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Can NOT decide between the VSG and RNY! How did you choose



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1. VSG can be converted to duodenal switch (DS) if the initial weight loss is insufficient. In both cases, the pylorus remains intact, so food is let out of the stomach gradually. Both have a much lower risk of dumping syndrome than RNY, and the weight loss outcomes of DS are even better than RNY.

2. More foods tend to be tolerated after VSG/DS than after RNY, mainly due to the intact pylorus and size of the stomach. VSG also allows regular nutrient absorption and doesn't cause as many embarrassing bowel/gas disorders.

3. Weight loss can be more gradual after VSG than RNY, which can result in somewhat less loose skin. No guarantees!

4. RNY is a better option for people who graze or eat junk food/fast food, though, because the sleeve only controls portion size and sometimes hunger, not eating frequency or food quality.

5. RNY may also be better for people with reflux, as VSG can worsen it over time.

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I just received the approval from my insurance and I will be receiving a date soon, and up until this point i have said I wanted the RNY! However now I'm second guessing my decision and want to know how you all concluded on which surgery was best. I'm just concerned that their are not enough long term stats on the VSG which is what led me to picking the RNY. Are any of you 5+ years post op from the VSG and can tell me how you have done thus far. My only concern with the RNY is losing weight too quickly, I want a more gradual weight loss believe it or not!! Please help

I have numerous reason for choosing the sleeve.

1. The risk for malabsorption was unacceptable. I have cvid which already causes a Protein deficiency.

2. Because of my cvid (common variable immune deficiency) I have a very high chance of stomach cancer. Having a left over stomach that isn't easily accessible to scope (think every couple months) would be asking for trouble.

3. because the RNY leaves the stomach in the body, it doesn't decrease the ghrelin hormone like the sleeve does. Decreasing my hunger is a big thing for me. Another side effect of cvid is stomach issues. I'm used to having diarrhea. I'm afraid that if I have the RNY I will still be constantly hungry, but because the pouch is so small I'll eat the WRONG things (like chocolate) and because I'm used to dumping syndrome it won't deter me.

4. Rerouting my whole system just freaks me out

5. The sleeve has nearly comparable weight loss stats (and if u look at the 2+ year studies it actually has more)

6. the sleeve also changes how the guts bile acids bind to a receptor called fxr. In the absence of fxr weight loss occurs. So aside from restrictive and hormonal changes the sleeve causes a change in your metabolism. That's huge for me!

7. I don't like the idea that I might not be able to absorb needed medications

8. If I find the sleeve doesn't help, I can revise it to add the malabsorption part.

I suggest writing out a pro/cons list and going with what feels right to you. Good luck!!

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I too originally chose the RNY procedure but had the decision made for me to change to the VSG based on my endoscopy which showed that I had polyps in my stomach and there would be no way to monitor them if I chose RNY. Even before that I was struggling with the complexities of the RNY procedure with the rerouting of the intestines, complications such as ulcers were much higher, and the issues with possible malnutrition and side effects like dumping syndrome. The VSG does seem like a much simpler procedure with results that seem to be as good as the RNY. In the end both procedures have very good results and I don't think you can go wrong with either. It's a hard decision to make and I wish that surgeons would be a little more proactive in helping us with the decision. Good luck with your decision. In the end these are just tools. You can be equally successful with either procedure if you commit to sticking with the diet and exercising.

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
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    • KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
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      https://alluniqueguide.com/java-burn-coffee-reviews/
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