so much!

Hello and welcome!

I had RNY over 7 years ago but I never had the option of VSG or DS- for me it was either the lapband or gastric bypass.  So, with that being said- I don't regret my decision.  I can't say that I have always felt that way but I definitely believe that is just part of the process.  I honestly don't know much about the other options but there are plenty of folks on here who do and they will be along shortly to share!

Best of luck to you!

Thank you so much for taking the time to respond. It is greatly appreciated!

I am going to share a link from the bariatric surgeon's association. It explains each surgery and gives facts about them. You can also explore this website to find out a lot of other things. procedures

Research indicates that initial weight loss with RNY is faster but that eventually both surgeries end up having the same weight loss success in the end. 

Deciding factors for me:  didn't want malabsorption issue and all the potential vitamin deficiencies and requirements for lots of vitamins that come with it; wanted the least invasive/fastest performed/least complicated surgery possible (I have anesthesia issues); didn't want a "blind" stomach left inside me; wanted the ability to take NSAIDs in the future.  

Thank you Tracy,

Everything you are describing are the reasons I had changed my mind initially.

Thank you so much for responding.

I had RNY because the sleeve wasn't available 7 years ago (and I have been successful and don't regret having had it at all), but if I were making the decision again, I would opt for VSG.  The permanent lack of vitamin absorption, IMO, isn't worth the temporary caloric malabsorption (and therefore losing weight a bit more quickly for about 18 months) with the RNY.  Also, only 30% of RNYers dump, so if you are hoping for (or counting on) that to keep you away from sweets, the odds are against you.  It still takes old-fashioned willpower.

With the sleeve, your digestive system works the way it was intended to... You just have a very small stomach.  With RNY, the changes to the digestive process have some negative effects (e.g., making us more prone to kidney stones, problems with medication absorption (including pain meds)). With the VSG, you still have your natural pyloric valve rather than a surgeon-made stoma that can potentially be stretched (which causes you to lose the sense of restriction and in severe cases causes your pouch and intestine to become one huge stomach, making it much easier to overeat). On the other hand, with RNY you keep the part of the stomach no longer being used (which can be put back into service if medically necessary because of damage to the pouch, cancer, etc.)

If you currently take NSAIDs (aspirin or any kind of Ibuprofen (Aleve, Motrin, etc.), or a prescription med like Celebrex), it can be difficult to adjust to living with only Tylenol and prescription medications for pain if you opt for RNY. Although some surgeons also suggest avoiding NSAIDs with the sleeve, they remove the remnant stomach so there isn't the risk of an ulcer in the blind remnant stomach (which cannot be diagnosed or treated easily since it can only be accessed by surgery). I personally had expected to get a lot of relief from my knee pain once I lost the weight, but that didn't happen and it was much more difficult to live without NSAIDs than I expected.

I did not really want the vitamin malabsorption from the RNY or DS (I worry about what happens when the body naturally loses the ability to absorb nutrients as we age), but my surgeon wisely informed me that there was no way I would lose close to 200 pounds with the band.  RNYers do lose more quickly than VSGers, but studies show that by about 18 months (when people have generally lost most, if not all, of their excess weight and when RNYers have lost much of the caloric malabsorption) there is little difference in amount of weight lost. Studies also show that by 5 years out the type of surgery makes no difference in maintaining the weight loss.  That varies only with compliance with healthy eating and physical activity.

RNY does potentially offer some permanent fat malabsorption, but that varies a LOT from one person to another and you should not count in it.  Some people can see that they still malabsorb some fat many years out (you can see the fat "rainbow" in the toilet) but many lose it entirely (or almost entirely). Unless I eat a meal that is pretty high in fat, I never see the rainbows anymore.

Finally, there are a number of long term issues that RNYers may face that VSGers do not: reactive hypoglycemia and increased risk of kidney stones, for example.

I didn't think that taking the vitamins would be a big deal, and you DO get used to it, but I personally find it to be kind of a PITA to remember to take pills five times a day (I have to take an extra calcium dose). I didn't know when I had my surgery that calcium has to be taken in three separate doses and that it cannot be taken with iron, so that means taking pills four times a day (or 5 in my case).  Every day, for the rest of your life.

If you have GERD or other particular medical conditions, though, there may be medical reasons that one surgery would be better for you (and those things would probably "trump" any of the above).

It is a very individual decision.  The most important thing is to consider both short-term and long-term pros and cons.  

Keep in mind, too, when reading responses here is that ANYONE who is within the first year of their surgery (no matter which surgery) is almost always going to give it glowing review because they are still in the phase where they are thrilled to see the weight rapidly coming off and they have not had the surgery long enough to have encountered any problems with vitamins, etc..  This is a case where I think responses from "vets" should be given more weight.

Good luck with your decision, and remember that long term success is far more dependent on the lifestyle changes than the surgery type.

Lora

Thank you so much for this response Lora. Long term was what has really been weighing heavily on me. Originally, when I attended the seminar for weight loss and I saw how quick the weight came off for RNY patients, I immediately decided that was for me. As I researched everything, I started to question, why would I have this done over the VSG? The malabsorption really bothered me, along with having a blind stomach. 

When they called to set up my pre-op surgery visit and said that I was meeting for the RNY - I said, "No, I had changed my mind and wanted the sleeve." The lady paused and said "Are you sure, your BMI is 51" and that is what stuck with me. I started asking her questions that she said I would need to ask the surgeon. It threw me again in a tailspin. I am compiling a list of all my questions and intend to write down the responses when I talk to the surgeon. 

Thanks again for your insightful and informative answer, it is truly appreciated. 

Thanks again,

Cynthia

My BMI was over 70 when I decided on the VSG.  My surgeon left the decision up to me on whether I wanted the RNY or VSG.  I didn't have any problems with GERD so there were no limiting factors.  I was a quantity eater, so restriction was what I wanted.  I had avoided WLS for years because the intestinal rerouting with the RNY always scared me.  I like that my stomach still functions as a stomach.  And the fact that they removed the portion that generates ghrelin, the hunger hormone, was a big plus for me to choose the VSG.  I also did not want limits on taking NSAIDS in the future.

My surgeon said that although you'll lose weight faster initially with the RNY, studies show that the results are comparable at the two year mark.  Both surgeries have pluses and minuses.  It's a very personal decision based on what's important to YOU.  Good luck with whatever you choose.  

Thank you so much for your response. Ghrelin is one of the things I am interested in also. I thought initially it was only removed in VSG, and then was told it was removed in both. So this is something I definitely need to research and ask my surgeon about. 

Thanks again!

Cynthia