RNY or VSG dilemma

I am still pre-op but have been looking forward to getting this surgery for about 18 months now. If all goes according to schedule, I may be able to have it done as soon as July. Here's the rub:

I had been planning to have RNY. I'm not diabetic but my BMI fluctuates between 59 - 62. My hope is to lose about 200 pounds. I have pervasive osteoarthritis and one knee in particular that is in desperate need of replacement. My knee is extremely painful and my ability to walk is severely limited.

Last week I went for my consult with the bariatric surgery. He immediately shot down my desire to have RNY and stated he would prefer I'd have VSG. He dismissed malabsorption as a non-factor in weight loss and after a few minutes at an impasse, he grudgingly agreed to RNY, pending results of an endoscopy.

Since that day, I have been torn up by indecision. I do believe that VSG is a safer procedure but I live in fear that it isn't enough and I will end up never achieving that healthier weight I need. On the other hand, VSG might also allow me a few more options for pain management than the RNY will, and until I get my BMI low enough to have this knee replaced, I need that pain management.

I feel like I am running out of time to make this decision - and also feel as if no matter what I choose, it'll be wrong. Any suggestions?

First, congratulations on getting prepared for surgery. As for which one, they are both great. However, I'm not sure what your concerns are about pain management. If you mean no NSAIDs after surgery, that is the current recommendation for BOTH surgeries. I had VSG and my surgeon even had me put NO NSAIDS on my med alert bracelet.

The surgical "risk" is about the same as well.

The thing is with both surgeries, the way you handle eating post-surgery is the key. You do have the malabsorption for the first couple of years with RNY, but I understand that does go away over time. So to be successful in the long term with either surgery, you have to permanently change the way you eat.

One big factor is GERD...if you suffer from it now, then get the RNY. Many people who have the VSG develop GERD after and end up with revisions. Personally, I didn't have it before and don't have it now, so I'm blissfully happy with my VSG.

Best of luck on your surgery, whichever one you choose!

I think many surgeons in the states are now migrating to VSG because it is faster and easier to do, in Ontario the preferred surgery is still the RNY and you really have to fight to get the VSG, because I'm diabetic and already had GERD the RNY was the only option. Just over 2 months out and I don't regret a thing, weight is coming off and overall health is a lot better, I've also got arthritis but have been managing pain with regular tylenol and T1's and T3's.

The big issue is how likely are you going to be able to maintain the vitamin and supplement intake that is essential with the RNY.

Did the surgeon give you real reasons for his desire to do the VSG? The malabsorption with the RNY is real and a big help in the first year to 18 months but it still comes down to what you eat.

I take issue with your surgeon dismissing malabsorption as a non-factor in weight loss. It is proven that the combination of restriction and malabsorption does help with weight loss, but more importantly malabsorption plays a key role with keeping the weight off long term. The sleeve is a good surgery but so is the RNY. It doesn't matter what I think. My personal experience was a BMI in the high 50's. Obese my entire adult life (had surgery when I was 45). I chose the DS. I lost 175 pounds in about 15 months (I obsessively followed the DS diet requirements to the letter and exercising as soon as I could). I've maintained that weight loss for 15 years. I have some deficiencies I've had to deal with over the years (primarily anemia and calcium) but I wouldn't trade that for anything. I don't diet at all - as long as I focus on protein, take all my vitamins, and drink plenty of water. But the DS is definitely not for everyone.

There is no wrong or right answer. You're the one having the surgery and you should have the surgery that you feel is best for YOU not him.

>> ...malabsorption plays a key role with keeping the weight off long term.

I'm inclined to disagree. Malabsorption is NOT permanent, and often lasts only a few years.

We agree to disagree. I know for a fact that I still malabsorb and I'm 15 years post-op from my DS. Maybe the malabsorption from the RNY (depending on whether it was proximal or distal) only lasts a few years.

There are new guidelines saying that both VSG and RNY patients should stay away from NSAID medications, so that has really become a non-issue.

Both VSG and RNY have similar success rates and average amounts of weight loss. VSG patients may take a bit longer to get to goal, but the long-term stats seem to be the same.

While VSG is a less complicated procedure, RNY has been around longer and many surgeons are more familiar/comfortable with the surgery.

The bottom line is that this is your body and your choice. Your surgeon is there to guide you, but this should ultimately be your decision. If you want the RNY, then go for it!