Effectiveness of the Sleeve for persons with higher BMIs

 Hello all, I am currently in my pre-surgery class, about half way through and I still am not 100% sure which surgery I would like to have. I won't be able to meet with the surgeon unil I have completed my classes, so another 6 weeks to finish and then wait for my appointment. I know I want to discuss the VSG and RN-Y with him. 
My questions is this : is the sleeve as effective as the rny for larger people (currently BMI is 57) and if so, how fast is the weight loss compared to rny? Are you required to take vitamins for the rest of your life like rny also?

 There are quite a few people here who have been successful after starting with a higher BMI. I think the stats for rate of weight loss are pretty similar between VSG and RNY with perhaps a slight edge to RNY bc of malabsorption. 

Most docs want their VSG patients on some vitamins post op because the amount of food we eat for a while makes it impossible to get everything we need from food but id imagine later on, you could tailor your vites to your specific labs - maybe you need them, maybe you dont. 

Just one thing to keep in mind for those of us that start at higher BMIs - we have a lot to lose. We usually aren't going to fall within the group of people that are getting to goal 6 mo, 12 mo, or even 18 mo post op. With the RNY, you are going to lose the benefit of malabsorption around the 18 mo mark - you may or may not be done losing, but regardless, you will have to have good eating habits in place to compensate for that loss of malabsorption. In the end, even with the RNY, you end up with a restrictive only procedure (except you will always malabsorp vitamins) but double the risk for ulcers, bowel obstructions, no nsaids, etc....so really, I personally think if I'm going to end up with a restrictive only procedure, I might as well have a plyloric valve and take nsaids. But the very bottom line is that you have to change your relationship with food with both surgeries in order to have long term success with getting to goal and maintaining. 

 acbbrown - "With the RNY, you are going to lose the benefit of malabsorption around the 18 mo mark - you may or may not be done losing, but regardless, you will have to have good eating habits in place to compensate for that loss of malabsorption. In the end, even with the RNY, you end up with a restrictive only procedure"

I had no idea this was the case. Thanks for the info. I never seriously considered the RNY, so my research was limited to the sleeve... but I love learning new things. 

 I considered the RNY for about....a day. Until I learned about the sleeve - and then I was all about the sleeve.   

I'm personally in the revision process from Lap Band to the sleeve.  I ended up switching surgeons for a variety of reasons, including the one I left (Dr. Baghai) wanting to give me a RnY (if that were the only thing wrong, I could have fixed it.).

All the surgeries have pros and cons.  If your BMI is truly high, DS is probably your best bet.  Many times, the DS is done in two surgeries, with the first being the sleeve and the second being the switch part.

RnY will probably get you where you want to go with the weight loss but the malabsorption is temporary (lasts about year), you should never have a blind NG tube (it could a rip a hole) and you shouldn't take NSAIDS.

You should be open and do enough research to discuss your options with your surgeon.  He/she can't submit the pre-authorization request to your insurance until you have had this discussion.  Use the six weeks or so to ready yourself.

Ditto what Alison said above.

As you do all your research, please don't use "how fast is weight loss" as a measuring stick, IMO. We all lose at different rates regardless of the surgery. This is not a race. When you start at SMO it's just going to take longer than allot of other people.  You should be looking at
the LT results of the surgeries from your surgeon perspective; utilize the input from your PCP and other specialists if necessary; and of course the differences in the surgeries.

Both are going to require a lifestyle change for life. Both will probably require some type of supplements, if not for life, for a significant period of time.

VSG has worked for me. Started at a 61.4 BMI. Still working on getting to goal but it will happen.

 Maybe we can both get to goal by Oct and celebrate in ATL :)

Lord---I'm hoping to get there before October. Losses are just creeping along now, though.

But like I said before....First round is on me!!!    (that's either a margarita or a glass of wine)

Ive found some renewed energy to kick it up a notch to get to goal....i really better be there before October, but who knows. Can't wait until October :)

 
There are many variables..... The VSG is not a standardized procedure......

I was a 54BMI and went from 338lbs. to 148lbs. in 13 months and have been in a 5lbs. range since.

Some things that will "GREATLY" increase your chances.......

- Picking a surgeon that has a high success rate/history with high BMI patients.

- Aftercare/Education

- Commitment and Compliance

The only bypass type surgery (in my opinion) to consider is the DS, It's a VSG (most times larger) with a bypass component to it.

** The DS requires a very strict vitamin supplement regime.....most times not the drug store variety........could be as much as a car payment every month. That said, the DS is a very effective surgery for the right person.


frisco