Gastric Bypass vs. Vertical Sleeve Gastrectomy: How did you choose?

I had my bariatric surgery consultation on May 25th. At the time I went in, I was pretty settled on the sleeve gastrectomy surgery. To my surprise, the consulting physician said he actually recommended the RNY Gastric bypass surgery for me instead.

To be honest, with the rise in popularity and success I have seen with the VSG, I didn't even consider the bypass. Everyone raves that you do not deal with as many risks and such afterwards.

He stated that the reason he recommended it was because of exactly how much weight I need to lose (160lbs) coupled with my history of big losses along with big gains. He said that in the long term, RNY patients gain less weight back.

For reference, I am 5'0 tall and was 334 at the time of consult.

He made it clear that it WAS my choice; and I would be successful in both, but if I am thinking long term and coupling with my history, it was his recommendation for the bypass.

I am looking for others who went through this kind of decision making process. How did you finally decide? What made that final decision easiest for you?

1) I had GERD. Bypass is usually recommended for people with GERD since it often (but not always) improves if not cures it. Sleeve often (but not always) can make it worse.

2) at the time I had surgery, I think sleeve was still fairly new. Or at least new-ish as a stand-alone surgery (it's been around as stage 1 of the DS for awhile). I wanted the older, more heavily researched surgery. There was A LOT more long-term data on it. However, the sleeve has been around for awhile now, so this might not be an issue anymore.

3) I also had a lot of weight to lose (over 200 lbs), and I wanted the malabsorption. I wasn't sure I could do it with restriction alone.

VSG has fewer immediate risks, but doctors are now seeing a higher incidence of GERD developing in patients after the surgery is complete. There are lots of folks on here (myself including) facing revision to RNY because of the GERD and its long term consequences.

A few things to consider in your decision:

• If you have diabetes, definitely do RNY. It has much better rates of quick remission for diabetes.
• If you have any history of GERD, stay away from VSG.
• If you need to take NSAIDs, VSG is probably the better choice, though doctors are also recommending that sleeve patients stay away from NSAIDs as well.
• You can be successful with both surgeries; your chance of success is entirely in your hands. There are people who have reached goal and maintained successfully with both surgeries.

I think you meant to say if you have any history of GERD, stay away from VSG.

RNY actually has cured GERD in many people, myself included.

Yes! Thanks for catching that, I'll go back and edit.

My surgeon says he deals mostly in complications and he just doesn't see as many (or any) from VSG. He said a lot of people don't have complications with RNY either but out of the two surgeries he seems more complications from RNY. He also said exactly what the previous posters have said, that they didn't do a lot of VSG before because there wasn't enough history but now there is many years of history and he is seeing people be just as successful without the complications or malabsorption of vitamins. That being said he made it clear to me that there are some people that are clearly suited for one of the two and if you are one of those people he will tell you and why just like your surgeon told you. I was determined I was going for RNY but after speaking to him I am scheduled now for VSG only because it's a slightly less complicated surgery. I may kick myself if I end up with GERD but I also may kick myself if I go RNY and then end up with severe arthritis like my mom and not be able to take anti-inflammatories. I think whatever decision you make is the right one!! Good luck!

Complications from RNY are very slightly higher immediately after surgery. Very slightly. Gallbladder and apoendix removals have complication rates a little jigher ygan RNY.

But as time goes by, complications from VSG are much, much higher. If I had a nickel for every person who had to revise from VSG to RNY for gerd, I'd be pretty rich.

At one point 5 or 6 years ago, it looked like the future would be all VSG. now, I wouldn't recommend it to anyone I knew. The odds that they will have to have another surgery and end up with RNY are just much too high. Any perceived benefits are just not worth it.

As far as vitamin deficiencies, anyone who stays on top of it doesn't have a problem. It's only those who ignore proposer supplements who run into problems. But that happens a lot with VSG too.

Something else to consider - some doctors prefer performing VSG surgery because it is an easier and faster surgery for them to do compared to RNY; it requires less skill on their part. They'd rather get the surgery done quickly, make their money and move on, which influences which surgery they recommend/market to patients.

Do your homework and fully research your surgeon's capability before moving forward, and get a second (or third) opinion as well.

Yes, very much so. The doctor's hourly wage turns out much higher for VSG.

So much this!!!