Sleeve vs RNY

[Little Green 582]

2 hours ago, OutsideMatchInside said:

I have healthy intestines and I did not want them touched. You can live without a stomach in case of complications. You cannot live without intestines, not well and not for long.

<snip>

Disclaimer: I would never question anybody having whichever surgery they prefer! I'm so glad you had VSG & you are one of my favorite members to follow due to your success.

Can you elaborate on your comment about intestines? It's my understanding they do not remove or otherwise alter your intestines, beyond connecting them in a different manner to the new pouch. I do completely understand that VSG leaves the intestines totally intact and that was your concern, but I'm confused as to how someone would be "living without intestines" due to RNY.

[OutsideMatchInside 10,166]

Long story short, I know someone who had a surgery, not a WLS surgery, but their intestines were nicked in the surgery, and part of their intestine died. that part hard to be removed and then it was just a slow downward decent into a slow hellish death from there (took over a year of non stop complications).

Also I watched a lot of Fat Dr UK and one of the Dr on there talked about how terrible it was to have to touch healthy intestines.

So much can go wrong with your intestines and kill you, and not even usually fast kill you, just slow miserable kill you.

Obviously most people that have RNY don't have serious intestinal issues. It was just something I was not willing to roll the dice on at all. They cut your intestines with RNY and reconnect them and that carries risks.

Plus pouch stretching, you have to be more diligent long term with RNY.

These were my reasons and obviously a lot of people don't have this opinion. I don't think there is anything wrong with RNY in general, it helps a lot of people, but for me, It wasn't really worth the extra risk to maybe lose an extra 20 pounds or so. And in the end I exceed the expected weight loss for RNY and for the Sleeve.

The 2nd chart is 24 month expected loses, Which has a bounce back (weight increase) from month 18

So...

Pick whatever surgery you want, it doesn't really matter, what matters is what you do with the surgery.

[Little Green 582]

Thanks for clarifying @OutsideMatchInside. I appreciate that. I personally have not heard or read of any incidents of intestinal failure due to RNY, but I am sure there are complications of all stripes out there. Thanks for bringing that one to light for this conversation!

[texanbandit 8]

I have had friends that had the bypass and sleeve and honestly the bypass scared me. I sat down and talked to my doctor about various options. The sleeve, the band, and bypass. I had heard of the band being implanted into the vital organs and I knew I wasn't extremely overweight. So when I discussed with my doctor she and I both agreed that for me the best thing was the sleeve. I have not been disappointed in it at all. I have lost 88 lbs from when I had my surgery. No matter what you decide on it is a lifestyle change. You will have to make changes for the rest of your life. I have had friends that have had the bypass and they are bigger now then when they started their journey. I have a good friend now that has also gained weight having the sleeve.

Remember it is a forever lifestyle change!

[JohnnyCakes 593]

On 7/13/2017 at 11:35 AM, OutsideMatchInside said:

Long term RNY is not better than the sleeve, and as there are more long term sleevers it seems the results are shifting towards the sleeve.

this is simply incorrect.

every single study shows RNY with higher long term weight loss than the sleeve. the mini-gastric bypass beats the RNY by a hair, and the DS offers the most loss potential (but with higher chances of malnutrition complications).

[OutsideMatchInside 10,166]

26 minutes ago, JohnnyCakes said:

this is simply incorrect.

every single study shows RNY with higher long term weight loss than the sleeve. the mini-gastric bypass beats the RNY by a hair, and the DS offers the most loss potential (but with higher chances of malnutrition complications).

Before you get your knickers in a knot if you read everything I posted I said the projected WL with RNY is better, but it is only 20 pounds or so.

I personally don't think 20 pounds is worth having healthy intestines cut and rerouted or the extra long term maintenance. I don't think RNY is worth the hassle unless you have GERD. I also said, I have exceeded the weight loss for RNY and Bypass.

OP is asking for opinions from people on why they chose one surgery over the other. I really don't feel that one surgery has better outcomes than others, just based on the surgery, the patient and their post op choices matter more. I have lost more weight than most people I know with RNY. My diabetes has reversed while a lot of people who had bypass are still diabetic.

Surgery doesn't matter as much as lifestyle changes, habits and food choices. People can easily eat around any surgery.

[Little Green 582]

1 hour ago, OutsideMatchInside said:

OP is asking for opinions from people on why they chose one surgery over the other. I really don't feel that one surgery has better outcomes than others, just based on the surgery, the patient and their post op choices matter more. I have lost more weight than most people I know with RNY. My diabetes has reversed while a lot of people who had bypass are still diabetic.

Surgery doesn't matter as much as lifestyle changes, habits and food choices. People can easily eat around any surgery.

Even though I am choosing RNY, the bolded is exactly what my surgeon and RD have said. In my consult I expressed concerns about ever being able to get to BMI 25 and said I'd settle for BMI 29. My surgeon dismissed that completely and said with my age and health there is no reason I can't get to BMI 25 if I want to. The numbers are just that, numbers. Statistics, averages, etc. They are of course very useful for educational purposes and I'm definitely an evidence-driven person, but body chemistry, hormones, environment, stress, etc. all play a role in our results and the stats don't factor that in. And... never forget that statistics proves the average human has one t*sticle! (Ok, I stole that from a Facebook post I saw!)

Nowadays the recommendations are usually based on which surgery matches the health profile of the patient better; if none of these specific "go left" or "go right" conditions is present, it's for the patient to decide which surgery they feel most comfortable with - based on any of the factors we're discussing in this thread. Which, incidentally, is the info OP asked for! So how are we doing, OP?! Clear as mud, eh?

Edited July 15, 2017 by Little Green

[JohnnyCakes 593]

58 minutes ago, OutsideMatchInside said:

Before you get your knickers in a knot if you read everything I posted I said the projected WL with RNY is better, but it is only 20 pounds or so.

I personally don't think 20 pounds is worth having healthy intestines cut and rerouted or the extra long term maintenance. I don't think RNY is worth the hassle unless you have GERD. I also said, I have exceeded the weight loss for RNY and Bypass.

OP is asking for opinions from people on why they chose one surgery over the other. I really don't feel that one surgery has better outcomes than others, just based on the surgery, the patient and their post op choices matter more. I have lost more weight than most people I know with RNY. My diabetes has reversed while a lot of people who had bypass are still diabetic.

Surgery doesn't matter as much as lifestyle changes, habits and food choices. People can easily eat around any surgery.

a brief jaunt thru your posting history clearly indicates that it is YOU who has "knotted knickers", waging a constant smear campaign against the RNY procedure. this includes promoting ridiculous myths and scare-stories.

quit it. you are helping no one but yourself get over whatever insecurity you clearly have with your decision to get the sleeve. it's not a contest.

[SleeveDreamer 383]

@JohnnyCakes I see you just had RNY on the 27th. How are you doing? I had sleeve revision to RNY on the 12th.

[JohnnyCakes 593]

7 hours ago, SleeveDreamer said:

@JohnnyCakes I see you just had RNY on the 27th. How are you doing? I had sleeve revision to RNY on the 12th.

i'm doing great. it's been about 2.5 weeks. zero complications. no nausea, throwing up, anything. energy is good and i'm losing a pound a day so far. can take in plenty of fluids and i'm up to 2 miles a day walking. thanks for asking.

back on topic - the reason my doctor and i chose RNY over sleeve is because of the "magic" (his word, not mine) of the malabsorption component of RNY. because restriction of food/calories has never been my problem in my lifelong struggle with weight. i've never suffered from uncontrolled hunger, incessant cravings, or food addiction. for the past 5 years, i've been able to gain a significant amount of weight keeping calories around 2,000/day and most of them very clean calories (avocado, eggs, fish were/are my mainstays). i am just genetically programmed to store fat, no matter what. so because of that, we didn't think i'd get good results with just a restrictive procedure like the sleeve. we needed the ace of spades card.

recent studies are bearing this out. showing that up to 70% of the weight loss after RNY is due to the profound changes in gut microbiota (not calorie restriction). there is some change in gut microbiota with the sleeve, but not nearly as much as with RNY.

https://www.medpagetoday.com/endocrinology/obesity/65603

https://www.ncbi.nlm.nih.gov/pubmed/27440168

further - it's interesting to me that the #1 reason i see a lot of sleeve patients cite in making their decision over RNY is "i didn't like the idea of my intestines being rearranged". this is fascinating to me. mainly because i LOVE the idea of my intestines being rearranged. i'm a nerd and the science of it, and the elegance of the surgery, is just so cool. i love being the subject in my own walking science experiment! also, i don't understand the reasoning because "god" (or whatever) never intended a surgeon to slice off 80% of your stomach with laproscopic instruments under general anesthesia either. oh well, not hating, we all have our issues!

[Little Green 582]

I don't think anyone needs to get defensive over their decision. I just think there are pros to RNY that I rarely see discussed on this site because a vast majority are sleeve patients who were fearful of the RNY or felt it was too extreme or invasive. If they felt that way, it's fine, but the truth is it's a very safe surgery that's performed without complications every single day and it's a great option for a lot of bariatric patients.

Not trying to flame any drama, but someone posted a thread the other day saying their doctor recommended WLS and they had no idea where to start, so they wanted information. Within just a few posts that person was saying that it sounded like "the sleeve is the better option" and she was going to go with that one. I don't mind if she gets VSG - heck, like I said, if I woke up with a VSG instead of RNY I'd be pleased as punch. But I would hate for someone to make a decision about surgery without evaluating all of the evidence simply because of fear.

[SleeveDreamer 383]

I wish scare tactics would not be used here when discussiing RNY. It is a perfectly safe option. As I said I have had both now, mainly because my acid was so out of control, i needed to prevent more damage to my esophagus to prevent esophagal cancer possibly down the road. When he started my bypass, he discovered a damaged spot on my esophagus that most likely would have ruptured in the near future and I would have been in deep doo doo. Luckily I have the best surgeon in California and he knew what to do to repair it before he continued with the bypass.

The recovery of this RNY is not one iota different than it was for my sleeve 5 1/2 years ago. The diets are the same, the incisions on your abdomen are the same. Of course the restriction is greater because the pouch is very small. I am not blaming anything on my sleeve. i had great success with it, however, had I realized it would not cure the bad acid reflux I already had, I would have chosen RNY at that time. Although I had about 75 pounds to lose, I did not have the surgery for weight loss. 2/3 of my stomach was over my diaphragm between my lungs headed for my heart. This was a result of a fundiplication surgery I had in 1999 to repair my stomach valve damaged by acid.

Many on the gastric bypass board here have chosen to have a revision from sleeve to RNY because of their severe acid. NO ONE is saying that the sleeve caused the acid. If you have severe acid reflux before the sleeve, the RNY is definitely a better option for you so that can be taken care of as well. This will prevent further acid damage to the esophagus down the road, this lreventing Barrett's Esophagus or cancer.

Some people just want opinions as to why others made their decisions. That does not mean one is the right way or the other is the right way. The doctor will make that decision based on the individual patient. Part of your intestine is NOT discarded with RNY. It is simply cut and attached to your new pouch. There is no difference than having 2/3 of your stomach cut off!

Please do not use scare tactics or such negativity here. WLS is a big enough decision in the first place. Some people will have complications with any surgery. Any surgery is a risk. As I said, I myself have had no complications, no pain, or any nausea with my RNY.

I have a great attitude when it comes to surgery. Never scared. That is part of the reason I recover so well with no issues. It will not do any good to scare people off here. They need to go into either of these surgeries with a positive attitude and be optimistic. We are here to help, not scare them to death. Enough of the negativity and statistics.

Edited July 15, 2017 by SleeveDreamer

[Sherrie Scharbrough 311]

15 hours ago, Little Green said:

Even though I am choosing RNY, the bolded is exactly what my surgeon and RD have said. In my consult I expressed concerns about ever being able to get to BMI 25 and said I'd settle for BMI 29. My surgeon dismissed that completely and said with my age and health there is no reason I can't get to BMI 25 if I want to. The numbers are just that, numbers. Statistics, averages, etc. They are of course very useful for educational purposes and I'm definitely an evidence-driven person, but body chemistry, hormones, environment, stress, etc. all play a role in our results and the stats don't factor that in. And... never forget that statistics proves the average human has one t*sticle! (Ok, I stole that from a Facebook post I saw!)

Nowadays the recommendations are usually based on which surgery matches the health profile of the patient better; if none of these specific "go left" or "go right" conditions is present, it's for the patient to decide which surgery they feel most comfortable with - based on any of the factors we're discussing in this thread. Which, incidentally, is the info OP asked for! So how are we doing, OP?! Clear as mud, eh?

Just a thought. Everyone says that the SLEEVE is less invasive but what about them removing up tp 80% of your stomach. Yes the RNY does have its issues but you will hear of so many having to get the revisions done. For some reasons like GERD etc. I think that if it is medically needed to revise that is one thing but so many times on different sites you hear them say my SLEEVE or Lap Band didn't work for me I stopped losing weight. Or whatever. I also don't think anyone should go into a WLS with intentions of revision surgery later on. Now I know that I will catch back lash on this but...each to their own!! I hope everything goes great for everyone. Take care

[JohnnyCakes 593]

4 hours ago, Sherrie Scharbrough said:

Just a thought. Everyone says that the SLEEVE is less invasive but what about them removing up tp 80% of your stomach.

always my thinking too. the sleeve is much more drastic because of the finality of it.

and despite some saying RNY is irreversible, that is not true. my surgeon (director of medical group at bariatric center of excellence, has done over 3,000 bariatric surgeries) said he could easily reverse an RNY. of course, he then added that he's never been asked to, but the option is there! not so with sleeve.

[Barbara1972 13]