Did you choose RNY over the gastric sleeve? Why?

My BMI is 49 and I was recently diagnosed with diabetes to add to my high blood pressure and sleep apnea. I really struggled with choosing between the gastric sleeve and the RNY. I ended going for the RNY and I have my surgery date in July. But now I'm starting to question my decision. The studies I read showed more weight loss and positive impact on diabetes with the RNY. But I'm really worried about digestive issues and complications now. The doctor said I'm a good candidate for either and would likely lose enough to get rid of diabetes with either procedure. But she did point out that they have more data showing a greater weight loss for RNY, but that could also be because gastric sleeve is newer. So it's really and either/or situation. 

Anyone else in my boat. Which did you go with? Do you regret your decision?

There was never any question in my mind... the doc said RNY was the "gold standard", and in the classes we learned a lot about the differences.  RNY is faster (my BMI was 44 and in 4  months it's alredy down to 34).  I've kept in touch with my class-mates, and those that chose Sleeve are far behind in their weight-loss compared to those of us that did RNY.  We were also taught that statistics show more weight loss retention after surgery (you keep it off longer with RNY).  That's just what we were taught.  

Bottom line, I think you have to work harder with the sleeve, and I didn't trust myself to not gain it back without the best tool in the shed.  Nope, I've never regretted my decision for one second.  

PS:  Most of the people in my class that chose the Sleeve had a lot LESS weight to lose than me.  If my BMI were lower then, I might have chosen the sleeve.  (Maybe.)

1. I chose RNY because it had a better chance to have a bigger impact on my diabetes.  I was on seven medications, and should've been on insulin, and now I'm only on Metformin 500 twice a day.  I was told it was the gold standard in helping diabetes.

2. I also chose RNY because patients on average have greater weight loss and keep more off with RNY vs. the Sleeve.  The way I figured it, if I was going to have surgery, why not choose the one that will help the most?

Any surgery has the potential for complications, but I felt that the positives outweighed the potential negatives.  I also saw some of the potential digestive issues as possible positive.  I haven't dumped yet, although I have had some sugar.  I still try to avoid large amounts, so I may just be keeping it low enough. 

Since RNY has been around for so long, I felt more confident having it done.  Maybe the sleeve will turn out to be superior in the long run, but I like the idea that RNY has been performed for over 30 years.  By this point they know the positives and the negatives, and how to work around those negatives.

At this point, the only food that bothers me is bread, and that's only if I eat too much or it's too dense.  Over the weekend we were at an open house where they served falafel with hummus and Syrian bread.  I only had one falafel and one piece of bread, but I was hurting afterwards.  And I'm glad, because it makes it much easier to avoid bread when I know I'll hurt.  

I'm still pretty new out from my surgery, but I don't doubt it at all.  

Either surgery is a great choice, although I'm partial to the RNY.  Whichever you decide upon, good luck!

My sister has the sleeve and While she has restriction, she can eat a lot. She's struggled with her weight loss, 2 years out and hasn't reached goal.

I chose RNY cause I wanted the benefit of a two fold surgery, malabsoption and restrictive. (sleeve is restrictive only, right?). I'm a sweet eater and wanted the possibility of dumping to keep me in check. I don't know if I dump, but it keeps me honest cause I've don't want to test it. 

I feel like sleeve people tend to be more sensitive to certain foods. And I wanted to avoid reflux. Also, sleeve folks revision is to gastric bypass. I figured I'd cut out the middle man. 

I didn't have a choice 8 years ago sicne VSG wasn't being done by any of the surgeons her and wasn't covered by my insurance. I have done well with the RNY, BUT... Iafeter living with my RNY for 8 years, if I were making the decision again now, I would choose VSG. 

Below is what I posted on a previous thread about this question. (There are literally hundreds of them on here since this question comes up at least once a week, usually more often. If you use the search function (a little tiny magnifying glass at the top of the screen), you will find many threads to read.

Unless you have medical considerations that make surgery more appropriate for you than another one (e.g., GERD), what it really boils down to is whether or not you are willing to trade 1) the ability to take NSAIDs (a no-no after RNY),  2) the need to take a significant number of vitamin supplements for the rest of your life (and we are not talking about just an extra pill or two, we are talking about taking some kind of vitamins at least four times a day every day since you need 3 doses of calcium and a dose of iron and calicum and iron shouldn't be taken together), and 3) the potential for dumping (only 30% of RNYers dump) in exchange for the temporary advantage of caloric malabsorption and the somewhat faster weight loss that RNY brings. (You will lose the vast majority of the caloric malabsorption within the first 2 years, so it will primarily be a restrictive surgery after that in terms of calories. The lack of vitamin absorption with RNY is permanent, however.)

With both surgeries, it is difficult (although not impossible if you overeat on a regular basis) to stretch out the actual pouch or sleeve, but with RNY there is the chance of stretching out the artificial stoma (which the surgeon fashions from tissue to replace the pyloric valve) and then being able to eat far too much.  With VSG, you keep the natural pyloric valve.

RNYers are at higher risk for developing reactive hypoglycemia and kidney stones post-op. RH is usually manageable by careful choice of foods and food combinations, but kidney stones hurt like hell!

It may or may not matter to you that you would keep your remnant stomach with RNY but would not with VSG (but some people care). Some surgeons "forbid" NSAIDs for VSGers, too, but with VSG there isn't the risk of developing an ulcer in the blind remnant stomach (since they remove the rest of the stomach) where the only way to treat it is with systemic drugs or surgery.

With RNY you will lose more quickly (although the rate of loss with either surgery varies widely from one person to another, anyway), but recent studies show that, at 2-3 years out, the amount of weight loss is only slightly higher with RNY.  When it comes to maintaining the weight loss, though, by the time people are 5 years out (or 7, depending on the study), the permanent change in eating habits matters far more than which surgery you have (except for the DS).

As far as my personal experience, it takes a LOT of sugar to make me dump, so with my RNY I eat pretty much the same way that I would if I had the sleeve, anyway. I had significant pain in both knees before surgery, and I greatly overestimated how much pain relief I would get from losing the weight and I underestimated how difficult it would be to not be able to take Aleve or Celebrex during the times that the pain was really bad. (I had both knees replaced, so that issue has been resolved, but I also have some arthritis in my back that sometimes bothers me.) I am also having trouble with bone loss despite taking 2000mg calcium citrate daily, and, to be completely honest, although taking the vitamins does become routine after a while, for the past several years I have times where it really is just a PITA to have to do it every single day of every single week, year after year. Just taking an additional multivitamin with the sleeve would have been so much easier.

So, there are some things to think about.

Also, you might want to pay attention to how far out the people are *****ply to RNY vs VSG questions.  People who are only a few months to a year out are almost always extremely enthusiastic about the surgery they chose.  They are watching the weight come off quickly, are getting lots of compliments, etc., so it is understandable that they would have nothing but glowing things to say.  People who have lived with their surgery for a number of years, though, and who have potentially experienced side-effects or complications, can provide a different perspective about living with a particular surgery for the rest of your life.  That is an important distinction.

Don't get me wrong, having WLS was one of the best decisions I ever made for myself.  I would just choose a different surgery if I were making the decision now instead of 8 years ago.  Ultimately, you have to choose what you think will work best for you.

Lora

Thanks for the assistance with finding more discussions like this. Very helpful for a newbie. 

I chose RNY because I had a family member who had been successful with RNY for 10 years, and I was afraid restriction only wouldn't be enough. I had restricted my intake in the past and not lost weight. I wasn't willing to take a chance of that being the case again. While the malabsorption may not last forever, I needed it to get me on the road.

I don't regret my decision one bit but I probably wouldn't if I had the sleeve either.  Honestly I wanted the sleeve but my insurance only covered RNY.  RNY has been great for me. I am very happy that I did it but mostly I am happy I spent the time before and all my time in the honey moon stage in therapy and doing the work to fix the issues that got me there mentally not just physically!

RNY has the best success rate.  I had the option of a band or an RNY, never sorry I did the RNY.  I think you made the right decision.

Good luck.

JA

RNY 7/21/2004 -100lbs forever!

I also am very happy with the choice I made for RNY.  I chose it for many of the same reasons listed already...I felt I needed the malabsorption to get to goal (which I did) and although I read some people are taking massive vitamins - my regimen isn't bad and my blood work has been fine.  I take 2 multi-vitamins a day (one in AM and one in PM) along with a Calcium/Vitamin D chewable supplement.  Twice a week I take a B12 dissolvable tablet.  I don't think that's too much to deal with for the rest of my life to be at the weight I've always dreamed of, and haven't been since I was a young teen.

Good luck with your RNY.  I agree with the others that the statistics show the greatest weight loss and greatest maintenance of that loss with the RNY.