Hello everyone. Been stalking the forums for a few weeks and decided to bite the bullet and join so I can get some feedback on something that I am seriously having trouble with deciding on, which is RNY or VSG?? I have been submitted to insurance for approval, and do not have a surgery date yet...so I need to make my decision quick. I am leaning towards the sleeve, but have concerns. Those concerns are: VSG not being restrictive enough (because I know how I have been over the years) and I already take heartburn medication and understand that issue gets worse. I don't want to lose too much muscle, don't like the thought of intestines being rerouted, and don't particularly want to deal with the dumping issues of the RNY. If anyone could give thoughts or opinions on how your decision was made, I would very much appreciate it. By the way, I'm male and 6'4" 345 lbs.

Just made this video today - perfect timing for you question. Its long but its jam packed with information to help you decide which surgery is best for you. Of Course I am a strong advocate in favor of the Vertical Sleeve Gastrectomy and this video tells you why.

http://www.verticalsleevetalk.com/topic/76009-vsg-vs-rny-vs-lapband-for-dummies/

I am only 1 week post op but decided on the sleeve after originally picking the RNY Bypass. I wasn't willing to deal with gastric dumping (I want to enjoy a ribeye steak later on, even if it is a small portion), the risk of blockages, and results from malnourishment concerned me long term.

My sister is in the medical field and spoke with a nurse friend of hers who worked in the bariatric center of excellence at her hospital. The nurse was very firm that I should do more research and look into doing the sleeve instead to ensure I was happy with my decision (I had chosen bypass and had my consultation at that time).

I'm 6'3" Male started at 415lbs and a currently at 380lbs. I don't have years of experience to share what it will be like, but I am only a few months ahead of you in this so I think our perspectives are similar.

You will have to examine all factors and determine what is important to you. Concern of regain may push you towards the bypass. I placed other factors in front of that when making my choice.

My surgeon (Thomas sonnastine in Columbus) said he though both were just fine for me. I am 5'10 and sighed about 340 at the time at the time of the conversation. He said he would push me for the RNY if I weighed a hundred pounds more or had diabetes but was very comfortable with me getting the sleeve.

Thank you for your responses...and you're right, the video did have a lot of information.

Deleted after correction. The video is great!

@mistysj - I have to disagree at least partially. first of all the stomach is blind. In fact it actually is referred to as being blind when the procedure is described. I do know the blind stomach continues to secrete lots of grehlin which is another problem with RNY. You are right on stomach acid still being released to aid in digestion so the stomach does do something. So basically no food enters the detached stomach and it sits there doing nothing but producing hunger hormones - sounds pretty blind to me though.

http://www.dsfacts.c...DS-and-RNY.html

Quote:

RNY

A pouch is created at the top part of the stomach to restrict the amount of food you can eat. The bottom part of the stomach that is no longer used is called the "blind" stomach. Food passes through the anastamosis (connection), or stoma, created between the pouch and the small intestine, which is deliberately made quite narrow to keep food in the pouch longer, thus making you feel fuller longer. The pylorus is at the bottom of the "blind" stomach and is no longer used to control food moving into the intestine. For some patients, food with a high sugar or fat content hits the small intestine rapidly causing "dumping

end quote

Secondly the blind stomach can be scoped but not easily. It requires patients to be cut open both externally to get the scope in then internally on the actual stomach to get the scope in vs simply sticking the scope down the throat in a VSG patient.

Quote:

The blind stomach can be scoped, by placing the patient under anesthesia, making a small incision on the abdomen, and advancing the scope through the incision into the blind stomach.

End quote:

extra tissue for stomach repair - ok Ill give you that one, however being you can actually live without a stomach its not life threatening if your stomach for some slim chance is 100 percent damaged. Not to mention you still have the vertical length of the stomach with lots of tissue so technically it could be shortened with the damaged part of the stomach removed. By damaged I mean cancerous tissue or something horrible like that.

I believe VSG is much better, i'm 10 months post op, and I can't understand why people even think about RNY. I lost 100lbs and almost no muscle lost. so losing muscles should not be your concern. And believe me once you lose weight you will never wanna go back.

you just have to stay motivated.

@mistysj - I have to disagree at least partially. first of all the stomach is blind. In fact it actually is referred to as being blind when the procedure is described. I do know the blind stomach continues to secrete lots of grehlin which is another problem with RNY. You are right on stomach acid still being released to aid in digestion so the stomach does do something. So basically no food enters the detached stomach and it sits there doing nothing but producing hunger hormones - sounds pretty blind to me though.

http://www.dsfacts.c...DS-and-RNY.html

Quote:

RNY

A pouch is created at the top part of the stomach to restrict the amount of food you can eat. The bottom part of the stomach that is no longer used is called the "blind" stomach. Food passes through the anastamosis (connection)' date=' or stoma, created between the pouch and the small intestine, which is deliberately made quite narrow to keep food in the pouch longer, thus making you feel fuller longer. The pylorus is at the bottom of the "blind" stomach and is no longer used to control food moving into the intestine. For some patients, food with a high sugar or fat content hits the small intestine rapidly causing "dumping

end quote

Secondly the blind stomach can be scoped but not easily. It requires patients to be cut open both externally to get the scope in then internally on the actual stomach to get the scope in vs simply sticking the scope down the throat in a VSG patient.

Quote:

The blind stomach can be scoped, by placing the patient under anesthesia, making a small incision on the abdomen, and advancing the scope through the incision into the blind stomach.

End quote:

extra tissue for stomach repair - ok Ill give you that one, however being you can actually live without a stomach its not life threatening if your stomach for some slim chance is 100 percent damaged. Not to mention you still have the vertical length of the stomach with lots of tissue so technically it could be shortened with the damaged part of the stomach removed. By damaged I mean cancerous tissue or something horrible like that.[/quote']

Thanks for the info. I was misinformed.

Did you make a decision? I chose VSG mainly because I didn't want the malabsorptive issues that come with RNY. The malabsorption might mean quicker short-term weight loss but longer-term health repercussions. Also, it is easier to take NSAIDs after VSG than RNY (though my surgeon allows them after RNY if you take a gastric protective agent). My surgeon prescribes Prilosec to everyone after VSG for 3 months and then starts step-down therapy. I needed to stay on the Prilosec and I'm fine. If I miss a dose, I do get heartburn. I don't mind being on it--I feel like it protects my smaller stomach. Also, make sure your surgeon checks for a hiatal hernia and corrects it during surgery if you have one. That could be causing your heartburn and the correction will help. I had one and I asked my surgeon how many patients do, and he said about 90%. They are very common! Good luck with whatever you choose. Lots of great support here.

Did you make a decision? I chose VSG mainly because I didn't want the malabsorptive issues that come with RNY. The malabsorption might mean quicker short-term weight loss but longer-term health repercussions. Also' date=' it is easier to take NSAIDs after VSG than RNY (though my surgeon allows them after RNY if you take a gastric protective agent). My surgeon prescribes Prilosec to everyone after VSG for 3 months and then starts step-down therapy. I needed to stay on the Prilosec and I'm fine. If I miss a dose, I do get heartburn. I don't mind being on it--I feel like it protects my smaller stomach. Also, make sure your surgeon checks for a hiatal hernia and corrects it during surgery if you have one. That could be causing your heartburn and the correction will help. I had one and I asked my surgeon how many patients do, and he said about 90%. They are very common! Good luck with whatever you choose. Lots of great support here.[/quote']

I did actually decide on VSG and am having it done on June 10th. Thank you for your advice, especially asking about the hiatal hernia. I will have to remember to ask about that day of surgery since I won't see him again until that day.