HELP - VSG or RNY...

I am sure this topic has been beat to death.

I am meeting my surgeon soon and I have to make a decision.

When I first started this journey, my mind was set on VSG, I rely on medications and I feel that this is best for me. I have since attended all appointments and classes and learned about RNY and I am not opposed to it as much as I was, however the malabsorption is really what concerns me. In Canada, RNY is the "gold standard" - your surgeon chooses for you what surgery you get, and that is the first choice. If you request a VSG - it has to be medically necessary. I have outlined reasons as to why I think the VSG is for me...but now I am having seconds thoughts...I should also mention that I am a lap band revision....

ANY advice is welcome. This is not intended to start a debate as to which procedure is more superior, I just am getting confused as the countdown continues...

Thank you :)

I have auto-immune rheumatoid disease and had to be able to take NSAIDs and steroids when needed. So the VSG was the best surgery from that POV. However, I had a history of slight reflux, which VSG can make worse. My team and I had to weigh all the pros and cons, and decided that we'd take a chance with the reflux, since mine was always controllable with a small dose of PPI or antacids and was most likely related to obesity. It was more important that we have the most treatment options available for my auto-immune. NSAIDs and steroids are what's called "relative contraindicated" in VSG, but are an "absolute contraindication" in RNY. The benefits outweigh the risks for me to take NSAIDs and steroids when needed, so long as I stay on PPIs. So that's one aspect your team may need to look at. I'm about 7.5 months out from surgery at this point, and just passed 90# lost. I'd have lost a little more, a little faster, if I could do ultra-low-carb, but my body doesn't tolerate it.

Ultimately, you and your medical team need to look at your specific situation and weigh all the factors. Both surgeries are good, but in some situations one is better for a given patient than the other.

I had the sleeve in 2011...Then in 2015 started having acid reflux. Not the usual symptoms.Then in Jan 2016 i developed a really bad cough and hoarseness.Went to Ear,Nose,Throat Dr. severe reflux. Tried different things ,then decided to go back to weight loss Dr,because they have a GI Dr connected to their office.Did upper GI and endoscope.This was to check for damage and also my swallowing.He then tried different meds and it never got better.I had revision Nov. 2016.No more reflux. Also protecting my esophagus from more damage. My hiatal hernia had also failed from the sleeve surgery.They fixed that again with the revision surgery.

I don't have an auto immune disease but I do have arthritis . I take Tylenol and use ice for pain.If that doesn't work I get a cortisone shot.

Hope this helps.

I chose RNY over VSG, even with Rheumatoid Arthritis (that is pretty severe). I had a lady tell me about the continued GERD after VSG and having to revise to RNY.

I was concerned about the RNY/NSAID contraindications, etc. I spoke with the rheumatologist about my concerns, and he told me that we didn't have to use NSAIDs in particular.

It's all going to come down to your personal preference. I was reassured by the rheumatologist, and I didn't want to go under the knife again for a revision due to GERD, so I chose RNY.

I take medications for bipolar, and was worried about absorption, so I opted for the VSG. Sure, RNY is the gold standard, but it's not worth risking my mental health for!

I've been very successful with my sleeve, and I've also had no issues with my psych meds. I don't regret my decision at all.

I wish the surgical community would stop using the phrase 'gold standard' to refer to RNY. It gives the impression the VSG isn't quite as good, which isn't true.

I have an RNY because that is what I and my surgeon decided would be best for me. If I thought the VSG would have served me better, I would have had that. I had GERD that was increasingly worse as time went on, so VSG wasn't a good choice for me.

There are people here fantastically successful with both surgeries. What does your surgeon say regarding your reasons?

I am still waiting to "meet" him - he actually did my band, but has since stopped doing bands. I am hoping he can guide me in the right direction. If he thinks one is better for me and my cir****tances then I would go with that - but I want the cir****tances to matter. I feel like the decision is made here without consideration of anything or what the patient might see best for them.

Ah, I see. I am not certain how long your initial appointment will be, but perhaps if you type out your reasons for leaning toward VSG it will be easier? I know sometimes consultations are rushed or don't progress in an orderly fashion.

I'm also a band revision and I'm in the process of healing from the removal so I can move on to the RNY in 3-6 months.

At first I wanted the VSG - I went in mainly interested in that because it seemed the less...extreme, of the two options. However... my surgeon told me that for band patients the VSG isn't as ideal because of where they need to cut/staple and the state of that particular area of the stomach after years of the band sitting/rubbing/moving is weaker than it needs to be, which can lead to problems down the road with leaking etc.

This made sense to me and I'm opting for the RNY. My surgeon's recommendation was really what clinched it for me, I trust that she knows her stuff.

It's also worthwhile to prepare yourself for the possibility of two surgeries (if you haven't already).

I had no issues with erosion (just the wicked GERD) - but I was warned ahead of time that they wouldn't know whether or not it could be an all-in-one removal-to-RNY until they got in there and could see.

Turns out I had quite a bit of scar tissue and it took my surgeon two hours to wrestle the band and port out...and after all that cutting and tugging she decided to give me time to heal up so that when she makes my staple-line for the RNY it will be in better shape and less likely to have problems. It means I have to wait, but I'm glad we took a safer route that will be better for me in the long-run.

Good luck to you!

That is a concern of mine. There are only a few surgeons in the province who will remove my band and perform the revision in one surgery. So far the individuals I have spoke with have had success with one surgery. I am going back to the doctor who placed my band (he no longer does bands - but does revisions)