Deciding on RNY or Sleeve... Please give me as much insight as possible.

I am trying to decide on which surgery is best for me. I am leaning towards the RNY and my wife wants me to get the sleeve.

First let me tell you a little about me...

46 yrs old, 335 lb CW, 355 HW.... I currently do not have high blood pressure, diabetes, or sleep apnea. But I am sure I will get some of these conditions if I don't do something about my weight. I do have a thyroid condition and take Levothyroxine 200 mcg.

I started to pack on the lbs in my late twenties, after getting married and starting a family. Prior to that I was very active with working out and sports. I did a lot of power weight lifting back then and was 195 -220 range muscular build. But over the past 15-20 years I no longer play sports and do not work out like I did and have been steadily gaining weight. I know that I do not eat correctly as I skip breakfast, have fast food lunches, and very large dinners. I am a flavor eater and love my bread and pasta, if it taste good I know that I over eat way past the point of being full and I am a late night snacker.

My surgeon tells me that he thinks I would do well with either the sleeve or the RNY... I am personally leaning towards the RNY simply because I believe it will keep me in check if I do eat the wrong things it will correct me by dumping and making me feel ill and teach me not to do that again.... However, my wife is scared that the RNY is too restrictive and fears that I would be miserable with such strict diet.

Please help educate us on the choices between the RNY and Sleeve.

There is no difference in the diet after RNY or VSG. I gave up sugar, flour, rice, pasta, bread, potatoes and sweets. I eat six meals a day of about 200 calories each. They are dense protein and non-starchy vegetables.

With RNY your food malabsorbs for the first year or two. That makes the initial weight loss easy. With the sleeve everything you eat is absorbed and you lose weight by eating fewer calories.

Both surgeries end up being a matter of eating the correct calories for your weight and eating protein for your health.

Dumping is a very effective reminder for me that I do not want to eat too much sugar. There was Halloween candy everywhere this week and if I did not have fear of dumping I would probably have been eating it.

I went with the sleeve in 2007 as was worried the bypass changed my insides too much.
The keeping in check was what I was battling with as I needed that too.
But I went the VSG and am now booked in for revision to bypass next year.
Yes the sleeve is great, but is restrictive only, nothing keeps you in check, potential for excessive reflux and potential to put the weight back on.
If I had my time again I would've just gone with the bypass. I think if you are going to do it..moo with what you think best and what you need. Being conservative didn't work for me.

I went with RNY mostly because I had GERD. I didn't want it to get any worse. It often gets worse with VSG. On the other hand, RNY often cures it (which it did mine - haven't had any issues with it since surgery). If it weren't for that, I think I would have been happy with either surgery. Post-op diets are the same, and although people often lose more weight *initially* with RNY, after a couple of years, it evens out - i.e., weight loss is about the same regardless of the surgery.

and yes - there's the dumping thing. I've never dumped, but then, I don't want to dump so I don't push the envelope at all. Whenever I eat sweets, which is rarely, I never eat more than a bite or two because of my fear of dumping.

The extreme restriction only lasts about a year or so with RNY. Not that you go back to pre-surgery but there are times I can eat what I consider a fairly normal meal. What made me decide to have RNY was I wanted the advantage of malabsorption to get my weight loss moving. I had been on diets where I was restricting myself yet at this point in my life I wasn't having any significant weight loss. So I feared restriction wouldn't be enough.

The diet is the same no matter which you chose, and while only 30% have dumping, fear of dumping will help keep you from going overboard. Both surgeries require vitamins.

This is your surgery, and you have to go with your gut....

I went with RNY because of it's long track record. I figured 'they' (doctors) have had years to finesse this surgery and really figure what makes it effective.

Be cautioned not everyone dumps- I see so many wanting that to keep them in check, when I think statistics say in reality only 15-40% dump. So I can eat sugar, but like most, I don't push the envelope cause I never know which bite may trigger an adverse reaction. Fatty foods don't agree with me at all-- so I eat nothing fried, even bologna is too fatty for me and leaves me with an upset stomach.

Good luck deciding!

I initially wanted the sleeve and was a little scared of RNY. Due to my history of GERD and Barrett's Esophagus, I was advised that RNY would be better for me. Now, a year later, I'm VERY glad I did RNY. In one of the groups I attend, the doctor has said they now believe they have longer lasting results with RNY and that the long term success may be higher. RNY is still considered "The Gold Standard" in WLS.

Hi

First of all congrats on your decision to have WLS. As you have probably heard, this is not an easy decision or life, but worth every minute. My surgeon still recommends RNY over sleeve as he feels the success rate is better. I have RNY (Laparscopic) 11 years ago, and the first few weeks were tough. I, too, was a huge pasta, bread person. I no longer eat pasta or bread, except on rare occasions. I find if I do, I gain weight. I have been fortunate enough to keep my weight off, but it is not an easy task and something that I must work at every single day.

It is a personal choice. Good luck to you! Wishing you great success.

JA

Hey there! Congrats on making the decision to improve your health. I think that's great.

I had the RNY and I did it for many of hte same reasons you listed. What I didn't know, however, is that not all RNY patients experience dumping syndrome! I think the last statistic I read was that 35-40% do.

So far as the post-op diet, there is no difference in how RNYers and folks with the Sleeve eat. In fact most surgeries follow the same general principles (the duodenal switch is slightly different). There's a heavy emphasis on protein intake, with moderate amounts of complex carbohydrates and good fats. You'll work directly with a registered dietician (so long as you have surgery at a Bariatric Center of Excellence) to figure out your unique caloric, protein and meal size needs.

I think it's a common misconception that RNY is more restrictive surgery. The biggest difference between the RNY and the Sleeve is that with the RNY a portion of the intestinal tract is bypassed so that it cannot absorb calories from food. This also means several vitamin absorption points in the intestinal tract are also bypassed, which means keeping up with your vitamins is essential to avoiding and managing deficiencies. Sleeve patients are also required to take vitamins, however, there isn't enough evidence yet to determine whether Sleeve patients (in the long term) develop deficiencies the same way RNY patients do.

I do think that the possibility of dumping syndrome could be a powerful tool but I just want you to understand that's not a given. I do in fact dump from sugar and it didn't take too many instances of me getting sick (usually from natural sugars from things like fruit) before I started to change my behavior. It was sort of like nutritional electro-shock therapy or something. I didn't like the reaction I got from ingesting sugar so now I sort of have a mind thing about sweet food in general!

I hope this helps.