So, last Friday was my fourth monthly appointment with the surgeon's office. I was ready to schedule the rest of my preop requirements (psych, teaching class, nutrition class) and possibly even get a tentative surgery date for my sleeve. I had a long list of nitty gritty questions for the staff and my doctor.

After weighing in, my surgeon came in and said I'd done "okay" in month 3 of my supervised diet, but not great. (I lost 4 lbs, compared to 5 and 7 the first 2, but was had major PMS Water retention working against me this time). I made an offhand comment about always losing momentum in month 3 of dieting, and always having to lower my calories under 1000 to continue to lose, and always crashing and burning when the loss stops. All of the sudden, we're having a discussion about whether I should be having RNY instead of VSG, because if regain is a problem for me, VSG just doesn't have the longterm data to back it up that RNY does. He said that patients like me (young, female, low-ish BMI, generally healthy) are hardest to advise in selecting a procedure, and that we should "continue to have an evolving conversation" about RNY vs. VSG. He said he thought I would do "phenomenally well" with either one, he just wants to make sure we're making the right choice.

So now I'm frustrated and confused. I know I need wls to lose the extra 80-90 lbs I'm still carting around, and I was 100% comfortable in my decision to go with the sleeve. Now, I'm questioning it. Can anyone help me get my head around this? Did anyone else's surgeon have a hard time advising one procedure over another?

I had similar stats as you weight-wise and had similar problems losing weight. It was very frustrating. I went with the sleeve because there were no surgical connections (less risky), no stuck feeling from a small pouch, and that the way it works is restriction only. The bypass works with restriction and malabsorption; they take out the upper part of the intestine which absorbs certain nutrients/vitamins. With the bypass, doctors have to monitor you more closely to make sure you are not heading towards a Vitamin deficiency. From what I've read on this site, if you have severe GERD or reflux, the sleeve is not recommended. Many people have lost lots of weight with the sleeve. Stand your ground!

in truth there is more data on RNY - there is a reason they call it the "gold standard"

However, the reality is that people have regain with ANY WLS. Maintenance is absolutely the hardest part.

I was overweight, obese or morbidly obese my whole life (exception maybe 2-3 years total - i was obese as a child too). I had also failed with the lapband and so I guess might be considered a "hard case" as my BMI was over 50 at time of sleeve.

I lost about half my weight and have been maintaining for 2 years post sleeve. I can't say how it would compare to rny but I lost 100% of my excess weight and with effort, am maintaining. With the band, and before that, i could never get to a normal BMI nor could I maintain any signficant weight loss.

I am not sure what i would advise you, but i am not convinced that maintance with the RNY is that much easier, there is alot more data however.

Sleeve for sure. Your digestive system is intact and you do not have the malabsorption and dietary restrictions of RNY. Sleeve has been done for years for treatment of gastric ulcers etc. I look at it this way: I had a 32 ounce stomach that I could fill until it hurt. Now I have a 4 ounce stomach that makes me pay if I over eat (pressure and even worse - throwing up). So even if I overeat and eventually stretch out my 4 ounce stomach, it will never be the old 32 ounce stomach that just let me over stuff myself whenever I wanted. Unless I decide to eat every hours, high carb, high calorie foods, I just can't imagine being physically able to gain back all the weight I've lost.

Does this make sense?

I'm sure the surgeon wants to make sure you have all the options, however, I would definitely recommend the sleeve. Why re-route digestion if you don't have to?

I went in for the sleeve and when i talked with my doctor just before getting insurance ok my doctor suggested the Switch for me. Thought I'd loose more weight and better chance of keeping it off. plus felt that i could come off meds and sleep apnia machine. I asked what the long term affects of the switch were. "What about when people are in their 80's, need to go to nursing home? " He said that there were not enough studies, but malnutrition would be a big concern.

plus with the switch you can have all the Proteins you want but NO CARBS. I like my doctor a lot. Good guy.

I said i'm not doing this for beauty reasons, he thought that may be one of the reasons. I said I have support for sleeve but didn't feel comfortable changing the procedure at this late in the game, i didn't want to go the rest of my life with No Carbs. The reason for my surgery was to be their for my grandson and family, ward off diabetes that is a real possibility for me and i already have bad knees. I've had bad knees since 18 years old, now 55. Sleeve has far less chance of malnutrition.

My doctor had a great response. " It sounds like your convinced to go with the sleeve and have really thought this out, ok then the sleeve it is." I did thank him for bringing the switch to my attention and going through all my options.

Doctors are not there to coerce you, they just really want you to be aware and see where your mindset is at.

I should add one more reason why i went with the sleeve and no regrets. i was sleeved december 31, 2014.

it's because it removes the part of your stomach that controls hunger. I know it can grow back sometimes, still went with sleeve. I see pizza on tv, fast food, my mind says.... so what! it has no affects on me want to eat. my focus is on life. food is not controlling my life any longer when i see it or smell it. Did i mention that I LOVE pizza.... carbs.

God is good! for the first time in 55 years my mind has replaced wonderful thoughts instead of i'm hungry.

My life feels like its just beginning......the sleeve, oh ya, i'd do it again in a heartbeat.

Thanks, all. I had done my research on both procedures and think I am going to move forward with the sleeve. I am put off by the rerouting and malnutrition, especially because I don't have a lot of comorbidities. I appreciate the support. I think I was just freaked out because I was (and am) so ready. My next appointment (and maybe scheduling???) can't come soon enough.