Roux vs Sleeve

Ok ... I'm glad I live in my house then, with all sorts of drugs and food that I dont personally take or eat.

And... their even newer recommendations is to listen to your doctor:

Q: Which medications should I avoid after weight loss surgery?
A: Your surgeon or bariatric physician can offer guidance on this topic. One clear class of medications to avoid after Roux-en-Y gastric bypass is the "Non-steroidal anti-inflammatory drugs" (NSAIDs), which can cause ulcers or stomach irritation in anyone but are especially linked to a kind of ulcer called "marginal ulcer" after gastric bypass. Marginal ulcers can bleed or perforate. Usually they are not fatal, but they can cause a lot of months or years of misery, and are a common cause of re-operation, and even (rarely) reversal of gastric bypass.

Some surgeons advise limiting the use of NSAIDs after sleeve gastrectomy and adjustable gastric banding as well. Corticosteroids (such as prednisone) can also cause ulcers and poor healing but may be necessary in some situations...

https://asmbs.org/patients/life-after-bariatric-surgery

In short, avoid NSAIDS if you have an RNY, but otherwise follow your doctor's advice.

Those are a lot of the reasons that I lean towards the sleeve. I like the idea of having malabsorption when it comes to absorbing less calories but it scares me a bit to not be absorbing the vitamins and minerals. I worry about osteoporosis when I get older.

Thanks so much for your response! I value the opinions of all of you who have taken the time to respond to me and I really appreciate it!

I don't believe anybody's mentioned this on the thread so far, but ASMBS recommendations for vitamin supplementation after WLS is pretty much identical for RNY and VSG. So in some ways, concerns about vitamin malabsorption is not completely relevant; no matter what surgery you have, you'll need to take a multi, as well as additional iron and calcium, for life. :)

Thanks for that Sparklekitty! Good to know!

Their recommendations used to be identical, as that is what many surgeons did as they were learning the sleeve, but they have caught up now with what the more long time VSG/DS surgeons had been doing for the past 8-10 years:

Q: Which vitamin and mineral supplements should I expect to take after weight-loss surgery?
A: Multivitamin, calcium with vitamin D, and in some cases, additional iron and/or vitamin B12 supplement. Sometimes additional fat-soluble vitamins (A, D, E, and K)are added to the regimen depending on the operation?s degree of vitamin malabsorption. A chewable form is recommended, at least initially after surgery.

The general case for all is the multi, calcium and D, as we (all of us in the WLS world) tend not to be able to eat enough to get enough of those nutrients, at least for a while. The "additional iron and B12" refers to the RNY as it malabsorbs those nutrients. The "Sometimes additional fat soluble..." refers to the DS which malabsorbs fats.Your surgeon will recommend some variation of this, depending upon how much experience he has doing sleeves, as most just combine requirements at the start until they get comfortable with the new procedure and the differences between them. The most important thing is how things shake out over time as your ongoing lab results will dictate what supplements you need, both as a result of your WLS, normal aging, and dietary habits but generally those with a VSG will need to supplement less over time than those with a bypass or a DS.

This piece offers a pretty good, current review of the different procedures and their relative plusses and minuses:

https://asmbs.org/patients/bariatric-surgery-procedures

Your concerns about the malabsorption and long term effects are well reasoned, as the bypass does have more limitations and quirks about it than the VSG. The main predisposition of the VSG is towards reflux. The bypass is predisposed towards marginal ulcers (hence the NSAID issue with it), dumping, reactive hypoglycemia and to some extent, bile reflux (though that seems to be pretty uncommon now as most have figured out how to minimize that with technique.) Some see the dumping and RH as advantages (as in "it's not a bug, but a "feature") in that they provide a form of aversion therapy to keep patients away from some of the junkier foods, but they are also limitations in nutrient intake, limiting the variety of foods that can be tolerated if they afflict you.

The malabsorption is a double edged sword of sorts, as the caloric malabsorption of the bypass is temporary, dissipating after a year or two, so it provides a bit of an extra edge while losing but no real advantage in maintaining over the long term. Nutritional malabsorption is a long term affair, so that will always need to be addressed for life. (The DS, in contrast, has long term caloric malabsorption , which is why it has better regain resistance than any of the other mainstream procedures.)

Another difference to consider is that the sleeve, while being non-reversible, is fairly easily revised to something else if needed - either the RNY or DS can be easily done as a "plan B" while the bypass is something of a dead end procedure, being very difficult to revise, so if it doesn't really work for one in getting satisfactory weight loss, experiencing excessive regain or re-emergence of diabetes, it is difficult to revise it to something more effective (there are only a half dozen or so surgeons around North America capable of doing an RNY/DS revision.) Reversals are possible, but rarely done unless there are significant problems that can't be addressed otherwise - I have seen a couple going through that in the past few weeks due to intransigent ulcers.

Another consideration, particularly in Canada, is the experience factor (as Canadian bariatrics is running some five years behind the US in sleeve adoption and experience) as while the VSG is a more straightforward procedure, it is not without its' quirks and subtleties that comes to the surgeon with only with practice. Some percentage of the sleeve revisions that we have seen are due to this factor - either issues from the original surgery ("twenty years of doing bypasses and they think they know how to do a sleeve", to paraphrase one prominent surgeon) or from not knowing how to surgically correct a faulty sleeve (many prefer to stick within their comfort zone and revise to a bypass rather than repair it, which can involve different skills that they may not have developed yet.) So, having a surgeon who is well practiced on the desired procedure is important. It is good to see that your surgeon is recommending the VSG for you, as that shows a reasonable comfort level with it (and hopefully not just an eagerness to practice on you!) but this is a legitimate line of questioning while making a procedure and surgeon decision.

Overall, the RNY is a good, mature technology that is well known and practiced in the industry and does a good job despite its' well known limitations. It is not a bad place to go if one is not suited to the VSG. The VSG offers very similar performance on weight loss and longer term weight maintenance at a somewhat lower cost in limitations and more flexibility in the "plan B" department.

Wow this is awesome information - thank you so much for providing it! Yes, my surgeon has been doing both sleeves and RNY for years I believe. He said that up until recently there hasn't been enough years of statistics on the sleeve to know things for certain but now there has been enough history on it that he's comfortable stating that he has seen equal success with less complications. I am definitely steering more towards his suggestion after having looked at the pros and cons that all of the wonderful people on this forum have provided me.

JANNIE - You CAN -and SHOULD- ask for the "numbers"...how many, of each type surgery the doctor has done. What's his mortality rate? Obese folks have health problems, to begin with, and NOT saying any deaths have to be directly SURGERY related, but, it's still good info to have

I know all these responses, and the back and forth stuff can be rather overwhelming, especially to a newbie. Obviously some people want to ring the bell, for their "own" surgery type. Human nature. Only you, and your surgeon, can decide, for YOU!

For ME, it was band or RNY, and insurance would only pay for RNY, so THAT made the choice, for ME. Back in 2002, I had never heard of VSG. I'll be 17 years out, next month. I'm under goal, am now 61 years old/no complications/no regrets...BUT...I follow the rules most of the time :)

Something to consider, that I don't think I have seen anyone ask: Do you have any history of arthritis, or any condition you might need long term NSAID/Steroid therapy for, in the future? That is my only real "drawback", now. I have to work around the treatment I need for my knee injury I got while running a half marathon...BUT...I never could have BEEN running, without losing weight...It's trade off!!!

Follow your heart. You will make the right decision

Hi Gina! Thank you so much for your kind advice and information. Part of the reason I was a little nervous about RNY is because although I don't yet have any arthritis pain, my mother is riddled with it. I was concerned if I followed in her footsteps that I wouldn't be able to take an anti-inflammatories for it. And chances are with being obese off and on for 47 years, I have arthritis brewing.

I did ask the surgeon for mortality rates and he said he has only seen 1 and it wasn't someone he did the original surgery on - this person had surgery in Mexico. He was quick to say that it wasn't because the person had surgery in Mexico that they died but they had a lot of other issues besides the surgery.

So many things to consider! Thanks for your thoughts and advice! :)

JANNIE - FYI - You will find Sparkle Kitty is a fount of factual information, and is our "go to" for "bringing the SCIENCE". She can always provide links to her sources, and I am grateful, for her ongoing, up to date research/knowledge.