PROS AND CONS OF ROUX-EN-Y OVER VSG SLEEVE

Finally got to meet my surgeon after 2 yrs. of waiting. Dr. AArts said she could decide roux-en-y or a vsg sleeve\. I'd appreciate any comments if maybe the VSG might be better.

I went with vsg 5 years ago. I lost 90+ lbs! kept it off three years! but began experiencing GERD that is now so severe, I sleep propped up.  This is fairly common with the sleeve. Also, I went on depression meds for 2 years and rather quickly gained back 70lbs.  I am now revising to the rny, this Tuesday coming. 

On the revision board, I see quite a number vsg-ers doing the same.  

That's experience , now you judge for yourself. ;)

 

G.

thanks so much for the info,will rethink my rny!

Where I went through, HRRH, you do not get to choose your surgery. Your surgeon will tell you what he is going to do after all your meetings with SW, NC, Dietician, Internest. I asked my surgeon about a sleeve as I thought it was for me,he shook his head and said we are doing a RNY. He would not even entertain questions about a sleeve. I have heard from others that this is the case with them as well and they have gone through other centers in the south of Ontario. You have to have certain crieteria for them to do it, as there are alot of people who get the sleeve, then have to have a revision to a RNY... who wants to go through WLS 2 or more times? Not me for sure. There is a board on this site that is devoted to people who have had revision surgery, perhaps you should read a bit about their plights. Then think it over. With respect, Doreen

This is my experieince with the VSG so far.

I had a VSG and am 15 months out at 8-9 months out I stopped losing weight becasue my body said thats enough. At around 10 months all my hunger, cravings and issue's I had pre surgery came back really strong and I am currently trying to deal with them so I do not gain my weight back.

I had no restrictions with the VSG except maybe if I ate to much chicken but other than that I can eat everything and drink everything if I choose to do this but I sure try not to. There are times I really wish I had a RNY and I told the hospital this recently.

One thing I do have is GERD and take medication to keep it under control it is one of the side effects of the sleeve.

Depending what health issue's you have you should research becasue the stats on the sleeve show lower results of medical issue's going away after surgery.

So do your research and make your decision and don't get me wrong I love my sleeve as my life has changed dramatically and any issue's I have are my issue's that I have to try and get under control. With either surgery once the honeymoon is over we all have to deal with the reality of life.

 

I have to agree with Nanato2. I asked to have a VSG because I get migraines and I really need to be able to take Advil because it works the best for my migraines without side effects. However I lost about 80 lbs immediately post op and then had a difficult time. With VSG you can pretty much eat anything you want just not as much at one serving. RNYers at least (most but not all) will dump with foods too high in fat and sugar. So I fell off the wagon pretty quickly with eating foods too high in bad carbs, not eating enough protein or drinking enough water. I think right now I am back on track but I gained back about 20 lbs and it has been a lot harder getting them off this time. I haven't had any problems with GERD thank goodness though. I do sometimes wish I'd had the RNY because I think I'd be at my goal but again who knows? It is not the surgery itself, it is what we make of it. I still have the emotional issues I had before my surgery. That hasn't changed. I think if I had to do it all again I would have the RNY. It is hard to admit that because my doctor said he thought I was a good candidate for VSG and I sure didn't live up to that. VSG sounds better because they do less, it is an easier surgery and I think less complications but maybe in the long run not the results you might want if you think that the emotional stuff isn't going to be handled. That is just my 2 cents and my personal experience but after 2 1/2 years I'm still not at my goal and lots with RNY get to their goal within a year but then again so do VSGers. It's all about using the surgery as a tool not as the answer to all your problems.

Lots of great points as I don`t decide but if I wanted VSG I thought she could be persuaded. So I think it will be up to her,it would be better then to get a Roux-en-y as most seem to want that more. I did hear many times the Roux is the gold standard of WLS.

I found this in one of my FB groups and found it very helpful.

 

the band has higher long-term complication rate and LOWER success rate...not the best choice.....I feel the sleeve is the better choice for most people... the bypass has it's own "issues" here is one study at Lenox Hill Hospital and a Doc's opinion on the bypass......pay attention to his conclusion. .................

 

 

 

New Data on Weight Gain Following Bariatric Surgery

 

 

 

Gastric bypass surgery has long been considered the gold standard for weight loss. However, recent studies have revealed that this particular operation can lead to potential weight gain years later. Lenox Hill Hospital’s Chief of Bariatric Surgery, Mitchell Roslin, MD, was the principal investigator of the Restore Trial – a national ten center study investigating whether an endoscopic suturing procedure to reduce the size of the opening between the gastric pouch of the bypass and the intestine could be used to control weight gain in patients following gastric bypass surgery. The concept for the trial originated when Dr. Roslin noticed a pattern of weight gain with a significant number of his patients, years following gastric bypass surgery. While many patients could still eat less than before the surgery and become full faster, they would rapidly become hungry and feel light headed, especially after consuming simple carbohydrates, which stimulate insulin production.

 

 

 

The results of the Restore Trial, which were published in January 2011, did not confirm the original hypothesis – there was no statistical advantage for those treated with suturing. However, they revealed something even more important. The data gathered during the trial and the subsequent glucose tolerance testing verified that patients who underwent gastric bypass surgery and regained weight were highly likely to have reactive hypoglycemia, a condition in which blood glucose drops below the normal level, one to two hours after ingesting a meal high in carbs. Dr. Roslin and his colleagues theorized that the rapid rise in blood sugar – followed by a swift exaggerated plunge – was caused by the absence of the pyloric valve, a heavy ring of muscle that regulates the rate at which food is released from the stomach into the small intestine. The removal of the pyloric valve during gastric bypass surgery causes changes in glucose regulation that lead to inter-meal hunger, impulse-snacking, and consequent weight regain.

 

 

 

Dr. Roslin and his team decided to investigate whether two other bariatric procedures that preserve the pyloric valve – sleeve gastrectomy and duodenal switch – would lead to better glucose regulation, thus suppressing weight regain. The preliminary data of this current study shows that all three operations initially reduce fasting insulin and glucose. However, when sugar and simple carbs are consumed, gastric bypass patients have a 20-fold increase in insulin production at six months, compared to a 4-fold increase in patients who have undergone either a sleeve gastrectomy or a duodenal switch procedure. The dramatic rise in insulin in gastric bypass patients causes a rapid drop in glucose, promoting hunger and leading to increased food consumption.

 

 

 

“Based on these results, I believe that bariatric procedures that preserve the pyloric valve lead to better physiologic glucose regulation and ultimately more successful long-term maintenance of weight-loss,” said Dr. Roslin

 

 

 

I am one year out from VSG in Mexico next week. I have dropped 145 pounds of which the majority came off in my first 9 months out. Maintenance is the true test for any WLS so the real game is just beginning for me.

I think either surgery is great. It just depends on which you are more aligned to stick to. People fail to reach their personal goal weight with both surgeries and also experience regain. Both surgeries have risks, benefits and downsides...you have to figure out which ones are important to you.

I chose to pay for my VSG as the only option I was given through the OHIP bariatric program was gastric bypass as I didn't have any comorbidities to warrant VSG. After really researching both surgeries I decided that VSG seemed to fit me better. So I left the OHIP program and began researching VSG surgeons. I found my surgeon and was totally confident in his abilities as he had done more VSG surgeries than the Drs I had access to in Ontario. I was more comfortable with it and felt I could manage what my surgeon laid out for me. His information and youtube videos explained the way I would  "eat" to lose weight and then maintain the weight loss.

I was uber vigilant for the first 8-10 months or so. Stayed low carb (under 40 g), high protein 70g +, drank tons of water and exercised regularly. It worked for me but I had to work hard to get there. I honestly did not feel any "hunger" and that is now returning a bit but only when I really work out hard or if I let too many carbs into my diet. When I stay low...the cravings are mostly at bay.

I still experience restriction, less than early on but that makes sense. I CAN eat anything but I don't. I committed to a lifestyle change. I eat well, I eat food with taste, I sometimes splurge out and have a glass of wine or a piece of birthday cake. I don't feel like I am on a diet all day long. I feel like I have gotten control of my eating and can let myself have a little sliver of a dessert once in a while. I don't feel like I will sneak back downstairs to finish the whole thing off. That being said I still keep my calories around 1000, my carbs low and my protein high. Many days I eat under 750 calories...I don't feel deprived.

Not one day in the past year have I ever regretted my surgery. I am thrilled with the way my life has improved. The VSG helped me get where I am today but I take ownership of the changes I have made in my life and the commitment it has taken.

Bottom line, you decide which surgery is right for you. It's your body and you are the one that has to take charge to make your weight loss happen! Good luck with your decision.

I wanted and fought for a VSG.  I didn't want a blind stomach based on family history of cancer and need to have full stomach scoped.  If I was going to have my intestines moved I would have chosen DS based on my research and my body type (apple) and my diabetes and family history of cancer and the fact that my doctor did that surgery too.  With a lot of loss on my own pre referral I had only 100 to lose and thought a VSG would be enough - it was. Every surgery has regain so don't base your choice on regain. I have had some regain due to bad choices and thyroid problems but am dealing with it. Again, many with the RNY have GERD too so do your research and read, read, read the boards. You ultimately have to work whatever tool you get. 

There is no magic in the type of surgery - it takes work, commitment and dedication to achieve and maintain your goals. With VSG there is no dumping which may or may not happen if you have RNY and which may or may not help you. I didn't need dumping to know sugar, and lousy carbs make me sick. If after you research more you have a preference discuss with the doctor just before you go in. Usually the doc talks to you before you are put under.  However depending on what the doc finds inside she may only be able to do a VSG.  So be prepared to deal with whatever you get.  My doc was more amenable to agree to a VSG during the consultation stage. 

I know it is hard to figure out what is best but 21/2 years out I know I would have worked whatever I ended up with. Look at how much you have to lose, how long you have been overweight, do you have diabetes or a need to take aspirin ( I have a blood clotting issue so aspirin and aspirin related products are a must for me. Personally if I had had more than 100 pounds to lose I would have chosen a malabsorptive  DS procedure but have seen numerous VSGers with over 250 to lose do extremely well.  My thinking has changed over the past couple of years and reading all the success stories regardless of surgery type makes me realize it is what happens after that is most important.