My Doctor is Trying to Talk Me Into RNY Instead of the Sleeve

Please look at this video from Dr. Weiner - he was not my doctor, but he presents the facts.  Pay especial attention to the post-surgery changes required for each of the options:  Lap Bands require the most "changes" - 12 of 12.  Sleeve fewer - ~8 of 12. RNY 4-6 of 12.  This is consistent with the development of the Sleeve - originally developed as a first step to RNY, but the results were so significant that they discovered that many people never needed more.

I recommend looking at the first 4 videos - although you may want to jump right to the 4th video:

How To Choose the Right Weight Loss Surgery

All videos can be found here                http://drmatthewweiner.com/surgical-weight-loss-video/

First, if you are prepared for the long term changes that you will need to make, then I think that any procedure is better than none. 

As I understand, generally speaking the RNY is for people over 50BMI,  sleeve for under 40 BMI  - I was in between and opted for the RNY because it has been done since the mid 1980s and the long term research is known.  Because my BMI was between at 40 and 50,  we had a discussion about which I would prefer.  I am 6 months post surgery, happy, and this is what I know now. (Last October a friend of mine had the Sleeve and she is just as happy with it - she is 10 years younger than me)

The sleeve procedure is usually a shorter surgical procedure and a day less hospital stay (ask your doctor for sure).  For some people, this will argue for the Sleeve. 

I am 57 and approached this as a one-time thing -so no lap band, and I went for the RNY because I have had a "weight problem" since first grade and I felt I would need the option with the best long term results.  If I were younger, had less weight to lose, I might have chosen the Sleeve.  

Bottom line - I think your doctor is presenting the long term results correctly.  From your post, it looks as if your BMI is in the range that the RYN would be suggested, absent complicating factors.  If think the post suggesting that you pose your query to the Sleeve Forum is a good one.

I hope the videos inform your decision.  If you do not see the part where the long term behavior changes needed to permanently keep the wt off for the different procedures, please contact me and I will look for them.  They helped match the surgery to what you will need to do long term to keep the weight off - which is really the goal.  It's really which procedure is the best match for YOU.

Keep us posted on your progress.

Update: It's been awhile since I actually looked at Dr. Weiner's video -  he presents 11 changes, not 12.  But the gist of what I wrote is correct.   He presents info that may help you have a more complete conversation with your own doctor.

Thank you so much, Sharon!  I really appreciate you sending me that link.  My homework for tonight is going to be watching those videos.

Jami

Just a few corrections and one comment:

1) The sleeve is the first part of the DS (which also utilizes a sleeve and removes the remaining portion of the stomach) not the RNY.

2) BMI really isn't much of a determinant of which surgery one should have, but if it IS used as a determinant, generally the DS is the surgery most widely recommended (by surgeons who DO it) for people, with a starting BMI over 50, not RNY. Note that the surgeon in Texas who does the surgeries on the patients who are 600-700 pounds in "My 600 Pound Life" actually does the VSG quite often rather than RNY.

IMO, the various items in this video that have to be changed based on which surgery you have are highly questionable.  One need not go any further than number one on the Roux-en-Y list: a pound of vegetables a day?!?  Um... No!  We would never get enough protein in! He also says that RNYers don't need to limit salt, which is untrue.  We are at greater risk of kidney stones and limiting sodium intake will help prevent kidney stone formation. Most of the changes should be made for all of the surgeries.

Lora

 A pound of vegetables A DAY!!!! 

Have you reached a pound this month, Grim?!? 

I have popcorn at the movies. I tell my nutritionist I count that as a veggie. At Easter I had mashed potatoes and corn. That's it for 2015. I had about a dozen Skittles at a party. I'm counting that as a dozen servings of fruit.

I had a lap band in 2010 that failed miserably. I didn't want it in the first place and my surgeon didn't want me to have it - he told me right from the start about the failure rate and said he took more lap bands OUT than he put in. But I had no choice - I WANTED an RNY but lap band was the only surgery the insurance I had then would approve, so I went with it, thinking it was better than nothing. I had it for a year, lost maybe 30 lbs, and it was a year of hell, let me tell you! I had to have emergency surgery when it slipped and my stomach twisted - but I was grateful that happened because it meant getting that darned thing out of me!

Fast forward to today. I am now in the pre-op phase for RNY -the insurance I have now will pay for it and as they say, the RNY is the gold standard of WLS, and I've decided to go for the gold! I was initially leaning toward the sleeve but after doing a lot of research and talking to others who've had the sleeve, I changed my mind and decided on bypass. Bypass is also what both my PCP and surgeon suggested for the same reasons you mentioned in your post.

I have 4 friends/acquaintances who have had by-pass surgery and 3 who have had the sleeve. Of the 4 who've had bypass, ALL 4 have reached their goal weights or beyond, and none have had complications except one who developed low blood sugar but she admits she did not take her post-ops supplements as she should, and once she started doing that again, she's been fine. Of the 3 I know who've had the sleeve, one has been very successful in reaching her goal weight in about a year's time - but again, she's only 1 year out so it remains to be seen where things will be a couple of years out. One has had no complications but has had very minimal weight loss despite exercise and sticking to the eating plan she was given. She is now very disappointed in the sleeve and is looking in to revision. The other person lost about 1/2 of what he needed to lose and after two years, regained all that plus more, developed severe GERD, and is now pre-op for a DS. I also met several people at the WLS support group I attend who had the sleeve and are now wanting revisions to RNY due to various reasons - mostly development of GERD and/or poor weight loss results.

I have already had one failed WLS and don't want another, so in the end, after all the research I've done and the personal stories I've heard from others, I've decided to definitely to go with the RNY. I think a lot of it depends on various things as well - age, metabolism, how much you need to lose. I am 64 with a very slow metabolism and need to lose about 150 lbs. If you are young and have a fast (or even normal) metabolism and don't need to lose all that much, a sleeve might work well for you. I would say to do a lot of research and talk personally with people who have had both RNY's and Sleeves and go from there. Good luck to you with whatever surgery you do decide on!

Catherine

Hi, Catherine!  Thank you for responding to my post.  I really appreciate all the information you provided me.  I have a lot to think about.  I'm 44, so I need to make sure to factor that in as well.  That is something I wasn't giving any thought to before.  

Again, thank you for your help!

Jami

I have heard that you may not lose a much weight with the sleeve and I have also heard that a lot of people get the sleeve and then convert to RNY. My very simple and not well research answer is this: I only wanted them to cut into me once. I was going to get the most bang for myy buck and only have one surgery and that meant RNY. Also the sleeve is still somewhat new in the US and I kinda ran into surgons who where not all that expereinced with doing a sleeve. Do what you think is right for you. I would suggest that if you do have more than 150 pounds to loose take a 2nd look at the RNY. Yes, there is some major changes that you have make when you do have an RNY but it has all been worth it for me. I am 2 months out (I had my surgery done on May 26th) and I have lost almost half my excess weight. I feel great and would do the RNY all over again. Good luck with whatever you decide to do.