VSG to RNY with only 10-25 lbs to lose?

question: Is there anyone out there who had a conversion when they were almost at or back to their goal weight? At the rate I'm losing what I gained back, I will likely only be 10 lbs or so over my goal weight by the time I have surgery. I need some reassurance that I won't be miserable please!

The story: It looks like I will need a VSG to RNY revision due to a hiatal hernia and GERD. I am trying to accept that this is what needs to happen, but I am honestly so so upset. I had my VSG 7.5 years ago, got to my goal weight (lost around 120 lbs) and did have a good amount of regain creep on over the years. But once I started paying attention to my eating (used Weigh****chers online) and running again, I've been losing weight pretty easily: 50 lbs over the last 16 months, following WW about half the time. I'm 25 lbs over my ideal right now, and going down consistently with WW since I started being serious about following the plan. I would never have a conversion for weight loss at this point.

The problem is that I have a large hiatal hernia, with GERD that causes severe pain when I run, and an almost daily episode of inability to eat more than a couple of bites of food without vomiting. I've had to start drinking protein shakes again in order to get enough protein in, and I'm not a fan of that. Its obviously not sustainable to stay like this. I only started having problems in January but my surgeon says nothing will fix this long term but converting to RNY. It terrifies me though.

I am a trail runner and had a goal of doing an ultramarathon at the end of this year. I'm afraid I won't even be able to take in enough calories to maintain a real training schedule. It took me a long time to learn how to manage that with my sleeve. I dread going through learning how to live with new anatomy all over again, and possibly struggling with calorie and vitamin intake for the long term. Everything went so smoothly with my sleeve until 2019 :(.

Someone tell me that it will be easier than I am imagining lol!

I'm not really sure what you are afraid of. I think it's that you won't be able to eat enough, and you'll waste away? Thats really, really not a thing. You can take in enough with RNY that you could be obese again -- if you eat too much of the wrong things.

There have been a great many people on here who were at, or below, goal weight, but had to convert from VSG to RNY because of GERD. They were all really glad they di d.

It sounds like you've been utterly miserable with reflux. And it's no joke. Long term you are looking at serious, life threatening issues from GERD. I think you'll be really relieved you had this done.

Thanks for your reply! I definitely agree that I need the revision. Although it has been hard to stop thinking "can't you just fix the hernia?" I'm very glad to hear that there are lots of people who had a revision at or near goal weight. Do you know of anyone who did so while maintaining any kind of intensive exercise program?

I'm not afraid of wasting away, but I am afraid of not being able to meet my energy/protein requirements for long distance running. I couldn't have done that for my first six months post-op VSG for sure. I can't stand the thought of not being able to get out and run the trails, or having to drop the goals I set for myself.

I'm thinking back to being a newly post-OP with VSG and how tight my sleeve was and I can't imagine getting in all the calories I eat now. I think I lost about 80 lbs in the first three months without ever feeling hungry or doing any real exercise. How will a new pouch with RNY be different?

I understand regain after several years, due to bad habits. I would not have regained without eating processed carbs (ie too many cookies) and I don't do that anymore. So I am wondering with my stomach reduced in size even more, and body not having that first two years to accommodate, what will post-OP eating be like?

I'm also afraid of dumping. During long runs (2+ hrs) I periodically eat energy gels. They are all sugar. If I don't have them, my blood sugar bottoms out. But I've heard that taking in pure sugar like that with RNY can lead to super unpleasant side effects?

I'm afraid of vitamin deficiencies too.

So I guess that's enough fears for one reply lol. Thanks again for writing back!

Not everybody dumps after RNY. I can't recall the exact number, but I seem to remember reading somewhere that it's less than half?

As long as you take your vitamins-- which you should already be doing after VSG-- there shouldn't be too much to worry about regarding vitamin deficiencies. Have your blood work done on a regular basis and follow the ASMBS supplementation guidelines. Most people can easily meet their requirements with a double dose of an adult multi (like Centrum) plus additional calcium and iron.

I would suggest checking out the revision forum, there are plenty of folks there who can share their experiences and hopefully put your mind at ease.

I did. I was about 10lbs from goal when I converted from VSG to RNY because of severe GERD. I run 1/2 marathons and didn't notice any appreciable change from the races I ran post VSG to the races I've run post conversion. I don't have problems with gels (although I find swedish fish or licorice works better for me than the gels, but that's a personal preference and not a surgery thing)

I revised in July, ran my first timed 10k in September and didn't have any problems with nutrition, etc.

Feel free to ask if you have specific questions.

Did insurance pay for the revision? I am about & years post op sleeve and have GERD w about 20lbs weight gain BMI approx 31 now.

Once again Grim has such good advice. I had hiatal hernia fixed and OMG it's a new life.