Deciding between sleeve and RNY?

HI everyone,

Hoping to get some feedback here - I'm deciding between the Sleeve and the RNY.  I have no co-morbidities (yet) except high lipids.  My BMI is 50.  I'm adopted, so I don't know my family hx.  Only had my tonsils out and a breast reduction in terms of surgery.  I'm a pretty healthy fat chick, but have made the decision to have weight loss surgery.

I feel like I should go for the RNY because if I'm going to have WLS, I want to do it right the first time. 

How did you make your decision?

Thanks!

-Shelly

Here's what I've written about making my choice.  

The four WLS are - sleeve, gastric bypass (RNY), lapband, and duodenal switch. My insurance covers the first three, but not the DS.

I ruled out the lapband immediately because the only people I know who have had it are miserable or have needed it removed. The complication rate is atrocious and it only lasts for 10 years or so. It's billed as being a "reversible" surgery, but the damage it can cause, like from erosion into your esophagus, is permanent. So no lapband for me.

The choice really boiled down to RNY or VSG and I chose the sleeve for a number of reasons. (Even if DS had been an option, I would not have chosen it.)

1. I really like the simplicity of the sleeve. All it does is remove 85% of your stomach. That's it.
2. I dislike the idea of having my intestines rerouted.
3. The "good" malabsorption that the bypass gives (of fats) is a temporary thing that only lasts for a few years whereas the "bad" malabsorption (of vitamins and minerals) lasts for forever. That's not worth it to me.
4. The sleeve is restriction only, no malabsorption. This also means that I CAN eat anything at all. Fats and sugars won't screw up my bowels the way they can for the bypass. (Of course I still need to make healthy choices, but that's a choice, not something that my surgery requires.)
5. With the bypass, you're left with a remnant stomach that can't be scoped. That scares the crap out of me. First, the idea that I have this weirdly connected non-stomach but then to not be able to get it checked out with an endoscopy if there's a problem? Eek. Do not want.
6. My understanding is that complication rates with the bypass are significantly greater, especially longterm due to malabsorption. While I will be taking vitamins for the rest of my life, chances are that I won't end up in the hospital if I stop because the sleeve has no malabsorption involved.
7. For the most part (and there are exceptions) the people I know with the sleeve look and seem healthier than the people I know with the bypass. That's nothing scientific though.. just a gut feeling. (This is based on people I know IRL, there are people here on the forums that have had RNY and look AMAZING.)
8. The sleeve leaves you with a fully functional pyloric valve at the bottom of your stomach whereas the bypass gives you a stoma which can stretch over time.

Thanks so much!  This helps!

^^^^ Everything Gwen said.  I like the idea that my stomach still functions as a stomach.  I started with a very high BMI  and I knew that the sleeve was the better choice for me.

You should also research the Duodenal Switch. The DS has the very best long-term, maintained weight-loss stats, especially for those of us with a BMI greater than 50. It's also the go-to surgery for high lipids, as it causes permanent malabsorption of about 80% of the fats we eat. Most DSers eat a high-protein, high-fat diet yet have cholesterol numbers around 100.

Those were two of the many reasons I chose the DS for me. Another reason was the DS's incredible stats for resolving or preventing diabetes, which runs in both sides of my family. I also knew I'd always need to be able to take NSAIDs, since I've had extensive arthritis since age 20. And like you, I wanted very badly to get the best possible surgery for me the first time.

I suggest you visit all the surgical boards, including the Revision board. Talk to people who're several years post-op, find out what they like and don't like about their surgery, and figure out which form of WLS that you can live happily with forever. I'll soon be 11 years post-op, and I'm still "in love" with my DS. (*grin*)

The ASMBS now recommends that people with all surgery types avoid NSAIDs.  Just FYI!

http://asmbs.org/resources/clinical-practice-guidelines-for- the-perioperative-nutritional-metabolic-and-nonsurgical-supp ort-of-the-bariatric-surgery-patient

Truthfully, all humans probably should avoid NSAIDs---except they're the best treatment we have for some things. Everyone should weigh the pros and the cons of taking NSAIDs, but the VSG and the DS don't really make the cons any greater than they were pre-op. (Unlike the RNY.)

Thanks!

I will be getting the Sleeve because my Dr. and I feel with all the present scar tissue, adhesions, intestinal issues and further surgery I will be needing down the line, it's the best option for me. I'm still in the process of gathering information about what protein, how much protein, what vitamins .. etc I will need. I've been abusing the search feature  lol 

You and me both!  Good luck!