I'm 400 lbs...will this still work for me?

[300PoundsDown 101]

Well I finally have the go ahead to get surgery. The problem for me now is choosing which one . My question is this....I have heard that for some super obese people certain surgeries are not as effective. Does anyone know about this? Please be honest. I need to pick the right procedure for me. Thtanks

[Go Kart Mozart 44]

Well I finally have the go ahead to get surgery. The problem for me now is choosing which one . My question is this....I have heard that for some super obese people certain surgeries are not as effective. Does anyone know about this? Please be honest. I need to pick the right procedure for me. Thtanks

It very well could be. This surgery was originally the first stage of a duodenal switch for highly obese people, but they began to see that it was oftentimes effective on its own in those patients, thus why it is now also a standalone procedure. I personally started at a BMI of 50 and couldn't be more thrilled with the results thus far.

[Tiffykins 672]

I agree with the above statement. When looking at all the different options, you really have to look at the pros and cons of each. With the band, it's not recommended for people that have that much weight to lose. With RNY, you have to consider that after 2 years, the malabsorption of calories/fat is no longer working (the little villi grow back, and you'll start absorbing calories/carbs/fats again) but the Vitamin and nutrient malabsorption lasts a lifetime. Plus, long term the sleeve has the least amount of complications vs. the band and RNY. You're left with a normal functioning stomach. Identifying your food issues really helps, and working on making better habits makes this journey much easier.

The sleeve is a great stand-alone procedure, and if you need malabsorption, you can revise to the full DS.

[Eureka-C 20]

I agree with the above statement. When looking at all the different options, you really have to look at the pros and cons of each. With the band, it's not recommended for people that have that much weight to lose. With RNY, you have to consider that after 2 years, the malabsorption of calories/fat is no longer working (the little villi grow back, and you'll start absorbing calories/carbs/fats again) but the Vitamin and nutrient malabsorption lasts a lifetime. Plus, long term the sleeve has the least amount of complications vs. the band and RNY. You're left with a normal functioning stomach. Identifying your food issues really helps, and working on making better habits makes this journey much easier.

The sleeve is a great stand-alone procedure, and if you need malabsorption, you can revise to the full DS.

Tiffykins, I hadn't heard about the microvilli growing back. That I fascinating. Do you remember where you read this?

[Tiffykins 672]

Tiffykins, I hadn't heard about the microvilli growing back. That I fascinating. Do you remember where you read this?

The studies have been posted numerous times on obesityhelp.com Since RNY was not an option for me, because I knew of the complications from real life friends, I never saved any of the links. They also talk about only 30% of RNY patients dumping with sugars and carbs.

The weight regain stats with RNY are downright scary, and you can search the Revision and RNY board over there to see just how many people are looking to get revisions called ERNY (extended rny) which is where they shorten the common channel even more to make the body start malabsorbing calories/fats again.

[momto2boys 0]

I was 300 pounds and at 6 weeks almost 7 I have lost around 60 pounds. And the dr. told me I was loosing it faster than he thought.I would recommend this surgery to any one. And I had a very rough first 3 weeks.. But the 4th week I was a new person all together..

[NtvTxn 1,262]

I agree with the above statement. When looking at all the different options, you really have to look at the pros and cons of each. With the band, it's not recommended for people that have that much weight to lose. With RNY, you have to consider that after 2 years, the malabsorption of calories/fat is no longer working (the little villi grow back, and you'll start absorbing calories/carbs/fats again) but the Vitamin and nutrient malabsorption lasts a lifetime. Plus, long term the sleeve has the least amount of complications vs. the band and RNY. You're left with a normal functioning stomach. Identifying your food issues really helps, and working on making better habits makes this journey much easier.

The sleeve is a great stand-alone procedure, and if you need malabsorption, you can revise to the full DS.

Tiff - is that why so many RNY patients regain some of the weight back? If so, why is it still considered the "gold standard" when it comes to WLS?? I wonder if sleeve surgery will end up proving to be a superior choice. What do you think?

[Tiffykins 672]

Tiff - is that why so many RNY patients regain some of the weight back? If so, why is it still considered the "gold standard" when it comes to WLS?? I wonder if sleeve surgery will end up proving to be a superior choice. What do you think?

Patients being compliant is a big part of the equation, plus they start absorbing calories again so they really do only have a honeymoon period of malabsorption for calories. I know a couple of RNY people that got to goal, and have been able to maintain their weight loss (I'm not super close with them, Facebook buddies, both are 5+ years out), but they had have complications, 2nd and 3rd surgeries to either deal with a bowel obstruction, pouch dilation, ulcers etc etc. For me, I won't call the sleeve superior, but statistically it's far superior when it comes to long term complications. I'm not sure on weight regain as the stats show a 10% regain rate for those further out. I can see how a major life tragedy to spur a sleeve patient into emotional eating, or compulsive behaviors again. I didn't suffer from either of those to a major extent so I don't really see it being an issue for me. I do love my carbs, but I also love how I feel when I focus on Protein and steer clear of the major junk food.

I'm not sure what the future stats will show for the sleeve, but I honestly believe that most of the regain isn't the sleeves fault. It all goes back to what we choose to put into our bodies. I know that I could never possibly gain back 145lbs, but I could easily gain back 10-15lbs. I did bounce up to 128lbs last week, I was pissed, the husband was elated, it was Water weight and gone the next day, but still I hated seeing that I was close to 130 again. It's a mindtwist for sure.

[emilygrace 5]

If I were 400lbs, I would probably go right to DS. If I couldn't find someone willing to do that in one op, I'd get the sleeve, lose some weight, then reassess getting the DS part done. Really at 400lbs though you need the heavy duty op. Also, only you know how much you need malabsorption - are you a big sweets eater?

[300PoundsDown 101]

If I were 400lbs, I would probably go right to DS. If I couldn't find someone willing to do that in one op, I'd get the sleeve, lose some weight, then reassess getting the DS part done. Really at 400lbs though you need the heavy duty op. Also, only you know how much you need malabsorption - are you a big sweets eater?

Yes I am a big sweets eater. However, I've been doing research on DS and RNY malabsorption component and neither looks like a good deal to me. With the RNY it appears to wear off after awhile and for some it never seems to take effect. With the DS I've been reading that a lot of people have severe issues and nutritional deficiencies. Almost like trading one evil for another. I think the sleeve is going to be what I choose . I went yesterday and found out i weigh 395. Close to 400 as I had guessed. Thankfully I have not actually seen 400 yet. He wants me to lose 30 lbs and so my goal is going to be to get serious about losing some of this weight on my own before surgery. I think the more i can get off on my own prior to it, the more successful I will be. In hte past, I always felt hopeless but now that I know I can get this surgery whenever I want to for hte most part...I think I have the hope that I need to get serious about it. We shall see!

[emilygrace 5]

Sounds like the sleeve is a smart idea to start with. Of course you can end up with nutritional issues when you get a malabsorptive procedure, but that's kind of the point. If you're a big eater of chocolate, sweets, icecream, candy you can still do a lot of damage after sleeving, because you can consume large amounts of calories in a small quantity of food. Just something to be aware of.