I am leaning towards RnY but the doc says she recommends VSG?

Hello, all!

I am just starting my WLS process, month 1 of my 6 month wait. I've consumed a lot of information over the last several years. Seriously. I tried to log in here and found out I had an account from 2012 that I made when a doctor told me to get WLS. So yeah, this isn't something spur of the moment for me.

I met with the surgeon last week and she seems to be highly recommending VSG. She even mentioned revision down the line. I think I would honestly just get the stronger surgery that I know I need all at once instead of 2 surgeries. BMI is 62, so she says I have a higher risk. I am unsure about that, but I was curious if anyone had similar stories and/or what helped them make their decision. The program navigator told me I get final say on which surgery, but I want to make sure I make a good choice. I am legit petrified of blowing it/regaining.

Thanks for reading!

Hello! If your surgeon is really pushing the VSG, I would be very open with her and ask her why. Tell her you were really leaning toward the RNY because of A, B, and C and you want to know why she believes VSG would be a better option.

My decision was easy, I wanted the surgery that would help me lose the most weight, the fastest, and had the highest percentage of success. So I decided on the Duodenal Switch. Well, turns out no one in my area preforms that surgery and accepts my insurance, so I went with the next best option, the RNY. In terms of weight loss and keeping it off, the surgeries stack up as 1) Duodenal Switch 2) RNY 3) VSG 4) others such as lap band and gastric balloon.

Also, I had heartburn, so I would've had a large risk of developing GERD with VSG, I think like 30% of people develop it after getting VSG regardless, so there was that.

Anyways, best of luck and I hope you're able to get the best surgery for your particular situation!

She mentioned me being larger was higher risk., but I think it's riskier to either do nothing or to elect for multiple surgeries. I have a pal who had switch, but I don't have a switch surgeon in my area. I'm trying to find data on the super obese ( !!!) and the additional risks and falling flat. I'm typing up an email now to the surgery navigator telling her where my thoughts are.

I am SUPER scared of failure. I already have psych scheduled (appt not eval) and all three of the required nutrition appts scheduled. It's probably not great to go into this thinking I may fail, but I've failed with wait all my life, so what else do I have to go off of? I just do not want to be a person that loses 100+ pounds only to be back where I started.

Welcome back.

With a 62 BMI you will always be higher risk no matter which surgery you choose. Face it before the VSG became popular the last few years the surgeon would have recommended RNY.

Why I personally chose RNY? I had gotten to a point in my life where I would put myself on diets but could never lose more than 10 lbs no matter what I did. I felt I needed the advantage of malabsorption to get me on my way. I too would want one surgery and done.

This may not be what you want to hear, but maybe you should get an opinion from another Bariatric surgeon. Maybe your surgeon is not confident in their skills at a high BMI range and VSG is an easier surgery. The fact that she mentions revision down the road says to me it is more about your size than which surgery is most beneficial to you.

Six years ago, just shy of 400lbs I needed a hysterectomy. My gynecologist- who I love and still see - was hemming and hawing about being able to do it laparoscopically. I decided to go to Sloan Kettering, the surgeon never said anything about not doing it laparoscopic. She not only had better skills but better equipment. Yes the surgery too longer than expected. Six rather than two hours, but she never made the decision to open me up just to make it easier for her. So something to consider.

If you do well on your six month diet, the surgeon maybe more supportive of RNY.

Good Luck!

I agree, sounds like the surgeon is not as confident doing an RNY and may also want to minimize any risks to her surgical stats. Her recommendation may be more in her best interest and not as much for your long term goals. I'd get a second (or third) opinion with a surgeon that has experience with patients over 60 BMI.

Something else to consider is that many insurance plans only allow 1 bariatric surgery per lifetime so if you go with VSG and need to revise to RNY later you may have to pay for it 100% out-of-pocket.

My surgeon also recommended VSG. My bariatric center said when you BMI is over 60 they prefer to do VSG as less complicated. My BMI was 63, lots of abdominal fat and I'm short so there wasn't a lot of room in there. I did my research and I wanted RNY, I was 100 percent sure. I had diabetes and I wanted the most successful surgery for me. I told my surgeon my opinion and he said he would do RNY if he got in there and he felt it was safe. If he didn't he would do VSG. My consent for surgery said VSG with possible RNY. I really did advocate for myself and made sure he knew my preference. I woke up with RNY and was thrilled, I was prepared for either but was so happy. The bottom line is they will do what is safe but it never hurts to advocate on your own behalf. In the end you will lose weight with either. Best of luck to you :)

I sent a long email to the Coordinator which my reasons why I want RnY. She said the decision is of course mine and she will let the team know. We will see what else happens. This is covered by my insurance, but I work for a hospital system so I have to use our docs. I can always see if there is a different surgeon in the same group or another of our office locations. Surely she isn't the only one. Oddly, when I first called the center.. first contact, the lady was going on about VSG and how that's what most co-workers get. From the start that seemed like the preferred surgery.

I guess it's just easier? I don't know but I also found out I'm vitamin D deficient, so that's my next hurdle