Hello all.... I am trying to decide on what surgery to have .. Either the RNY or bastric band... I am 28 years old and 320 lbs..... is there any one out there that is around my age..... and if so how is the skin situation??? and how much have you lost in how long. My Dr. Thinks RNY is right for me cause of my weight? but i am weighing my options...Literally. So any thoughts from all of you guys who are or have gone thru it? I have to let my dr know by friday so everyone's response is welcome......Thanks and good luck to all of you!

I'm 35.  I am having an RNY in October.  My doctor, surgeon, and I have decided to go for the RNY over the band for several reasons - my surgeon has seen much more success with the RNY.  I think it is a decision that is really personal and one that you really need to think about. 

In terms of skin... I am worried too.  I am 5'10 and have about 100-120 pounds to lose.  My dermatologist says I have "good skin" so I shouldn't have huge problems with sagging skin - whatever that means.  For now, all I am doing is slathering on creams with Q10 in them.  It probably won't make a lick of difference, but just  tiny bit of improvement in elasticity might help...

Jenn

I would research all surgery types - RNY, Band, Sleeve, and DS. I was worried about future complications (I am not close to medical facilities), and long terms success, and chose the DS. The statistics show the DS has the best sustained weight loss. Like the RNY, you MUST take vitamin supplements for life and have labs to keep track of vit levels. I only wanted to be cut open once, so did alot of research. If you have any DS related questions, you can ask me or feel free to come over to the DS board and ask, as there are many well informed folks that are happy to answer questions.
Deanne

Would you please explain to me the difference in the DS, RNY and the VBG? I am in the decision stage and going through the nutritional phase for insurance to approve.

LeaAnn posted the info I was trying to find for you earlier, but I ran across a nice compilation by the lovely Hayley that was succint as well. I'll paste below.

RNY compared to the DS

RNY – expected weight loss

·         50-65% expected excess weight loss (percentage varies in opinion – this is the most commonly seen estimate)

o        Results may vary

·         Regain

o        Possible regain: more prevalent after 2-5 years

o        50-100% regain of weight has been recorded

o        Results may vary

o        Must follow “pouch rules” in an attempt to not regain

DS – expected weight loss

• 85% expected excess weight loss
  • Results may vary
• Regain
  • Studies show little to no regain (20-40 pounds recorded)
  • Results may vary
  • Highest success rate over 10 year study (78% avg. Excess Weight Loss – EWL)

 RNY – have a stoma (stomach made into a pouch – size of an egg)

• Size: 2 oz
  • Stretch to average size of 6 oz in 2 years  (possible to stretch up to 9-10 oz)
  • You can eat more as time goes by
  • Average after 1 year is 1-1.5 cups of food
• No Endoscopes on blind stomach/remnant stomach that is bypassed
  • Doctor evaluation: cannot use an endoscope (to find ulcers and tumors)
  • RYGBP construction makes the large bypassed distal stomach inaccessible to standard non-invasive diagnostic modalities. Neither x-ray contrast studies nor endoscopy can assess this potentially important but hidden area.
• Stoma: pouch
  • Should not take Nonsteroidal Anti-Inflammatory drugs (NSAID).
• NSAIDs are: Advil, Alka Seltzer, Aleve, Anacin, Ascription, Aspirin, Bufferin, Coricidin, Cortisone, Dolobid, Empirin, Excedrin, Feldene, Fiorinol, Ibuprofen, Meclomen, Motrin, Nalfon, Naprosyn, Norgesic, Tolectin, Vanquish
  • NSAIDs are used for arthritis, bursitis, tendonitis, back pain, headaches, and general aches and pains.
  • Taking NSAIDs could develop into a bleeding ulcer and interfere with kidney function.
• Possible Problems
  • Ulcers (Some doctors recommend taking prilosec for 6 months to 1/2 years in an attempt to prevent the ulcers)
  • Possibility of a staple line failure
  • Noncompliance: simply do not lose enough (even with following the rules)
  • Vitamin Deficiencies
  • Narrowing/blockage of the stoma
  • Vomiting if food is not properly chewed or if food is eaten to quickly
  • Dumping syndrome, NIPHS, Hypoglycemia
    • No Valve (pyloric valve that opens and closes to let food enter intestines is bypassed) which means food empties directly into the small intestines and causes dumping and/or can cause NIPHS or Hypoglycemia
• Dumping: food (most commonly sugar but not necessarily “just” sugar) enters/dumps directly into small intestines and causes physical pain (some people believe this pain enforces good eating habits)
  • Dumping varies in degree of occurrence and discomfort
  • Dumping symptoms:
    • Nausea
    • Vomiting
    • Bloated stomach
    • Diarrhea
    • Excessive sweating
    • Increased bowel sounds
    • Dizziness
    • “Emotional” reactions
• NIPHS (insulin over production): “the body overproduces insulin in response to food entering the intestines at a point where food would normally be more digested already - this part of the intestine is not used to coping with metabolizing glucose in the condition it arrives after RNY, and it is suspected that the intestine signals the pancreas for more insulin to aid digestion, causing a MASSIVE overproduction.  The change occurs on a cellular level, hard to diagnose.  Treatment: Removal of half the pancreas.”
  • RNY stoma that is created allows food to go straight through the stomach into the small intestine unrestricted so it does not control the flow.  Because of that the body reads that it needs more insulin because the food is moving through so quickly and it thinks there's going to be a lot more food.  With the DS, the normal peristalsis works because the pyloric valve is in place and can control the movement of food into the small intestines.  
  • NIPHS, Hypoglycemia is deadly if not corrected

 DS – whole stomach (size of banana)

• “Whole working stomach” - meaning the stomach’s outer curvature is removed as opposed to making a pouch/stoma.
  • Part of the stomach removed is where most of the hormone called Grehlin is produced.
  • Grehlin gives the sensation of hunger so by removing most of that section of the stomach a DSer is not as hungry as before.
• Whole working stomach: no blind stomach.  Endoscope can be used.
• Can take NSAIDs
• Do not need to take Prilosec to prevent ulcers.
• Valves are in tack: no Dumping Syndrome or NIPHS

 RNY – Eating

• Eat protein first
  • 60g of protein a day
• Recommended to chew food to liquid consistency (pureed, soft, thoroughly chewed)
  • This is more important for people early out (new pouch stomach will stretch out with time).
  • Food is thoroughly chewed to prevent blockage (the hole/path leaving the stomach and into the intestine is roughly the size of a dime).
  • To get food unstuck, patients drink meat tenderizer mixed with water.
• Low carbohydrates
  • Carbohydrates can slow weight loss and lead to possible regain
  • Avoid sugars in particular (to prevent dumping syndrome)
• Low fat
  • Foods high in fat may cause Dumping Syndrome
  • Fatty foods can lead to slow weight loss or possible regain
• 64 oz of water
  • Stop drinking within 15-30 minutes of a meal
  • Do not begin drinking after a meal for 1-1.5 hours
  • Some doctors do not encourage the use of a straw (pushes food too quickly through the stomach and can cause gas/discomfort)
• Water Loading
  • 15 minutes before the next meal, drink as much as possible as fast as possible. 
  • Water loading will not work if you haven’t been drinking over the last few hours.
  • You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness.
    • Disclaimer: this is a practice some people use to feel “full” and lose weight. Not a requirement.

DS – Eating

• Eat protein first
  • 80-100g of protein
  • DS patients can on average eat more food than any other type of weight loss surgery.
• Low carbohydrates
  • Carbohydrates can slow the weight loss and lead to possible regain
  • No dumping syndrome from eating sugar (or fat)
• Eat high in fat
  • DS only absorb 20% of fat (do not need to eat low fat)
    • If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or RNY absorbs ALL 20g. (this is just an example, measuring absorption is not an exact science)
    • When experiencing a “stall” (slowed weight loss/plateau) a DS patient commonly increases fat consumption to resolve
• 64 oz of water
  • Can drink with meals
  • Can use a straw

RNY – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins B12, iron, and zinc
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Gas
  • Constipation
  • Dumping in the form of loose stools
• Reversible procedure (Reversals of any surgery is very complicated)
  • Revision often performed instead of reversal
  • Revising to a different type of surgery is possible.

 DS – Possible Issues

• Vitamin deficiencies: Must follow a vitamin regime for the rest of your life
  • Common vitamin deficiencies found in vitamins A, D, and iron
  • “Water soluble”/ “water miscible” / “dry” vitamins absorb best (in other words get vitamins that are not fat/oil based)
  • Calcium must be supplemented for the rest of your life
• Bathroom issues
  • Gas
  • Loose stool (Most common in the first few weeks of surgery. Generally food related)
• Reversible procedure
  • The intestinal bypass is reversible for those having absorption complications
    • revision: lengthening common channel (to stop losing weight and/or to absorb vitamins)
  • Stomach is obviously not reversible (part of stomach was removed)

 

RNY - Diabetes

• 85% cure rate
  • RNY can put diabetes in remission.
  • Diabetes may come back in two or three years--even if the
    patient maintains most of their weight loss.
  • Even a small amount of weight gain, long-term, can cause a diabetes
    relapse.

 DS – Diabetes

• 98 % cure rate for type II diabetes.

 

DS – Myth or Fact

The DS is only recommended for the super morbid obese (BMI over 60) = Myth / Not True

• To be eligble for ANY type of weight loss surgery, a person has to be 100 lbs. over weight or have a body mass index (BMI) of 40 or more.
• BMI’s under 40 have also been approved (usually require a comorbidy/health problem - an example is sleep apnea).

The DS is “experimental and investigational” = Myth / Not True

• Medicare approves the DS
• Many insurance companies are starting to cover the DS.
• DS has been performed since the 1970s

DSer will have a problem when they become old = Not True

• We wont need to eat as much when we are older b/c our bodies will adapt
• The little hair-like villa located in the intestines grows longer to adjust to the new digestive system (grows longer to increase absorbtion).

DSer’s gas stink = true

• The gas does smell. (This is true for the DS and RNY)
• There are products called air fresheners that a person can use.
• May take Flagyl or fish zole

DSers may need to wear a diaper = Myth / Not True

• That is silly

Skin color turns yellow or pallor = Myth / Not True

• Patients who follow their regular vitamin regime (keep up with blood work) do not turn pallor
• If someone looks pallor, they could have a vitamin deficiency.  This applies to any type of weight loss surgery. For both RNY and the DS.
• Vitamins and blood work must be monitored for life. For both RNY and the DS.

DSers will have a heart attack from all the fatty food they eat = Myth / Not True

• Cholesterol levels lower after having the DS. 
• 80% of the fatty food is not absorbed – the fatty food is healthier to eat as a DSer than a person without surgery.
• If a taco has 20g of fat, a DSer only absorbs 4g while a person without surgery or a person with the RNY will absorb ALL 20g.  Good meal for the DSer. (this is just an example, measuring absorption is not an exact science)

Dsers don’t need to exercise = Myth / Not true

• DSer’s are aware of the benefits of exercise (body and soul).
• Exercise helps in losing weight and maintaining goal weight 

 *Some practices may not be used by all patients. Some recommendations will differ depending on a person’s surgeon.  Possible issues are just that, “possible,” and may or may not occur.  

 

You might also want to look into the DS: 

Type of Operation	RNY, Gastric Bypass, Roux-en-Y, LAP, RNY	Duodenal Switch, BPD-DS, Distal Gastric Bypass with DS	VBG	Lap Band
Modality of Weight Loss	Restrictive 1-3 ounce stomach	Restrictive & Malabsorptive	Restrictive	Restrictive 1-3 ounce stomach (15cc)
Description	A very small pouch of fundus connected to a limb of small bowel. Pyloric Valve is bypassed.	Sleeve gastrectomy, with 4- 6 ounce pouch. Pyloric valve remains functional. The bilio-pancreatic secretions are kept separated from food to limit absorption except the last ~75cm of small bowel.	A silastic ring is used to create a small pouch of stomach.	An adjustable silicone constricting band is place completely around the very top part of the stomach creating a very small pouch.
Long term success	Average. 60-70% Peak results 18-24 months [8],[9],[10],[11]>30% regained >15% or lost <50% [12]	Above Average.  70-80% excess weight loss reported over long term follow up.[3],[4],[5],[6],[7]	Poor. Only 26% of patients maintain >50% of excess weight [12]	No long term studies yet available. At best should be similar to VBG.
Complications Non Surgical	68.8% “continued” problem with vomiting, 42.7% plugging of the gastric pouch outlet.[13] 12% stenosis & 12% ulceration, with over all stomac complication in 20%.[14] Up to 76% of Patients develop Dumping Syndrome, with no association between severity of Dumping Syndrome and weight loss.[15]	Fat soluble vitamin deficiency- Rarely seen with adequate dietary supplements, in addition to a normal healthy diet. Protein malabsorption- again with healthy well balanced diet far less common than seen in VBG or RNY patients with stenosis or who only consume high sugar/calorie drinks.	21% Vomit more that once a week. 14% have heartburn.[1] Binging and purging very common secondary to pain.	89% of patients have at least one side effect. Nausea and Vomiting 51% Heart Burn 34% Need for re-operation or removal as high as 25% [17]
Opinion	“Gold standard” with frequent complications and hospital visits for patients 8.	Technically a difficult operation to perform. Division of the post pyloric duodenum is a difficult step and could be dangerous in an inexperienced hand.	Poor long term results with VBG[2]	Actually not a new idea and was abandoned years ago. Some top surgeons in the field feel its resurgence will give bariatric surgery a bad reputation [18]
Summary	A restrictive procedure rendering a patient to a very limited diet, with significant complications. Long term results acceptable.	The best surgical solution available for treatment of Morbid obesity. Allows a patient to lead a normal life with normal dietary intake of meals in smaller volume, without the side effect of dumping syndrome, continued vomiting, plugging, etc.	A restrictive operation with poor long term track record and numerous complications.	Restrictive procedure with no long term studies. Preliminary results disappointing.[19]
Long Term Dietary Modification	Significant dietary restriction. The unhealthiest diet after any weight loss surgery. Meat intolerance in majority of Pt.[16]Patients resort to high calorie drinks because can not tolerate “regular” meals	Most balanced diets tolerated well with no adverse effects. Patients tolerate “normal” diet.	Extremely poor diet- Patients are not able to consume any solids since it plugs the opening at the silastic ring.	The same as VBG
Nutritional Supplement Individual patients requirements may differ. May also differ among physicians.	Multivitamin, Iron, B12, Calcium for life	Multivitamin and Calcium for life.	Multi vitamin, Iron, Calcium For life	The same as VBG

 
[1] Balsiger BM, Poggio JL, Mai J, Kelly KA, Sarr MG, Ten and more years after vertical banded gastroplasty as primary operation for morbid obesity, Gastrointestinal Surgery 2000 Nov-Dec;4(6):598-605.

[2] McLean LD, Rhode BM, Sampalis J, Forse KA Results of the surgical treatment of obesity. Am J Surgery 1993;165:155 - 59.

[3] Scopinaro N; Adami GF; Marinari GM; Gianetta E; Traverso E; Friedman D; Camerini G; Baschieri G; Simonelli A, Biliopancreatic diversion, World J Surgery 1998 Sep;22(9):936-46.

[4] Hess DS; Hess DW, Biliopancreatic diversion with a duodenal switch, Obesity Surgery 1998 Jun;8(3):267-82.

[5] Baltasar A; Bou R; Bengochea M; Arlandis F; Escriva C; Mir J; Martinez R; Perez N, Duodenal switch: an effective therapy for morbid obesity--intermediate results, Obesity Surgery 2001 Feb;11(1):54-8.

[6] Marceau P; Hould FS; Simard S; Lebel S; Bourque RA; Potvin M; Biron S, Biliopancreatic diversion with duodenal switch, World J Surgery 1998 Sep;22(9):947-54.

[7] Marceau P; Hould FS; Potvin M; Lebel S; Biron S, Biliopancreatic diversion (duodenal switch procedure), European J Gastroenterology Hepatology 1999 Feb;11(2):99-103.

[8] Balsiger BM et all, Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity. Mayo Clinic proc. 2000 Jul; 75(7):669-72.

[9] Oh CH, Kim HJ, Oh S, Weight loss following transected gastric bypass with proximal Roux-en-Y, Obesity Surgery 1997 Apr;7(2):142.

[10] Reinhold Rb, Late results of gastric bypass surgery for morbid obesity, J Am College Nutritio***** Aug;13(4):326-31.

[11] Avinoah E et all, [Long-term weight changes after Roux-en-Y gastric bypass for morbid obesity]. Harefuah 1993 Feb 15; 124(4):185-7,248.

[12] Brolin RE et all, Lipid Risk profile and weight stability after gastric restrictive operations for morbid obesity, J Gastrointestinal Surgery 2000 Sep-Oct;4(5):464-9.

[13] Mitchell JE, Lancaster KL, Burgard MA, Howell M, Krahn DD, Crosby RD, Wonderlich SA, Gonsell BA, Long –term Follow up of patients’ Status after Gastric Bypass, Obesity Surgery, August 2001,11(4) 464-468.

[14] Sanyal AJ, Sugerman HJ, Kellum JM, Engle KM, Wolfe L.,Stomal complications of gastric bypass: incidence and outcome of therapy, Am J Gastroenterology 1992 Sep;87(9):1165-9.

[15] Mallory GN, Macgregor AM, Rand CS, The Influence of Dumping on Weight Loss After Gastric Restrictive Surgery for Morbid Obesity. Obesity Surgery 1996 Dec;6(6):474-478.

[16] Avinoah E, Ovanat A, Charuzi I., Nutritional status seven years after Roux-en-Y gastric bypass surgery. Surgery 1992 Feb; 111(2):137-42

[17] U.S. Food and Drug Administration, FDA Talk Paper T01-26, June 5, 2001

[18] NIH, Working Group on Bariatric Surgery, Executive Summary, May 8-9, 2002

[19] Doherty C, Maher JW, Heitshusen DS., “Long term data indicate a progressive loss in efficacy of adjustable silicone gastric banding for the surgical treatment of morbid obesity”, Surgery, 2002, Oct.;132(4):724-8

bY NO MEANS SHOULD OFFENSE BE TAKEN TO THIS: HOWEVER, THIS INFORMATION IS OUTDATED AND WAS GATHERED AT LEAST 5 YEARS BEFORE IT WAS PRINTED. AS WELL, IS UNTRUE AND RECENT SCIENCE HAS PROVED IT. THE DATE IS SKEWED. DATA CONTAINING STATISTICS COMBINING RNYAND LAP BAND PROCEDURES TO GATHER AN IDEA AS A SIGNIFICANT STANDARD IS WRONG. LAP BAND AND RNY DO HAVE THE SAME IDEAL GOAL, HOWEVER WORK DIFFERENTLY AND HAVE VERY CONTRASTING RESULTS. I WOULD SUGGESTION ANYONE TO CHECK OUT STATISTICS FOR EACH INDIVIDUALLY COMPARED. FOR EXAMPLE, RNY DOES NOT REQUIRE FREQUENT TRIPS TO THE HOSPITAL. LAP BAND DOES AS YOU HAVE TO KEEP GETTING THE BAND FILLED(TIGHTENED)OR LOSENED PROBABLY ABOUT MONTHLY. NOT WITH RNY. THE STATISTIC THAT DUMPING OCCURS ABOUT 67%OF THE TIME IS ALSO NOT TRUE. THAT RESEARCH, AGAIN, WAS DONE WHEN WASNT MUCH TO KNOW ABOUT IT. NOW THAT IT IS PROVEN THAT PRETTY MUCH CERTAIN KINDS OF SUGARS, FATS, FOODS, ETC CAUSE IT, IT IS MOSTLY IF NOT TOTALLY AVOIDABLE. I COULD GO ON, BUT THIS IS NOT A SCIENCE PROJECT.

RESEARCH EACH ONE SEPARATELY AND COMPARE THEM SEPARATELY. ANY GRAPH OR NUMBERS THAT COMPARE IN GROUPS HAVE SKEWED STATISTICS, ESPECIALLY WHEN COMPARING LAP BAND TO RNY. TOTALLY DIFFERENT IN RESULTS AND SIDE EFFECTS.

First.... "Interesting" information people have sent you...   What I would strongly recommend is that you do some research on your own and pay close attention to both good and bad for both, any and all types of surgery.

Some of the information posted to your question is inaccurate and just flat out wrong, not to mention funny, but I'll leave it to you to dechiper it...

Regarding your question, I researched both and after long discussions with my doctor and research on my own, chose to have RNY.  For one - it provided greater long-term weight loss than banding.  Another - I had more than 100 lbs. to lose and that is difficult with a band, but not impossible.  I was willing to take the up front risk of major surgery, to live a healthy life afterwards.  But please understand, it is a risk - it's major surgery and very dangerous.

There are some potentially serious complications to banding that you don't hear about often including that it's not designed to be a permanent thing.  I wanted permanent; something to force me to change.  I got it :)  and I'm happy with the choice.

Regarding skin - I've lost 115 lbs and yes, I have some lose skin in all the common places - upper arms, though not bad, thighs and stomach and let's not disuss the mammory glands...  However, I would do it again in a heartbeat.  Some day, may have PS, but not in a hurry at this point.  Victoria Secret has the wonder bra and I don't show my thighs in public very often, so it's been a worth while choice for me.   Unless you plan to lose 1/2 lb. a week, you're going to have issues...

Someone recently said, I spent all this time abusing my body, this just happens to be the price I had to pay; and they were right.  I'll personally take a little sagging skin any day over weighting 300 lbs.  At my highest, I was 313.  I'm nearly 40 now and truthfully - look much younger, in spite of losing a significant amount of fat from my body.  But then, you can see my picture - do I look 40?  It probably helps that I'm VERY short.

Whatever you choose to do - just choose carefully and be willing to accept the good with the bad.  Only you can pick whether it's the right choice for you - Good luck!

Thanks for all the information on the differences in each procedure.

i was gonna have rny, then i started losing the weight i eeded to lose pre op to shrink my liver and kept on going...cancelled my surgery even and lopst 60 lbs so far. i figure that the demands from this surgery are more tougher than those of just eating right and exercising.

after this surgery your life will not be the same...it seems your life will have to revolve around your eating forever and i hate that kind of commitment.