Initial WLS impressions...right or wrong?

Hey guys! Let me bounce some things off you and you can correct me as needed: Saw that Gil Gerard/Buck Rogers thing on Discovery Health.  That's what opened my mind to WLS in the first place, rather than "toughing it out" my damself. Now that I've lurked & read some, and posted a little, tell me if I'm "getting it"... MGB is the 'property' of His Highness Dr. Robert Rutledge.  You must swear fealty to him and no other, should you choose this option. Pros: Quick, Easy surgery, quick recovery, control-freak level support medically.  Quick weight loss. Anything else? Cons: Seems if you want a revision, or have 'issues', you are excommunicated from First Rutledge Church and shunned. RNY: "The Gold Standard" (which smacks of elitism, but that's just me).  Surgically, it seems...NOT working with a body's natural functions...not far from "just use a ZipLoc bag and some surgical tubing for a stomach, and cut it ALL out..." Pros: Time-honored, established benchmark, lots of success stories, (what else?) Cons: ? Duodenal Switch: Just learning...cool that I see a bunch of really enthusiastic POST-op folks on this one...kinda attractive due to use of restriction + malabsorption. Pros: What else? Cons: Seems...one of the more COMPLEX and difficult WLS options...can be done lap, I hope? Failure rate? LapBand: Got a know-it-all sis-in-law with this one, who's had a NUMBER of complications & adjustments, yet continues to beat the drum that this is the ONLY way, because SHE chose it... just not really interested in this one... I know there's some others and I'll continue to read up, but am I way off-base on any of this so far? Thanks, Dan

Dan, you're definitely doing the right thing by researching the different surgeries and by being here. Also, research the Doctors you are considering too. Sometimes it seems folks get wrapped up in the "my type WLS is better than your type WLS", which is a crock of crap in my opinion. The main thing is to find which is best for YOU and YOUR NEEDS - WLS is a personal thing.  Once you meet with a Surgeon, you may have a better idea of what surgery type will best work for you. I started out tinking Lap-band after my cardiologist suggested I consider weight loss surgery. However, once I met with Dr. Richards, he told me that he recommended I have the RNY gastric bypass because I had over 150 pounds to lose and with the heart issues I needed to lose it faster than I could with the band.  I went with Dr. Richards suggestion and I am totally happy with it. I have lost 60 pounds since my surgery on 4/28/08 (93 since Feb. 9), am no longer pre-diabetic, no longer take any heart medications, no longer have to use my bi-pap machine, can actually go to the gym and exercise now, and am becoming healthier and happier with each passing day. Continue your research, ask questions, and keep an open mind and you will find the answers.  We;re here to support and help in any way we can. Good luck to ya buddy.  

VSG (Vertical Sleeve Gastrectomy) is the "upper-GI" restrictive component of the DS (Duodenal Switch).  It was originally performed on super, super morbidly obese individuals as a simpler initial component of the DS; once a significant amount of weight was lost after several months, the intestinal malabsorptive component of the DS could be performed more safely.  It turns out that many of the candidates *****ceived only the VSG lost sufficient weight that it wasn't necessary to revise the procedure to a full DS.  So, now the VSG is being offered in many places as a stand-alone WLS. The bariatric practice where I had my RNY is beginning to offer the VSG; the big issue right now for them is to convince the major New England insurance plans to cover it. Advantage over the RNY: a smaller, but fully-functional stomach with a normal pyloric valve which controls stomach emptying.   That means (like DS and LapBand), no dumping.  Like the LapBand, there's no malabsorption, so nutritional deficiencies are somewhat less common.  Unlike the LapBand, there's no foreign body which has the potential to erode or slip in the future.  Like the LapBand and DS, in the opinion of many WLS surgeons, NSAIDs can be taken once your gut has healed up.  If you're suffering from hip or knee arthritis (or plan to be! ), this may be important. There are a number of reasons why MGB isn't a mainstream WLS procedure, and only a few of them have to do with Rutledge himself.  With all the other malabsorptive surgeries, bile (which is extremely corrosive) cannot easily reflux back up into the stomach and esophagus.  With the MGB, this intrinsic barrier to bile reflux is gone.  Hope this helps, /Steve

Thanks guys! Steve, that's very helpful to compare/contrast.  I've got some joint issues (though none with the bionic hip!) so NSAID's may be important in the future. I kinda wonder if the additional risk and complication of the DS is worth it/necessary vis a vis the VGB, but that'll become more clear as I consult with the experts. Sure is alot to learn, but glad I'm in a place with no shortage of experience!

Dan, What Steve said…. Plus- The MGB?  Do some more checking on it- just saying- snake oil is still being sold in these United States…. Don’t be led astray by some of the Myths- RNY’ers regularly are prescribed NSAIDs by their docs after the first 6 months. I’ve taken NSAIDS for the last couple of years for a torn rotator cuff, no problem. My doc does have me take them with a Nexium, but the notion of- NO NSAIDs Ever?  BS Big time….I know over a dozen RNYers who do take them. Another Myth? “Slower weightloss will prevent loose skin.”  BS! If it’s stretched, it’s gonna sag when the stuffing is removed. If anyone is deciding on a slower loss method based on that, they are fooling themselves.  Ask a Plastic Surgeon. RNY is “The Gold Standard! So that’s what I’m going for!” The RNY is the Most done. Period.  If you want to make a decision based on “Jumping on a BandWagon,” then that’s the one.  Elitist? No.  Common? Yes. Another myth-  “With the DS I can eat whatever and still lose!”  BS. The DS will let you eat a lot more fat and still not absorb it- (only absorbing around 20% of Fats)  But the Carbs and sweets will still hold the pounds on if a post-op eats them.  Eat too many of them, and gas an loose stools result. All of the surgeries work for some one. Figuring out the one that’ll work for you is the trick. Some provide more restriction –if volume was your issue that added on the pounds. The DS allows more fat in the diet, if that was the problem. If sweets were your Kryptonite, the RNY will put you off them for quite awhile. Which ever you choose, don’t be swayed by anyone, even me. Do check with a person touting their surgery and ask what their BMI is now.....If they are not built like Stallone and start talking about the 'ridiculousness' of BMI as a measuring tool, that'll tell you a good bit... The BMI is a fairly crude measurement, but docs use it for a general guide for a reason.  It's the Best "General" guide they have. (Mines been in the Normal Range now for right at 4 years...just sayin...) Anyone who has had success with a procedure, Will pretty much feel certain that their procedure works. “Hey, it worked great for me!” Read, know what your specific problems to losing weight have been in the past, And know that they ALL require a change of life style in order to work. Best Wishes- Dx

DX,

I think that this comment is the most important thing for anyone who is considering WLS to think about prior to deciding on a procedure.

"All of the surgeries work for some one.
Figuring out the one that’ll work for you is the trick. "

WLS is not one size fits all, go knows we of all people should know that one size fits all is a lie.  I know I never found a bathrobe that was one size fits all.  These two sentences sum up why I chose RNY over the other WLS.

Jim 

http://www.obesityhelp.com/forums/vsg/ also VSGFAQ.com read read read all you can on all procedures. the VSG(sleeve) is a little more diffucult with some insurance companies but is getting easier to get approvals. Particularly with BCBS

GoingMobile,

How are you doing? I see you finally got the VSG. Must have happened while I was out. How's the first month going?

Hope You're Well,

Dave

Hello My Brother... I have to say from first impressions....you are doing your homework, with a very skeptical eye.... Ok you do like the doc that does the MGB....ok scratch that off your list... Dude....your explaination of the RNY..and the skeptical "Gold Standard " remark... makes me think you need to do some homework on that one....you know it is restrictive and Malabsorbing at the same time...right.... You are right..the DS people are very enthuseastic.., I have had some great friends be very successful with this procedure... Hell, I got friends here that have been successful with all the procedures...and I got good friends that have struggled... Ok, he is my suggestion...don;t do this research with the plus or minus on a sheet of paper... make sure you add in the changes that you are willing to make, with each surgery...to get the success you want... ask more direct questions....we can debate all sides to an issue... ask away....

Dan, You are off to a good start doing your research.  All the procedures have pros and cons to them.  You can damn near start a riot among the supporters of each one by dissing their surgery.  Before you commit to any one method go to a few doctor's seminars and keep asking questions!  In the end you are the one laid out on the table and before you get to that point you want to have confidence in your decisions of what type of surgery and surgeon.