RNY or VSG

I thought I had my mind made up when I went and met with my surgeon two days ago. They sent in for pre-approval and said I wouldn't have to make my mind up until my final meeting with him.

I was dead set on the VSG. My doctor informed me that he prefers the RNY. He said with the VSG you can get acid reflex and you don't feel as full as fast as with the RNY.

I've heard with the RNY you can get malabsorption and this worries me a little bit. Also, with the RNY I would lose weight quicker which I'm worried that I will have more lose skin than I would if i lost a little bit slower if I had the VSG.

My history:

I'm a female 35 (36 when I would actually get the surgery done)

5'6

265ish pounds (goal would be around the 145-160)

I've had two kids via c-section- No more kids will come out of this body ;p

No history of acid reflex.

He said with the VSG you can get acid reflux - This is true!

You don't feel as full as fast as with the RNY - This is not true!

With the RNY you can get malabsorption - Malabsorption is a component of RNY, so it's not "can" but "do."

With the RNY I would lose weight quicker - This is not true!

I will have more loose skin than I would if I lost a little bit slower - This is not true! Loose skin is not affected by how quickly or slowly you lose the weight. If you're going to have loose skin, you're going to have it.

Do you have a history of diabetes? If you don't have a history of diabetes or reflux, then going for the VSG seems sound. But understanding the differences between the surgeries is also a good idea because you have some misconceptions!

I don't have a history of diabetes. I've been boarder line a couple years back but nothing was done about it.

I agree I do have misconceptions which is why I'm here. I've been doing research on both and it's all so overwhelming at times. I have 120 days from being approved (i was told my insurance company takes about a week to approve). While that seems like a long time it's not. Maybe I'm pressuring myself too much and I should slow down.

With the RNY, malabsorption is a feature, not a bug. It's not permanent, it usually goes away after about a year.

While RNY patients lose more quickly at first, the statistics for overall loss are very similar. They're both good tools, and you can reach your goal as long as you follow medical guidelines for eating and exercise.

Just about everybody has loose skin, and the rate at which you lose weight has pretty much ZERO impact on your outcome in that regard. We grow extra skin to cover our fat, and when that fat goes away-- no matter how quickly or slowly-- the skin will be loose.

I sure wish I'd had both a VSG AND an RnY so I could tell you from personal experience which I thought was best. But I've only had the VSG.

I started at 235 pounds (well, 235.6, but who's counting?). I've lost 100 pounds and maintained that for over 1.5 years now.

So far, I'm a very satisfied VSG person.

I did have acid reflux pre-op and took antacid Rx meds. And I still have acid reflux if I eat pizza, chocolate, and red wine for dinner. I still take antacid Rx meds and manage it that way.

IMHO, the speed with which you lose weight is entirely irrelevant to anything -- it's how well the WLS you choose helps you improve your pre-op health issues and maintain your healthy weight long-term that matters.

I think you're wise to invite opinions here. I think the info offered above by others is quite sound. But I'm a little bothered by the black/white/generalist and maybe a bit misleading information provided by your surgeon. Maybe she/he just isn't into nuance? Maybe she/he just is more comfortable doing RnY surgery? I'd pull on that thread a little harder, if I were you.

loose skin, is a pain in the butt. Then again having a few rolls disappear I trade it for all over again. After the first couple of years the malabsorption calms down as long as you eat right. I still get it from time to time but teaching an old dog a new trick after 50 years of doing the same thing sometimes just ain't easy. Make the decision that you feel comfortable with, not what everybody thinks is best for you.

The main benefit of the RNY and DS is not the malabsorption, I'd argue. Bear in mind I almost became an evil biochemist.

The main benefit is that, for reasons we do not completely understand, the enteroendocrine cells of the intestines are altered with intestinal bypasses to a significant degree. This is permanent, and does not occur to the same extent with the VSG. People who get their bowels re-sectioned for non-WLS purposes also have the same "bonus."

Enteroendocrine cells line certain areas of your intestines, and make cute little peptides (seriously peptides are adorable) called incretins (like GLP-1 for example) that can change insulin resistance and have other metabolic effects. The biggest benefit to the RNY is that these cells "reboot" basically, reversing any insulin resistance you have. I'd argue that this is the main reason for the faster RNY initial weight loss rather than the malabsorption, which is minimal.

As for why this is a big deal: the main mechanism by which fat is stored is insulin, and obesity is a disease, ultimately, of hormones not being regulated correctly. The sleeve also helps to a large degree, however the mechanisms it uses are different.

The thing is, either surgery will result in success. You can also change/alter insulin resistance with diet, actually. It just takes longer. Either surgery will have profound metabolic effects.

However, either surgery will result in failure if you do not eat correctly, too. Your habits are far more important than what surgery you choose, especially at the lower BMI you have. I've spoken to DS patients who have gained weight eating crap, even.

Great post!

"Your habits are far more important than what surgery you choose ...."

Hear, hear!

I had this same dilemma too. I spent the 6 months of doctors visits and meeting insurance requirements researching VSG vs RNY. Stalking the WLS forums. Endlessly reading PubMed articles. I met with 2 different surgeons I consulted, and I knew which surgery I wanted. I kept going back and forth, but ultimately, it came down to this: I couldn't ignore what my gut told me was the right choice for ME. You have that same voice telling you what the right choice is, and I believe you already know what you should do. My best advice is this - make YOUR decision (after all, it's not the surgeon's, or your husband's, or your mom's, or your friend's, but YOURS). And do not look back. Be confident in what you choose.

I followed what my instinct told me, and I'm extremely grateful for it, because I'm coming up on 3 months out, and I still believe 100% I did what was best for myself (in my case RNY).

Good luck!!

Great answer!