RNY or Sleeve... now THAT is the question.

A bit of history: Started this process for real (actually seeing a surgeon and not just dreaming) in August of 2010.  I have BCBS of FL and my husband works at the hospital I was going to have surgery at.  The insurance required him to be there for one year prior to my surgery and also requires me to only go to certain approved facilities.  So I chose the one he works at and it's also the closest.  I began seeing a surgeon every month for a 6 month supervised diet.  Also began walking and getting serious about my life post op.  Lost roughly 30lbs over the last 4 months or so. The surgeon I was seeing offered the band and the sleeve.  I had originally chosen the band since the sleeve wasn't covered by my ins.  Somewhere during the 6 month diet the sleeve became a covered option through my insurance co. so I jumped at the opportunity for that since I wasn't super comfortable with the band from the beginning. 

Fast forward to 4/11/11 when my paperwork should have been submitted to the ins. co.  The surgeon quit... and took his surgery practice partner with him to start their own practice.  The hospital refuses to let them do any surgeries in their facility so I am without a surgeon.  I scramble to find another surgeon at an approved facility and find one located an hour away.  I make an appt with him and he says everything is a go EXCEPT I need a visit to the pulmonologist and a visit to the NUT he uses.  Those are scheduled.  

So here's my dilemna..... this new surgeon offers the band, sleeve and bypass.  I've been doing the majority of my research on the sleeve since that was what I was going to get with the last surgeon.  Now I'm with this one and he says the band is definitely out because of my BMI (starting at 52) and says it's completely my choice between sleeve and bypass. 

I have roughly 175-190 lbs to lose (depending on what goal weight you're looking at)... I"m starting this at roughly 320 with 351 being the highest weight recorded.

This surgeon told me the eating requirements post op for sleeve and bypass are very much the same.  He did state that the big differences he knows of are that the bypass patients will have dumping syndrome as a reminder to not eat the bad stuff and the sleeve patients might have issues with slider foods going down too easily... therefore, easier to regain through bad habits. 

I wanna hear it from you all .... what are the pros and cons from your surgery?  Any help/input would be appreciated in making my decision.

Ginger

For me the choice between the sleeve and RNY was pretty easy.  The band was definitely out for me from the beginning.  The failure rate is high and the amount of weight lost is low.  I've seen people have great results with both the sleeve and RNY.  I chose the RNY because I wanted the malabsorption and I actually wanted to have dumping syndrome.  Sweets have always been an issue for me and the fear of dumping is enough to keep me away.  Now not everyone dumps.  I think something like 30% of people do dump.  So don't let dumping syndrome be what sways you towards one or the other.   I not only dump on sugar but I dump on carbs as well.  I was not anticipating that, but I think it's for the best since I was a carbaholic before surgery.  

One thing that I didn't give much thought to and wish I had was the fact that you can't take NSAIDS after the RNY.  No Advil, Aleve or any of the good stuff for inflammation.  I have fibro and back problems. It would be wonderful if I could take an NSAID for them, but I can't.  Hopefully the pain gets better as I lose weight.  For me that is the only draw back to the RNY.  I would still have the RNY over the sleeve any day.  I think if you have a lot to lose then the malabsorption factor to the RNY is beneficial.  Sleeves don't malabsorb.  

Whatever type of surgery you get (out of those 2) have great success rates.  It really is a matter of preference and what you're willing to live with.  With my RNY I accept that I will be on vitamins my entire life.  I accept that I can't take NSAIDS.  I accept that I dump.  I'm okay with all of those things because in the end my health is worth those minor inconvieniences.

I honestly think you could go either way and make it work.  I had the RNY and I am very happy with it.  My aunt had the sleeve and had done very very well also. 

With the RNY, you will have to focus more on vitamins and getting your protein in because of the malabsorption.  I have personally had to take extra iron because mine is low.  I am also trying to up my protein because at my 3 and 6 months blood tests, it was low too.  Dumping doesn't always happen.  I do dump occasionally, but sometimes I don't.  I dumped once from barbeque sauce, but can eat a handful of M&M's with no problem.

With the sleeve, you keep your pyloric valve, which is nice to have. 

I am obviously going to tell you to get the RNY because that is the surgery I had and it has worked out well for me.

Good luck with whatever you choose.

Only about 30% of RNY patients develop dumping sydrome -- I don't dump-- so don't choose RNY because you think that dumping will keep you from eating sweets. RNY is generally better for patients with Diabetes or GERD. The sleeve won't fix reflux and the remission rate for diabetes is lower with the sleeve than with RNY. If those aren't concerns for you, you might want to choose the sleeve. However, you do have a lot of weight to lose and the malabsorption you experience with RNY ought to help you lose that weight faster. The biggest reason I can see to choose the sleeve over RNY would be if you need to take NSAIDs for any kind of chronic condition like arthritis. NSAIDs are forbidden after RNY, so if you need to take them, go for the sleeve.

 

 I am partial to RNY because of the malabsorption.  The dumping has worn off for me.  I can eat pretty much anything with no problems.  Just a lot less than someone with a full size stomach.  The malabsorption wears off, so you have to make the most of the 18 months or so that it works.

I had RNY.  Some complication, and many that will never go away. app 2-3 years post op RNY the body compensate for the calorie malabsorbtion, but never for the vitamins - minerals malabsorbtion.  So ... at the end we are like the Sleeved people - but with so many more restrictions, possible complications, and more vitamins minerals to take. Let's n forget the "no NSAiDs for life - ouch...).  No drinking with meals, reactive hypoglycemia,etc.. etc. 
I wish I had Sleeve - that offers much more chances of semi normal life after WLS surgery.  No stoma to worry about, no other issues... 

If I could choose it again I would definitely had the VSG... but it was not available to me at the time of surgery.  Longer post op people have less "RNY is great" view on things.

I just spoke to my surgeon about this yesterday. I was also confused. My insurance covers both and he does both. One of the reasons I am going with the RNY is b/c I have PCOS and insulin resistance. I am a sugar and carb addict and feel that the RNY would be best for me b/c you need to eat protein 1st. RNY's still can eat slider foods and gain weight. With any WLS surgery, if you don't change your habits you still can gain weight. I think the sleeve is great for volume eaters, b/c you are unable to eat large volumes of food and like the pp said you still retain your pyloric valve. Personally, if I didn't have the issues I have, I would have chosen the sleeve. My surgeon also said that with RNY I have the biggest chance of losing most of my excess weight. The sleeve is slightly less. Does that mean people who get sleeved can't lose all of their excess weight? Absolutely not. This is a very personal decision and you need to pick the one that is best for you.
Good luck on you decision.

Out of the two, the RNY is more likely to get you to lose the 190 lbs you want to lose. I was told that the sleeve weight loss is similar to the Band. I had 150lbs to lose and I chose RNY. It was a pretty easy decision for me, the reason for having surgery was to lose most if not all my excessive weight. Based on my calculations, with a Band or sleeve I was looking at about 40-80lbs weight loss. That was not good enough or me. I wish you good luck.

Hi! I had the sleeve, a little over a year ago.  Yes..I know this is the RNY forum.  I seen your post and thought I'd respond.

I started at 354 lbs one year ago and have lost 139 lbs so far and am still losing.  I was wearing a size 32 jean, today i am in size 16's..(so far).  

I had my one year postop appt last week.  Below are the stats my surgeons assistant gave me on that day.  He told me I had lost 66% of my excess weight so far (if my goal is to get to 150 lbs..) I told him I didn't think that was good for the first year..so he gave me the following information..

He said that with the Lap Band..in 3-5 yrs postop they lose only 40-50% of their excess weight.

With the DS..within 18-24 mths postop they lose 85% of their excess weight..but have risk of malabsorption..

With the RNY they lose 60-80% within 18-24 mths postop..also with risk of malabsorption...

Again..he pointed out that I had already lost 66% in 12 mths with the sleeve..and no malabsorption..

Definitely do lots of research on which surgery is right for you and your situation.  For me..I felt the sleeve was right.  I just want you to know that you CAN lose the weight w/the sleeve as well as with the RNY.  I think you can lose it with any of them.   And I think keeping the weight off all comes down to you in the end..and NOT which surgery type you chose.  All surgeries are just a tool to help you get there.....you can 'eat around' any of them

I chose the RNY for two reasons. One; all the people in my family have the same body type. My dad and brother both had RNY and have had wondrous success. Two; I want the restrictions and the threat of dumping. I want those reminders that I have to change the way I eat for the rest of my life.

Good luck!