Question:
HOW DO YOU CHOOSE WHICH TYPE OF SURGERY TO HAVE?

I'M NEW TO THIS....JUST STARTED THE RESEARCH SO I'M WONDERING WHETHER THE SURGEON CHOOSES THE TYPE OR IF THE PATIENT DOES. IF THE PATIENT DOES...HOW DO YOU DECIDE WHICH IS THE BEST FOR YOU??? GUESS I'M NOT TOTALLY UNDERSTANDING THE DIFFERENCES AND WHAT THE +++ AND --- ARE FOR EACH....ANY THOUGHTS ANYONE?    — DELINDA T. (posted on September 6, 2002)

September 6, 2002
Some docs offer you choices, some don't. Mine offered 2 choices back in 1993. VBG or RNY distal. I'd met about 6 patients. Of those, the VBG"s vomited daily and were not under 200#, no matter how far post-op. The RNY did not vomit and were all of normal body wt. That wasn't much to go on, but it was all I had. I chose the distal RNY. I only vomit if I get silly, I am of normal body wt. I'm delighted, wouldn't change a thing. Today, my docs offer variations, so they talk with you, customize to fit.
   — vitalady

September 6, 2002
DELINDA - I had the same questions when I started looking into WLS. I found a few things online and via this website that helped answer most of those questions. If you'd like, you can go into my profile and click on two of the links specifically. 1) Pro's & Con's for Surgery 2) Gastric Bypass Surgery. When you click on my name and access my profile, you'll need to scroll down a bit. The links are located AFTER my journal entries. Hope this helps! MICHELLE Curan - I just wanted to congratulate you on the success of your surgery! Your before and after pictures in your profile are added insentive to those of us that are still in the researching and waiting to have surgery stages. You and your sweety look absolutely maaaaaaahvolous!
   — [Deactivated Member]

September 6, 2002
As Michelle wrote, some surgeons offer choices, and some surgeons specialize in just one or two specific procedures. I felt fortunate that my surgeon performs a number of different weight loss surgeries and he was able to provide detailed information about the pros and cons of each. He routinely does the BPD-DS (Duodenal Switch), the proximal RNY, the medial RNY, the VBG (modified with a sleeve gastrectomy for greater effectiveness w/ less hunger), the VG (vertical gastrectomy without banding, with or without an "extra stitch"), and the Lap-Band. He offers this variety of WLS procedures because he feels that different patients have different needs, due to their individual eating habits, starting BMIs, weight loss goals, and tolerance of the specific risks, side effects, and lifestyle changes of the various surgeries. He's a laparoscopic specialist, so all of his procedures are done lap, unless there is a compelling reason not to. He does not offer the straight BPD or the very distal RNY (more than 250cm), because he feels that there are better alternatives to those procedures for virtually any patient. He does require that all prospective patients attend a group information meeting before coming to their first consult with him. At the meeting, he provides a thick packet of information containing hand-drawn diagrams and a list of facts about each procedure (including the distal RNY, even though he doesn't do that one). He goes over the pros and cons in depth and stays to answer questions until there aren't any more. The packet includes information about average weight loss and failure rates for each surgery, the relative risks, the types of post-op supplements required, lifestyle issues, and what kinds of eating behaviors may "defeat" the operations. He focuses quite a bit on this last point. He asks you to think about what kind of "eater" you tend to be: a "Grazer" who eats small amounts all day, a "Bloater" who consumes most calories in one or two big meals a day, a "Sweeter" who consumes lots of desserts & sugar, or a "Greaser" who eats lots of high-fat foods. Some surgeries work better for one type of eater than for another (for example, a "Grazer" may out-eat a purely restrictive operation such as the VBG, while a "Bloater" is much more likely to be successful with that surgery). By the time you come to see him for your individual consult, he wants you to have a good idea of which operation you want, and to be able to discuss your reasons. He really wants you to make your own choice, with his guidance, and based on a thorough understanding of the pros & cons for *you*. I came to this surgeon already knowing I wanted the lap DS, but I was very impressed with the thoroughness of his approach. However, I don't think it's typical. My advice to anyone who is just starting out in this process is to do a LOT of research on the various procedures before you ever see a surgeon. Don't get tied into a particular surgery just because it happens to be the one that your doctor offers. This is a decision you'll live with for the rest of your life... make sure it's the best one for you. I almost had the proximal RNY with a local surgeon because that was the only procedure he did. After more research, I cancelled that surgery date and traveled out-of-state to have the DS instead... and I couldn't be happier with my decision. It was the right one for me. Good luck, Delinda!
   — Tally

September 7, 2002
In most cases, the surgeon will choose. Unless you have a real preference for one. However, my surgeon let me choose basically and I chose lap. He said that the laparoscopic surgery really depends on the size of you liver. If it is too big, then they can't do it lap. They need to lift it out of the way with the lap instruments and if it is too big, then they can't. I went in for surgery on August 26th and I had both! Turns out my liver was fine and they did lap surgery on me, but I had a complication and they had to open me up. I was told to always anticipate the open procedure. My surgeon always has the open tools on hand just in case. Turns out, my stomach was deformed and too big and they couldn't see that with the lap surgery. I am glad he decided to open me up. If you have any further questions, don't hesitate to ask!
   — sammygirlwpc