RNY or VSG

Hello!  This is my first post on here!  I have enjoyed reading the lively discusions here!  Differing opinions never hurt anybody in my experience.  I am finished with all preop and ins green light for surgery and then I'm told by my case manager at my surgeons that my antidepressant meds which are very important may very well not dissolve in my pouch even after crushing them due to almost zero stomach acid after RNY gastric bypass surgery.  I am confused and discouraged because now she is recommending the VSG surgery instead.  I am 52 and 5' 4" and I weigh 294, I m also insulin dependent  type 2 diabetic with high blood pressure controlled by meds.  They did an upper GI scope because I had a bleeding ulcer 5 years ago and no new scarring or signs of GERD so was given green light on that.  I had a bad accident 8 years ago and I crushed 5 discs in my back and neck.  I went from being 45  yrs old and 130 pds to almost 300 pds 8 years later.  I have to walk with a cane and only can exercise by swimming ( I used to be a lifeguard and avid snorkle head). Lol  I told you all that info to ask this question; with very hard to move much except mild swimming at the Y 3 times a week I feel I must have the mal absorptive surgery of bypass to lose the weight and for my diabetes to be the same as gone but for absorption of some crucial meds which 1 does not come in a liq or sublingual form I'm thinking I must have the VSG?!   I have only one shot at this tthru Medicare and I very much want to make the right choice.  Anyone who sees my post please feel free to respond!  I am open to any and all tips especially re: absorption of meds after gastric bypas.   Thank u so much! my name is mary, I signed up as fishfreakmary as my friends used to tease me over my extensive sal****er aquarium habit!  Oh how I miss my tanks!  God Bless!  

All of the studies that I have seen indicate that DSers lose and maintain their weight loss the best because of the huge malabsorption component, and that RNYers lose a bit more quickly than VSGers and lose a bit more, but that after about 5 years (the actual study timeframes vary a bit), the type of surgery doesn't determine successful weight maintenance... The change in eating habits does. 

I am very confused by your surgeon saying that the sleeve is more easily stretched.  I have seen NOTHING in any of the medical literature to support that.  On the contrary, the most likely thing to stretch in any of the procedures is the RNY artificial stoma, which replaces the body's natural pyloric valve (which DSers and VSGers keep). If that happens  -- from repeated overeating or, allegedly (I have not seen any medical literature supporting this), from drinking with meals and "forcing" food through the stoma) -- you end up with your pouch essentially just connected into the intestine, which makes it much easier to overeat.  There have been several procedures (Rose procedure, Stomaphyx, etc.) that attempt to tighten a stretched stoma, but they all have pretty dismal success statistics and most insurance companies won't cover the cost.

It is entirely possible for you to lose all of the weight you need to lose without malabsorption.  Your reflux is a very important consideration when making your decision for surgery, though, because it can become much worse with VSG, but there are serious considerations with RNY, too.

You mentioned general malabsorption of meds after RNY, but I want to be sure that you understand that most medications are designed to dissolve in the intestine and their absorption is not significantly reduced after RNY. The problem drugs are generally the extended/slow/controlled release meds that may not get fully absorbed because of their design and the shortness of our intestine and a few that are designed to be broken down in the stomach (which does not happen properly since they don't stay in our pouch long enough AND because our pouch doesn't have the amount of stomach "juices" that the natural stomach has. Then there is the prohibition on NSAIDs.  Many surgeons also restrict them with the sleeve, but it doesn't pose the extra problem of potential ulcers in the blind stomach that it does with the RNY.

Good luck on your decision.  If you use the search function (little magnifying glass towards the top of the page), you will find MANY discussions of RNY vs VSG that may be helpful.

Lora

****rogirl the PH D version

hello!  I found you response to be the best info for what I am searching for yet!  I am on a slow release med for diabetic nerve damage ( neuropathy) and I need to research my other few meds to see if they require stomach acid to properly break them down.  If so then this would make more sense as to why the MA at my surgeons office is leaning harder towards the VSG.  I happen to know she herself had the VSG and comes across as someone who thinks weak willed aging disorder people need RNY gastric bypas to force them to lose from the very unpleasant "dumping syndrome". I could be wrong but I sure got that impression.  Any hoo thank u so much for that info that gives me a starting place to reasearch.  Have a blessed day.  I am about 5 weeks preop with all my pre op tests completed.   

As an RN, if you end up taking medication in the future, the doctor should continue monitoring the medications. Because if it is not working, they adjust the dose. So, I am unsure how the surgery can affect absorption of medications, but good Healthcare involves monitoring the efficacy of whatever dose you are on.

As someone who has had RNY, I have had no issues with medications and it's been 13 years.

As you are an RN i would like to list my meds and I know this is just a lay men's forum, but everyone  from my GP doc to my pharm to even my surgeon seem woefully vague or just flat unsure how my meds will do after gastric bypass surgery.   I am on clonazepam which I believe is a slow time release as well as buspirone which Wud have to be crushed and mirtazapine for depression/ panic attacks and neurontin for diabetic neuropathy.  Also 2 Prevacid a day for 5 years to prevent any new ulcers.  My upper GI was excellent, no GERD or new erosions or ulcers.   After 5 months of prep and 5 weeks from my surgey my case manager said I should consider the VSG instead.  I am disabled from an accident and have a lot of chronic pain so exercise will consist of how much I can swim ( the water takes the weight off of my bone on bone vert where the discs where crushed.  I am afraid without the bypass to force malabsorption I won't be able to exercise enough to lose the weight but if I'm nutso with out my psych meds than skinny won't do me much good!  Lol!  Well if you have the time to reply that would be awesome!  Thank u so much!  

OP, as someone that's been through two lap-band surgeries (original in 2007 replaced in 2011 due to a massive slip) and is currently researching revision/conversion options, I would like to warn you to be careful about putting too much faith in "projected outcomes."  When I had my first lap-band surgery, it was still fairly new to the U.S. market, and all the literature was stating that while initial loss was slower, the projected long-term outcome of the surgery had overall loss being as good as or better than RNY.    Eight years later, we know differently.

Do your research, but be careful about how much stock you put into statistics that aren't fully established.