Am I right to choose vertical sleeve over bypass? Need advice

Well, I got my date today (June 24), so I'm happy about that. I just want to make sure that I'm making the right decision. Basically, I feel most confident about the sleeve. The only reservation I have is that it can trigger acid reflux, which I have from time to time. But my surgeon said that only about 2% of his sleeve patients have had problems with reflux and I've also read where it has made some acid reflux cases better.

I'm not too thrilled about bypass. I don't want my intestines messed with, I worry about the residual stomach not being able to be scoped, and one of my long-term, daily pain medications is extended release, and I'm worried about the malabsorption interfering with the extended release action. However, I'm 317 pounds, and I've read that the bypass is better for people who have large amounts to lose. 

I'm lucky that my insurance will pay for either surgery, and my doctor's office believes in letting the patient decide which surgery to have. So it's basically completely up to me. I think that, for me, the sleeve is the right decision. I guess I just need some encouragement. What do you all think?

It sounds like you've weighed the pros and cons of each surgery very carefully and done your research.  Based on all that, I think you've got to just trust your gut and go with the surgery you're most comfortable with.  

If you end up developing reflux it can be managed with OTC meds or prescription PPIs.  As for losing the amount you want, plenty of people on the VSG forum can tell you their stories of losing hundreds of pounds successfully with VSG. 

You can be successful with any WLS surgery.  It's not the surgery that will get you there, it's your compliance and ability to change your lifestyle.  

Ask yourself this question:  'Is eating less all I need to help lose weight?'  For many people, this is the answer to all of their problems.  For others....notsomuch.  WLS is not one-size-fits-all, so you want to give this some serious thought.

I bring this up because that's what the sleeve will give you.  You will have satiety sooner and not be as hungry.  Have you had significant success with diets in the past?

Now, if you answered 'not really', then you may need more than to simply eat less.  Procedures like the bypass and duodenal switch address the body's metabolism in addition to eating less.  This synergy produces better results, statistically.  Patients lose more initially and keep it off longer than the restriction-only procedures.  Expectation for the sleeve is to maintain 65% of ewl. That's a completly acceptable number for lightweights. Will that be enough for you to consider yourself a success?

Congratulations on your date!  I had severe acid reflux prior to sleeve surgery.  (I was on prescription Prevacid for decades).  Even on medication I would have reflux from time to time, depending on what I ate.  I too went back and forth.  I really wanted the sleeve, but I was concerned about the reflux.  Well I went ahead with the sleeve, and I am on a PPI (prescription Prevacid again) and I have not had any issues at all.  (I will say that fatty foods caused me problems prior to surgery and I am not eating near the amount of fat that I was previously eating).  I am not saying you won't be one of the 2% that suffers, but I just wanted to give you my experience.  (If my surgeon said I couldn't have the sleeve, I would have been happy with RNY, as I wanted the weight off any way I could get it off and there are tons of satisfied RNY success stories as well).  Good luck to you! 

IMO I was considering both and decided to have the vsg since it for the reasons you mention about the rerouting and re plumbing. This has defenitely been a success for me as I made my goal weight in just under 6 months. I am currently in maintenance mode and finding the right combination of protein, carbs, etc to maintain my weight within reasonable limits. 

Both surgeries have advantages/disadvantages.  With either surgery, your ER pain meds may no longer be effective.

I had surgery weighing 392 lbs.  My surgeon gave me the choice of which to have.  I never had heartburn prior to surgery, but I do now.  It's controlled by taking a PPI daily.  

I avoided the possibility of WLS for years because I didn't like the concept of the bypass.  When I heard about the sleeve, I knew it was a better option for me.  Ultimately it's your body, your decision, so go with your gut, as it were  

Thank you all for your input, it's been very helpful.

i didn't realize that the sleeve also affects extended release meds...I need to talk to my doctor about that.

Honestly, I'd love the malabsorption that RNY offers, especially since portion control is not my only problem.

Still, my instincts tell me that the sleeve is best for me, so I'm going to just try and trust that it's the right decision. Thanks again to everyone *****plied, I appreciate it.

Has anyone told you about the Duodenal Switch? The DS has a Sleeved stomach, plus an intestinal bypass that causes permanent malabsorption of a significant per centage of calories. The RNY does not---for most people, so little is bypassed that their body manages to grow enough extra villi to completely overcome the malabsorption of calories by 18-24 months post-op. (The malabsorption of certain vitamins and minerals is permanent with both the RNY and the DS, however.)

Most people can lose tremendous amounts of weight with any WLS---the trick is keeping it off long-term, and that's where the DS really shines. (That permanent malabsorption of calories, y'know. *grin*) The DS is also the surgery with the best stats for resolving or preventing co-morbs like diabetes and high cholesterol.

If I had to choose between the Sleeve and the RNY, I'd go with the Sleeve every time. There's just no justification, stats-wise, for choosing the RNY when you're not really likely to lose a significantly greater amount of weight, but have a greater chance of complications.

I'm 11+ years post-DS, and I'm maintaining a loss of 170 pounds pretty easily.

It sounds like you've weighed the pros and cons of each well. Everyone has a different case to consider. I had my heart set on the sleeve for over 3 years before my surgeon talked me into the RNY because of my diabetes and severe GERD that isn't even well controlled now on a high dose of Prilosec and hasn't gotten any better with the weight I've already lost. Studies are mixed -- some seem to show the sleeve causing GERD; some seem to show it alleviating it. GERD is strongly tied to obesity, so many have GERD issues after surgery that resolve with time as they lose weight.

Interestingly, my husband will have the same surgeon I'll have, who was fully on board with him having the sleeve. My husband is also diabetic and weighs about 420, but he's never had issues with GERD. People can lose impressive amounts of weight with both surgeries. When it comes down to it, WLS gives you a tool that it's up to you to use. Some may be more like spoons and some more like chopsticks; it's just a matter of what balance of risks and outcomes feels right to you. Good luck!