Still can't decide...

Hi all, I am new here. I went to my first meeting the other day and was set on having a bypass, but the more I research I'm not sure if the sleeve is where I should be leaning toward. I'm so nervous about it all, but I know I need to have WLS for myself and my family, I have 4 boys that I want to be around for for as long as possible and with obesity and the problems that occur with it running crazy in my family I need to do something about it now.  I just can't decide which is best for me. My mother had the bypass a long time ago, and that's why I've been leaning toward that, but my BMI is only just over 40 so not sure if I need the whole bypass or if the sleeve will work for me. I just don't want to get the sleeve and then regret not getting the bypass later. Please let me know your experiences, I would really appreciate it. 

Doing as much research as you can is best and the surgeon can give some insight. But it'll come down to what you want. I chose the sleeve as I IMO thought it was less risky for immediate reasons and long term, such as malabsorption or malnutrition issues and meds after surgery. Im young Andy avve young children and it just made me feel better. The less dietary restrictions afterward were also big for me. No dumping etc. I know some choose bypass because maybe they are afraid if they don't dump they will be more tempted? I feel if you're ready for the change then you're ready regardless. Whichever you choose will work as much as you put forth the effort and make it work :-) it's exciting so goodluck!! I love the decision I made it was right for me. 

Do your research - and if you're going to consider bypass then look into DS too.  If you really decide the malabsorption piece is important you'll want to know that the malabsorption with the DS is for life while the RNY decreases significantly after a couple of years.  Important to know for long-term results.  

I went with VSG because I didn't want any malabsorption, didn't want my intestines re-routed, etc.  My starting BMI was just over 40 too but I also had Type II diabetes, sleep apnea and borderline high B/P.  It was the right choice for me.  

Please understand that the sleeve is as effective as the RNY with less metabolic complications . The sleeve is permanent, the other procedures can be reversed. There is no disruption in the normal digestive pathway with the sleeve. The gastric and pyloric valves, which control food going in and emptying from the stomach are intact. With the sleeve, a part of your stomach is removed and your capacity for food is greatly diminished. The post-op rules for both are the same. 

 I had the sleeve in 10/11, and have lost 200 pounds.

There is such joy in being able to go to a regular store and shop for clothes! I wore a size 32, now I am a 10-12. 

good luck. 

How does dieting work for you?  Do you lose weight with your diets at all or is it living the "lifestyle" of the diet long-term the problem?  Look into your heart of hearts for this answer, for you know better than any doc.  Keep researching and understand how each procedure works against obesity, for we are not all the same.  Some people never find satiety while others have screwed up metabolism that need fixing.

The sleeve is simply restriction.  The stomach is smaller, so you're satisfied with a tiny bit of food.

The RNY has restriction but also malabsorption, which gives you a significant boost metabolically for a couple of years. With that, you'll have to supplement vitamins to make up for what your body is discarding.  The restriction is from a tiny part of the stomach dissected to make a pouch with the intestine attached artificially.

The DS is also a combination of restriction and malabsorption and has the biggest, longest, metabolic punch. We have a sleeve stomach, but our intestines are changed to decrease absorption of fat and calories on a more permanent basis. Patients lose more weight and sustain it longer than any other procedure, but it requires the patient to become an expert on nutrition, for the medical community just doesn't get us.  We, however do share with each other - so we're years ahead of the medical community for our long-term needs.  I consider it the best of both worlds, but it requires the most work to keep healthy.  Over time, for me it has become second-nature, though, and not a big deal at all.

WLS is not one-size-fits-all, so again....look to yourself and your own physiology instead of convenience and fear factors.  The goal is to only need one surgery.

First, consider carefully whether you are willing to take a significant number of vitamin supplements -- three to four times a day, every day, for the rest of your life --and have regular, comprehensive lab work (once a year after things really stabilize in the first two years, but more frequently if you are having trouble keeping certain levels up) for the rest of your life. If not, cross RNY and DS off the list.  If the people you know who have had RNY and don't take their supplements say they are still healthy, ask them how recently they have had labs drawn.  Many who don't take their supplements also don't get lab work and don't know what is happening in their body.

Second, consider whether you are willing to trade about 18 months of caloric malabsorption for a lifetime of vitamin malabsorption and not being able to take NSAIDs for pain (which means taking only Tylenol or prescription painkillers)  If not, cross off RNY.

Someone else mentioned that the sleeve is permanent (which is true since they remove the rest of your stomach..l and if you really are uncomfortable with losing all but that very small portion of up your stomach, cross of VSG). For practical purposes, though, the RNY is also permanent. "Taking down" a RNY is a much more complicated procedure than doing one in the first place, not many surgeons have any expertise in doing it, and the result may not return you to the way you were before surgery... So you should consider the RNY to be permanent, too.

If you are counting on dumping to keep you away from eating sweets after a RNY, we'll, DON'T.  Only about 30% of RNYers dump, so chances are that you won't be one of them.  Be aware that RNYers are more prone to kidney stones and can develop reactive hypoglycemia (or, less commonly, regular hypoglycemia). Someone who already has hypoglycemia may find it worsens. 

Both surgeries require that you change your eating habits if you want to be successful long term. Studies show that weight loss is a bit slower with VSG than RNY, but that by 2 years out, the amount of weight lost is about the same, and that after 5 years out, how much you have changed your eating habits matters far more than which surgery you had.

I had a RNY almost 8 years ago when VSG wasn't an option.  I have been successful with it, and don't regret having done it at all, but I have endured several of the long-term complications/side-effects of RNY (kidney stones, hypoglycemia, bone loss from lack of calcium absorption despite taking my supplements) and if I wee making the decision now, would opt for VSG instead.

Lora

Well written!

Thanks everyone for your feed back, I really appreciate it. I will be doing more research for sure. And I look forward to talking to my surgeon to see what he would recommend.  In the end I know it will be my decision and I plan on working my hardest with which ever plan I decide to choose. Thanks again everyone.