Question:
Should I choose RNY or VSG?

I'm 29 yrs old, need to lose 95 lbs    — Rox75 (posted on May 15, 2008)

May 15, 2008
Look at lap band.at an center of excellence
   — stanwalker

May 15, 2008
i am 31 and had rny 5 months ago.. i am so happy with my decision. i would research all your options and speak to your surgeon and see what he/she recomends. good luck
   — JACKIESMOM

May 15, 2008
Take this for what it's worth. I am telling you up front that I am NOT an "Expert" on Weight Loss Surgery. I encourage EVERYONE to RESEARCH EACH surgical option FOR THEMSELVES! THIS is the information that I have found in MY research. I have posted it here for people in an effort to help GUIDE folks and help them START their OWN journey into their OWN research. There are a LOT of differences in the different types of surgical procedures. There are a LOT of differences in different SURGEONS. Some surgeons require more of their patients than others. Some PROCEDURES require more of the patient than others. You need to do some research and find the BEST fit for YOU. I just had a Vertical Sleeve Gastrectomy on March 1, 2008. My surgeon did NOT require me to lose weight. I had a BMI of 43.6. Now that isn't NEARLY as bad as many people. Had I been HEAVIER, he may HAVE required it. I don't know. What I CAN tell you is that I was having problems with arthritis in my knees and my shoulder. That was almost three months ago. Now it is GONE. There is just a TWINGE every now and again but NOTHING NEAR the constant agony that I was in before! I was also a Diabetic 3 months ago. I have had to DROP all of my diabetes medications on Easter Day because the ONE glucovance pill that I was taking caused me to have my blood sugar to DROP to 53 POINTS! My sugars are still a LITTLE high, but under 150 (usually between 114 to 140 after a meal) and WITHOUT medication! In a FEW weeks with some MORE weight loss, I figure that my diabetes will be in COMPLETE remission! I have lost 59 pounds in a little over 2 MONTHS with my surgery (the VSG) and it was done WITHOUT feeling HUNGRY! From what I have learned, your MAIN options are the Lap Band, the Vertical Banded Gastroplasty, the Gastric Bypass, The Duodenal Switch and the Vertical Sleeve Gastrectomy. There are other options, I am sure, but these are the most common that I have found. There are also combinations of these options ALSO available such as the Banded Duodenal Switch, the Banded Gastric Bypass, and the Banded Sleeve Gastrectomy. The Banded options are basically the same as the Regular surgeries but they have a Lap Band added as additional insurance in case of future need. The Lap Band: (http://www.obesityhelp.com/content/wlsurgery.html#LapBand) is well known. It basically squeezes the stomach to make it smaller and creates a pouch with a restriction at the top of the stomach which fills quickly and empties slowly. The advantages of this surgery are that it is reversible if needed and it is adjustable if needed. It is a HIGHLY flexible procedure. This surgery is well known and excepted by many insurance companies. It may be best for people who have a history of cancer either themselves or in their family and may need to take chemo-therapy and for women in childbearing years who may become pregnant. There are also other reasons for wanting this type of surgery, but I don't want to spend ALL day writing this. There is an effective Excess body weight loss over 3 to 5 years of 50% to 60% noted in some studies. The PROBLEM with this option is that there are sometimes complications with this device. Some people have a reaction to the foreign object in their body. People with immune issues should NOT have this device. Lupus and MS patients for example, can have a reaction to the foreign body and it may trigger an immune system response. Other issues with the Lap Band are that it is common for the band to "Slip" on the stomach and cause the pouch to enlarge thus causing the person with the device to eat more and negating the purpose of the surgery. Some surgeons have started stitching the band to the stomach to prevent this from happening. It would be wise to ask your surgeon if you are considering this option if he does this. Other times people have learned to "Eat around the Band" and force the food PAST the band to fill up the rest of the stomach and thus defeat the purpose of the band. Actually, this is an issue with ALL weight loss surgeries. All can be defeated by a patient who is either ignorant or intent on doing so. It seems to be MORE common with the Banded options, however. Another issue with Banded options is that occasionally the bands will erode the outside lining of the stomach causing damage to the stomach that often needs repairs and calls for a removal of the band and or a revision to some other type of weight loss option. This happens in about less than 1% of the Lap Band Surgeries but it IS something that needs to be taken into consideration. In the Vertical Banded Gastroplasty: (http://www.obesityhelp.com/content/wlsurgery.html#VBG) (commonly known as stomach stapling) the surgeon makes a cut into the stomach to create a pouch. He sews the pouch and places a band at the bottom of the pouch. This banded option has less chance of the band slipping since the cut in the stomach holds it into place. It also has the advantage of being somewhat reversible but is not as easily reversible as the Lap Band. It is NOT as well known as it's more famous banded cousin, the Lap Band. There my be difficulties in getting this option with some insurance companies. It has many of the advantages and disadvantages of the Lap Band surgery with the exception that the Band does not tend to slip and let the pouch expand. The Gastric Bypass: ( http://www.obesityhelp.com/content/wlsurgery.html#RNY) is made when the surgeon cuts the TOP of the stomach off and creates a pouch. An OLDER version of this surgery left the stomach intact but had a line of staples that was used to create the pouch. This method is no longer in use much if at all. The surgeon then takes a length of intestine and BYPASSES it. He takes the LOOSE end that is still attached to the intestines and sews it to the SIDE of the pouch that was created from the TOP of the stomach. The BYPASSED intestine is then attached to the side of the intestine that was connected to the pouch so that BILE from the bile duct can empty bile from the liver into the intestine. This option is often the DARLING of insurance companies. Many companies that won't pay for any OTHER Weight Loss Surgeries will pay for THIS one. THAT makes THIS surgery quite popular for many surgeons! This surgery has the advantage of being a HIGHLY effective tool in the arsenal of weapons against the foe obesity! It has an effective rate of weight loss and maintenance of 60 to 80% in some studies at 1 to 2 years. The DOWNSIDE of this weight loss option is that there issues of malabsorption of minerals and vitamins due to the bypassed intestine. This often leaves the patient reliant on his doctor for the special supplements required to maintain his or her health. Other issues are dumping, nausea, and vomiting. Dumping is basically when you have diarrhea that is caused by the intestine's inability to absorb the food that was eaten. Along with the diarrhea can come intestinal cramping, sweating, palpitations and other unpleasant side effects. Some people experience dumping with sweets. Others experience it with fats. Each person seems to have their own issues but whatever they are, they cause them to excrete the food that they ate before it was fully digested. Nausea and vomiting, while experienced by many in ALL weight loss surgeries is NOT experienced by ALL. It does seem to be MORE PREVALENT in the GASTRIC BYPASS and DUODENAL SWITCH patients according to the research that I have seen. The gas and foul smelling stool are also a result of the shortened digestive process due to the bypassed intestine in both the Gastric Bypass and the Duodenal Switch. The Duodenal Switch: (http://www.obesityhelp.com/content/wlsurgery.html#DS ) is the STRONGEST tool in this arsenal of weapons! Many surgeons think it shouldn't be used lightly and often only recommend the procedure for people with a body mass index OVER 50! In the Duodenal Switch, the surgeon REMOVES approximately 85% of the stomach including MOST of the region of the stomach that produces the hormone grehlin. Grehlin is one of the hormones that create HUNGER. Removing the section of the stomach that creates hunger is a HUGE feature of this procedure. The surgeons then sew the rest of the stomach back together and create a tube shaped stomach that resists stretching. The stomach varies in size depending on the surgeon and the patient but can be anywhere from 2 ounces to 6 ounces. Perhaps more. The next step of this procedure involves bypassing the intestine just like in the Gastric Bypass. Instead of attaching the intestine to the SIDE of the stomach, it is attached to the BOTTOM of the stomach where the intestine used to exit. The bypassed intestine is then sewn at one end near the liver and the far end of the intestine is sewn to the intestine that was attached to the stomach to pass bile to the intestines as it does in the gastric bypass. This procedure is MORE efficient than the Gastric Bypass in losing weight. This option has an effective rate of weight loss and maintenance of 70 to 90% in those same studies. The downside when compared to the Gastric Bypass is that Insurance companies often do not know of this option and are often reluctant to pay for it. This option has many of the same issues as the Gastric Bypass. There are some severe malabsorption issues. There are often issues with dumping, nausea, vomiting, GERD (acid reflux), gas and foul smelling stools. The Many surgeons have been reluctant to perform this surgery due to the severity of the complications that can arise. This is why it is often reserved for those who are considered severely morbidly obese. Many surgeons had looked for an alternative to this surgery which lead to what was initially considered a "Half Duodenal Switch" or as it later became known, the "Vertical Sleeve Gastrectomy." The Vertical Sleeve Gastrectomy: (http://www.obesityhelp.com/content/wlsurgery.html#VSG) (if you get the same picture as the Vertical Banded Gastroplasty, just scroll UP) is a GREAT tool to use in the fight against obesity. While not QUITE as effective as the Duodenal Switch, it is often JUST as effective as the Gastric Bypass without the severity of the side effects of EITHER of those two options. The Vertical Sleeve Gastrectomy initially started as an attempt to create a safer Duodenal Switch alternative. While early attempts were not as successful in weight loss reduction, this was mainly due to the fact that the surgeons were relying on the larger size stomach often used for the Duodenal Switch patients who often rely on the "Switch" part of the surgery for some of the weight loss. Once the surgeons started reducing the size of the STOMACH, the Vertical Sleeve Gastrectomy became a much more effective tool at helping the patient loose weight. In the Vertical Sleeve Gastrectomy, the stomach is cut and approximately 85% of it is removed. Just like the Duodenal Switch, most of the cells that produce the hormone grehlin are removed. This eliminates most of the hunger that the patient used to have, if not all of it. The stomach that is made from what is left is turned into a tube that is resistant to stretching. This tube is often designed to hold from 2 to 4 ounces of food or liquid. At this point the surgery is complete. The surgeons just need to close up and the patient needs to recover. The upside to this surgery is that it is simple and has one of the LOWEST rates of complications of all the weight loss surgeries. It also has one of the HIGHEST rates of excess weight loss with one study in California coming in starting at 58% to 77.9% loss in a ONE to TWO year study and one doctor in England reporting that 100% of his patients had a weight loss and maintenance OVER 70% at 6 YEARS of living with the Sleeve. He also reported that patients with hypertension, diabetes, impaired glucose tolerance, obstructive sleep apnea, asthma, or arthritis were all cured or improved after surgery. It has also been said that this is the ONLY recommended option for people with immune system problems. People with diseases like Lupus or MS can have this procedure because there is NO foreign object placed in their body. This also is one of the few recommended options for people with organ transplants. People with transplants need their intestines to metabolize their anti rejection medications. There are possible issues with GERD in this surgery as there are with the Duodenal Switch There are NO malabsorption issues with this surgery. There are NO additional foul odors. There is NO additional intestinal gas. While nausea and vomiting is common in ALL weight loss surgeries, it is NO MORE PREVALENT in the Vertical Sleeve Gastrectomy than in most of the other options. If needed, the Vertical Sleeve Gastrectomy can be easily converted to a Duodenal Switch should additional Weight Loss measures need to be taken at a later date. This act is called a "Revision." Having your Vertical Sleeve Gastrectomy converted to a Duodenal Switch would be said to be having a, "Revision of your Vertical Sleeve Gastrectomy to a Duodenal Switch." The Biggest DOWNSIDE to the Vertical Sleeve Gastrectomy is that it is considered "Experimental" by many insurance companies. While it has not been practiced HERE in the US as a weight loss option for very long (about 5 years or so) it has been done for QUITE a while in Central and South America and in Europe for quite some time. The surgery has been used HERE in the US for OTHER reasons for QUITE a while. It has been used QUITE effectively to treat stomach cancers and ulcers with good effect. These treatments have been done in the US for quite some time. There is a NEW option that is being explored for people that have had the RNY that may be expanded to include OTHER weight loss surgical options and possibly be used to REPLACE them in the future if it becomes approved for that use. This new option is called stomaphyX. The stomaphyX surgery basically takes a post down the INSIDE of the stomach and then FOLDS the stomach in upon ITSELF and makes the available volume INSIDE the stomach SMALLER. There is NO CUTTING on the abdomen or anywhere ELSE. All of the surgery is done through the esophagus. None of the stomach is removed or cut. At the moment, from what I have been able to find according to MY research, the device is only approved for use with Gastric Bypass patients to help make their existing pouches smaller. Permission is being sought to expand the device's use to other types of weight loss surgeries and for use on patients that have NOT had weight loss surgery but to be used in PLACE of traditional weight loss surgery. From what I have been able to find, this device has not been approved for this use yet. To find out MORE about this option go to this link: http://www.themorbidme.com/2007/09/stomaphyx-incis.html . Options for getting surgeries that are not paid for by insurance can be found if you are persistent. You can sometimes petition the company and get them to reconsider with a doctor's explanation. You can also self pay or take out a loan. Many times, the surgeries are cheaper in Mexico or other central or South American countries. Do some research to find your options. Not every surgery is going to be right for every person. Frankly, for ME, if I were an obese male with a BMI under 50 (which I am) or an obese woman NOT of child bearing age, I would choose the Vertical Sleeve Gastrectomy (which I DID). If I were an obese male with a BMI OVER 50, I would get the Duodenal Switch. If my insurance company would not COVER it, I would get the Sleeve. If not THAT, then the Gastric Bypass. I would keep working my way down the list until I found SOMETHING that I could get. If the insurance company wouldn't pay, I would try to take out a LOAN (this is actually what my wife did for me). If I were a WOMAN of child bearing years or a person facing the possibility of chemotherapy or some other health issues that would require periods when I would NEED more sustenance, I would want the flexibility of the Lap Band. The short of it is, Do YOUR RESEARCH and CHOOSE the right surgical option for YOU! If you can't get ONE option for a reason, at least get another! For the sake of yourself and the ones you love, do SOMETHING to fix the problem before it is too late. If you die due to health problems caused by obesity, it is TOO LATE! Whatever surgical option you choose, for whatever REASON you choose, we are ALL here for the same reason. We are here to HELP and BE HELPED. Please, let's respect each other. There are those on the OH boards that consider themselves to be "Experts." Most of these folks do not have any medical experience. They are patients just like me. It is best to take any advice you get on the OH boards with a grain of salt (if not the whole cellar). Some folks have a severe bias towards or against certain surgeries. There are folks who will TELL you that the surgery you are considering is WRONG and is BOUND to fail! IGNORE these people. Not every surgery is right for every person! DO YOUR OWN RESEARCH and and CONSULT with your PHYSICIAN or your SURGEON! I cannot stress the importance of doing your own research enough. There is a revised version of this post at my profile page. I have added some links to some web sites that have some interviews with some surgeons that perform weight loss surgeries and have videos that actually SHOW the surgeries. You can watch the surgeries being performed and get many of your questions answered by the surgeons as they explain what they are doing. They explain the positives and negatives of each procedure. My Profile page can be found HERE: http://www.obesityhelp.com/member/hubarlow/ . Look for a post called Surgical Comparisons. If you can't find the post on the profile page, look for the post in the March Archives. I hope this helps Hugh.
   — hubarlow

May 15, 2008
The short answer is that you need to evaluate what contributed to your battle with obesity--- do you simply need a restrictive procedure because your weight gain was due to portion control, do you need some strong disincentives to limit sugars and dense, refined carbs or do you need a method with the least risk of weight gain. Once you figure that out, you then need to evaluate what level of follow-up care (and particular side effects) ou can live with. Then, you'll have your decision.
   — SteveColarossi

May 16, 2008
You need to research, read, and study about any procedure yoiu may consider. That being said, RNY sounds pretty drastic to me for a relatively small amount of weight to lose. After all, you have to live with your decision for the rest of your life, except for the lapband. I chose VSG, and am certain I will never regret my decision. Consider your choice very wisely.
   — corky1057

May 16, 2008
Well, I am 39, had 100 pounds to loose and am 1 year out and at goal. I had the RNY. It was laproscopic and for *me* it was an extrememly easy surgery. Easier than my c-section and easier than an open abdominal surg I had for a prior colon cancer. I am VERY happy with my decision. My blood pressure is down. My kidney labs are better now. I just could NOT get off the sugar on my own, even after the cancer, so I chose the RNY. I am very pleased. I think THAT is they key; figure out what will work for YOU and go into that decision with confidence. That is part of the reason there are people who are so militant that their decision is the only right decision; because it WAS the right decision - for THEM. That is where you need to be. Do enough research to be SURE. :-D We wish you the best!!!
   — MAG

May 17, 2008
I attend my local support group meetings with people who have had RNY, Lapband and VSG and for the most part all of these people are happy that they had WLS. Some have lost more then others and some have lost faster, some have to take more vitamins and some have to have more Dr. follow-up appointments but I have not met one person yet who is sorry that they made a very real and very difficult decision to have WLS. I had a VSG, slightly less then a year ago with Dr. Alvarez in Mexico and lost to my goal weight within 6 months and a few days. I eat a very small amount of food each day and I still do not experience hunger. I have had NO health problems at all! I am currently down 91 pounds from my pre-surgical weight. I started working out after losing to my goal weight and I am now 14 pounds below what I thought my goal weight was :) The working out is the key to building muscle and firming up all that is slightly saggy after the weight loss. I am not trying to lose anymore, so I make a conscious effort to get in enough food each day but I know I will lose and gain a little as time goes by and that is OK. RESEARCH the pros and cons of each of the surgeries and non-surgical choices. What is right for me, may not be right for you. The VSG is perfect for me because I am very busy and active and I have 3 children the are also active. I needed a surgery that would work for me with virtually no maintenance and very few side effects and that is what the VSG has proven to be for not only myself but also for my husband who is 2 years post-surgery with VSG (he lost 120 pounds in 8 months). Weight loss has changed our lives and our health! You can check out more details on my profile if you would like. Best of luck with your decision!!
   — Michelle D.