New to Lightweights borad - Having trouble deciding on surgery type.

I have read on other boards that if you have reflux the sleeve is not a good choice.  Does anyone know why?  

 

 

i had GERD for years before my surgery. Bad enough to have an erosion in my esophagus a year before surgery.  I thought my surgeon said the sleeve can actually HELP, not worsen, GERD.  Maybe I misheard. 

My experience is no GERD problems so far, but then I'm only 10 weeks out. And I stopped taking the PPI  a  month ago.

As for eating sweets with my sleeve, I'm like Kim.  A little sweets now goes a long way.   You know those people who put 1/2 of a pink envelope sweetener in their huge cup of coffee?  Yeah, that's me now. 

I can only speak from experience, and I had the sleeve.  I had awful GERD diagnosed about 3 years ago.  Eventually I got it under control with some lifestyle changes and Nexium.  I can honestly say that my GERD is even better after surgery.  I'm going to explore with my doctor the possibility of changing to another med (generic) since it's more under control. 

I lost my taste for sweets after surgery; some people say it will return, but it hasn't yet.  I crave meat, vegetables, and fruit, and I've read that this is quite common--my body wants the healthy stuff.  Hard to believe, but it really has happened to me.  I like that I haven't had one issue related to nutrition deficiency, and that my vitamin regimein is quite manageable and affordable.

On the other side if I had a procedure with the added component of malabsorbtion, I would probably have lost more weight by now.  I fully anticipate that I'll reach goal; it might just be slower than other procedures.  If I had diabetes, I would seriously consider RNY since it has very good results for diabetes resolution.

There are long term results for sleeve, but it's just that it's data related to partial gastrectomies that have been performed for dozens of years for people with cancer and bad ulcer issues.  For me it may have been somewhat of a leap of faith since studies for this procedure focusing on weight loss are only around 5 years out, but the whole philosophy made sense to me.

Go with what's in your heart.  No one else can tell you what's right for you.  All of the major procedures have great qualities.  Good luck.

I have to say that I do love my sleeve.  I'm 2 years and 4 months out now and am well below goal and maintaining pretty easily.  I am and always have been an avid exerciser...been exercising since my mid 20's and am now in my late 40's.  This may be why it's been so easy for me to maintain.  I can eat anything I want without issue but choose to follow a relatively lower carb/higher protein diet to meet my fitness goal of building muscle.  I still have excellent restriction and eat about 2.5 to 3 ounces of dense protein with 1/3 cup veggies.  I drink protein shakes daily to supplement my protein intake and take in about 1500 - 1800 calories a day.

I know this is a very personal decision, but wanted to relay my experience. : )

Laura

I know you've already decided (saw the other thread) but I wanted to throw out my two cents for the lurkers.

I think you need to keep your eating issues in mind but that's only one piece of the puzzle. For all these surgeries, there are lifestyle adjustments that come with them and that is also a factor. So are medical conditions. So is $$$ (i.e., what insurance will pay for; what you can afford)

The way I see it:

Lap band: least effective statistically and has the highest re-surgery rate. Therefore, it should be reserved for those with no other choice - insurance won't pay for something else, medical reasons you can't get one of the other ones, you can't deal with having a more permanent surgery.
-Does work pretty well for people who are high-volume eaters and have no other issues.
-A bad choice if you have bulimic tendencies.
-Probably not a good choice if you are SMO given its poor weight loss stats (compared to the others, not to dieting. They all beat dieting.)
-You need to be okay with needles (fills) and with having a foreign object inside you (freaks some people out).
-Need to realize that it is a permanent surgery and your stomach may never go back if you have it taken out even though it's touted as reversible

RnY: decent stats but regain has been an issue
-Some chance of nutritional issues and reactive hypoglycemia (compared to a band).
-Has dumping which is a deterrent for some, a deal-breaker for others.
-Almost always covered by insurance and has been done the longest so has the most stats and studies about it.
-3rd most expensive if you are a self-pay.
-Can be reversed by it's a hairy surgery that is usually only done to prevent death - so you have to think of it as permanent

Sleeve: decent stats (similar to RnY) but hasn't been around long enough to have 10 year studies or the volume of studies that RnY has.
-Costs more than a band at first but when you factor in fills and stuff, it's about the same; this makes it a great value for self-pays.
-Also, it's designed to be revised so it won't lock you out of another surgery down the road if that's necessary.
-Still not as widely covered by insurance as the others.
-Has great hunger control because it lowers ghrelin significantly
-Can't be reversed, period.
-Even though there is no intestinal bypass, nutritional issues can happen. It's much less likely than with RnY or DS but the chance isn't zero.

DS: best weight loss stats, most complications especially nutritional ones. (But less chance of RH than RnY?)
-Good choice if you have metabolic issues, are SMO, or have lots of exercise restrictions.
-Bad choice if you are bad about taking supplements and monitoring your labs.
-Eating carbs causes noxious gas which is a deterrent for some, a deal-breaker for others
-Intestinal part can be reversed, but stomach part can't (it's a VSG stomach)
-Most expensive if you are self-pay.
-Usually covered by insurance, but not as much as RnY or the band.

I'm sure I left some considerations out. This is just a summary of the main ones. If others have other considerations, throw them out!

I know when I was deciding, the most important factors FOR ME were:
-hunger control
-good weight loss (but I didn't need the best because I'm a good dieter)
-least chance of complications down the road

I felt like the sleeve provided these things.

As a self-pay, I couldn't see paying more for a surgery that wasn't any more effective but had more complications post-op (RnY). But, if insurance had paid for some types and not others, I might have seen it differently.

Plus, the part of the stomach that is removed is the part that makes ghrelin and I knew I had too much ghrelin. So I felt like VSG directly addressed my food issues while RnY and lapband only indirectly addressed them.

If I had needed the extra "umph" of the DS, I would have considered it, but I didn't so I figured there was nothing to be gained by taking on the extra cost and extra risks. That would be different if I was SMO or had diabetes or something like that.

Good summary

Okay a few points I'd change:
Carbs can cause gas in RNY patients
Carbs do not always cause gas with DS patients (I wi**** did, my hubby is addicted to carbs)
Stats for the remission rates on diabetes can be found here: http://www.asmbs.org/Newsite07/resources/aace-tos-asmbs.pdf
(DS is best there). The RNY rate is 85-93%, the DS rate is 95-98%.
Diabetes has been known to return later on with the RNY. But the RH (or late dumping as it's also called) was one of the major reasons I avoided that surgery.

Liz

The RH thing is tricky because apparently people get it who have all the surgeries. (Except maybe a lapband?) It seems like more RnYers get it but there are more RnYers. So the question is: is the percentage higher? No one has studied this clinically so we don't know.

I thought white carbs (simple, not complex) caused bad gas with the DS worse than with the other surgeries. That's what my DS friends told me and what I saw on the DS board. But it's just white carbs. I know I said "carbs" but I just spaced on that. :-D

Simple carbs do affect me if I'm not careful but there are many DSrs that have the same common channel length as me and aren't bothered by them. Also, there are a few DS surgeons who are now doing longer common channels for LWs and they aren't getting the gas issues that some of us do. Perhaps a YMMV thing and common channel length thing.   

I did a google search of RH and weight loss surgery (not any specific type) and leaving out the non-medical while I was still researching surgeries. Time and again, the medical articles I came across mentioned the RNY not any other surgery.

Now, the DS may not be performed as much and that may mess with the statistics but when I see thread after thread after thread mentioning RH (late dumping as some are calling it) and 99% of them are RNY'ers that tells me it's primarily a RNY problem.

Some of us already had RH before we even had surgery and that condition is usually affected by carb intake. So the more carbs you eat, the more likely you will still have it. I know I do but I have had RH for almost 2 decades...I knew I had it and therefore my carb intake tends to stay low and away from starchy carbs of any color.

Here is a list of articles I found:
I have these articles for reference on diabetes and Reactive Hypoglycemia (or late dumping as some articles are calling it)
Endocrine News
Endocrine Today Blog
Evaluation and Management of Adult Hypoglycemic Disorders An Endocrine Society Clinical Practice Guideline
Low blood glucose levels may complicate gastric bypass surgery
Gastric Bypass Linked to Abnormal Glucose Tolerance
Abnormal glucose tolerance testing following gastric bypass demonstrates reactive hypoglycemia
Pathophysiology, diagnosis and management of postoperative dumping syndrome which is the video posted by MeltingMama and done by the Joslin Clinic who specializes in Diabetes Care.

But Melting Mama is compiling a list and she has people with DS and VSG on it. Not very many, but some.

So that's why I think it's tricky... I think we just don't know yet.

It's kind of like when they were telling bandsters that NSAIDs would cause erosion and then latter on they said... oh no, nevermind. :-D

I'd just hate to tell someone not to get RnY because of RH and have them get RH anyway. So I think it's a consideration but probably not a deal-breaking one until we know for sure.