Decision: Gastric Bypass or VSG?

I do agree with those who said to meet with several surgeons. I have read on here(I think) about surgeons who specialize in higher BMI cases. I never thought I'd do this and wasn't even sure when I went to see the surgeon for the first time. I do not regret it. Good Luck.

To be honest with you, I think any WLS is good IF you work with your tool and follow your surgeon's instructions.  I started at 488 lbs.  My highest was 513 lbs.  I got the LapBand and lost 271 lbs in less than 22 months.  I was strict and didn't cheat even with one bite.  I lost my first 100 lbs at 4 months.  That first year for all surgeries is the golden time to lose the most weight.  With the RNY, I have friends who have all regained back to pre WLS weights.  They relied on the malabsorption to lose and when their bodies stopped malabsorping, they gained.  I had my band removed 2 years ago and got the Sleeve.  I lost down to my goal weight in less than 9 months.  I believe, any tool works, if you're committed and will work it.  If you have Reflux, I would not get the Sleeve.  If you don't, I think the Sleeve is the best choice.

I also have Lymphadema from being SMO for over 15 years.  I lost weight and my Lymphadema has resolved by 80%.

As the others have said, please at least consider the DS surgery. Although I believe that anyone who is determined enough can be successful with any of the weight-loss surgeries (except the band), with such a high BMI you will probably do much better with one that has a malabsorptive component: RNY or DS.

That being said, however, I opted for RNY because VSG was not available eight years ago and the extreme malabsorption of the DS frightened me. If I were making the decision for myself again, however, I would opt for the VSG to avoid the issues with the lack of vitamin absorption of the RNY (and DS), and just accept that I was going to need to do more work on my own to be successful without the temporary caloric malabsorption. IMO, losing wieght a bit faster with RNY simply isn't worth a lifetime of not absorbing vitamins.

Because of your BMI, there may be a more limited number of surgeons were willing to accept the risk to do the surgery on you (or have the necessary specialized equipment to do it laparoscopically), so you might not be able to just pick and choose your surgeon as someone with a lower BMI might. For the sake of safety, I would seek out someone who has done a significant number of surgeries on people with very high BMIs.  Even then, the surgeon may require that you lose some weight before it is safe to do surgery, especially with the breathing issues you identified.  

I work part time for three bariatric surgeons, one of whom is retiring at the end of the year, and only one of them --the one who is retiring -- will do surgery at all on patients with a BMI over 60 (and one of the other two will only do open surgery on someone over BMI of 50) so it will be important for you to ask a prospective surgeon about lap versus open surgery. None of them will do surgery on someone very large without both cardiac and respiratory clearance so you might also need to work closely with other doctors in order to get clearance.

I would also strongly encourage you to get into counseling if you are not already. For most of us who are super morbidly obese (and I was as well... I had a starting BMI of 57), the obesity is not just a matter of making poor food choices or eating a bit too much. It is a matter of eating way too much and making very poor food choices over a very long period of time. There is almost always some kind of significant psychological component, and if you don't deal with the psychological issues and dysfunctional behaviors, your chances of being successful with ANY surgery are lessened.

Good luck!

Lora