Which Procedure is Right for Me

[SteveT74 360]

Hi Guy,

This is my first post to the forum, but I have been doing a ton of research lately and I am trying to decide whether surgery is right for me and which procedure to go with. I am a 44 year, 5'10" and at my highest weight I was 258. I was always a thin guy up until my late 20's (when I was generally around 185). In my late 20's, I somehow managed to get up 210, then went on diet and started working out and got back down to 185 in a couple of months. Then I got married and got up to 220, then back down to 200, then back up to 241, then down to 215, then back up to 256, then down to 217. Now, I am 44 was back up to 261 of June this year. The pattern is pretty clear and continuing going up and down the scale isn't doing me any favors. I was sort of on the fence about surgery, but last month I was diagnosed with Type 2 diabetes and that freaked the crap out of me. I always knew I was at risk cause I get the fat all in my tummy, but it's one thing to be at risk and another to actually have the disease. I also have high cholesterol, high triglicerides and sleep apnea. At this point, I am really concerned about my health. I am married and I have two young daughters, 2 and 7, and I would like to live to see grand children someday (and live with good health--not with crappy quality of life).

My cardiologist referred me to a bariatric surgeon in March, so I have been through the initial seminar, consultation, nutritional counseling and monthly weigh-ins. At that time, I was leaning towards VGS, but that was before I was diagnosed with diabetes. Now, I am thinking maybe RNY is the better option? I would like to be able to consider mini-gastric bypass, but it doesn't seem like any doctors in the NY area perform this procedure (I don't think many in the US do it actually). I am kind of scared about doing this, but more scared about not doing it. Is there any reason why I should go with VGS over RNY???

Thanks in advance for the advice!!!

[Sosewsue61 3,185]

Hey check out @JerseyJules success w vsg. Also you are not anywhere near 300 so you should have success with VSG putting type II in control or complete reversal. There is little difference in overall weight loss between the two. Some prefer RnY if there is evidence of acid reflux.

I picked VSG, because I do not want the malabsorption risk, nor the risk of an ulcer in the left-in unused stomach portion. I have only experienced minor heartburn resolved with one pepcid dose, but only 3 times in 9 months. Good luck on making a decision, it is one that only you can make. And welcome.

[MarinaGirl 609]

Many folks that select VSG either don’t reach goal, do not get resolution of diabetes long term, or develop GERD and end up revising to gastric bypass. I recommend RNY so you don’t have to have a second WLS down the road. Good luck!

[KimTriesRNY 1,853]

I believe either surgery would work for you. If the idea of the bypass is off putting to you, there is no reason to pursue it as realistically your weight is not that dramatically high. I would think differently if you were over 300 pounds.

Many times diabetes type II is brought on by excess weight and either surgery would certainly help with that.

‘If you have GERD or frequent heartburn steer clear of the sleeve as that does seem to be a problem we see on here.

The best surgery in the end is the one YOU are most comfortable doing!

[elmatador 167]

Sounds like unless you have terrible GERD that VSG makes perfect sense for you. Either will be successful I'm sure, p4esuming you're ready, mentally prepared and committed to making a healthy change. Good luck!

[Bryn910 519]

it seems like you would have success with either surgery honestly. But since you mentioned diabetes, I would go with RNY only because of the way it could alter your tastebuds, malabsorption and possibility of dumping.

I was a huge sugar/carb person and had VSG. I felt the VSG allowed too much leeway after a while. And I see many people still eat carbs, fried foods, sugar etc with the sleeve.

Now with a revision to RNY, no way can I have an abundance of sugar and/or carbs. I get uncomfortable and some diarrhea. I am 3 months out and still trying new foods and learning but these “consequences” let me know what I need to stay away from. Which is what I wanted all along.

Whatever you choose, good luck and much success to you

[SteveT74 360]

Thanks so much for the responses guys. I guess there's a diverse view of this subject---which is why I am struggling to decide what's best for me. I don't think I have GERD. I do get heartburn every now and then (probably once every week or two), but it's not a constant and I think it's mostly a side effect of being on Victoza for type 2. The long term studies seem to suggest that people lose more weight with RNY and have less issues with regain after 5 years post-op. Patients that have either operation seem to have some regain, but the amount is significantly less with bypass. I don't think I have much concern about dumping syndrome (maybe I should be more concerned?). I don't have a sweet tooth. If given the choice between a piece of chocolate cake or a slice of pizza, I'll go with pizza every time (although obviously, that's not much better for you than the cake).

My surgeon really didn't really tell me which procedure he thought would suit me best and sort of left it up to me (just explaining the pro's and con's of each). I guess I'll weight until the results are in from the rest of my pre-op screening consults with all the doctors on the list they gave me and then I'll have another conversation with the surgeon about this.

[MN_Meg770 125]

Hi Steve,

I was initially going for the sleeve but my surgeon recommended the RNY instead because, like you, I had high BP, high Cholesterol, was diagnosed with diabetes, and have sleep apnea. I am glad I chose RNY in the end. I am off of my diabetes meds now except for a tiny amount of insulin (and that will be gone eventually too), and am off of high BP and cholesterol meds now as well. I have to see about the apnea and CPAP - I bet anything if I have another sleep test that I don't even need the CPAP anymore either. All this and I am only down 25 pounds/a month out! Of course this is just my situation, and your surgeon will know best.

Good luck to you!!

Megan

[CrankyMagpie 509]

I'm going for the sleeve (and I am over 300 pounds and shorter than you and also not male), because I need to be able to take NSAIDs and probably methotrexate for my arthritis. (Sometimes WLS clears up arthritis. That's why I'm seeking it, not the weight itself.) With the bypass, NSAIDs are off the table for, as I understand it, forever. And Tylenol does almost nothing for arthritis.

(Also, I'm self-pay in the US, and the sleeve is less expensive; I have enough money in savings for the sleeve, but I do not have enough money for the bypass, I suspect--I didn't ask for a price, already having made up my mind. Also, the sleeve has a lower rate of complications. Not enough lower that that alone should be the deciding factor, but it certainly factored into my decision. The long-term difference in weight loss is only about 10% of excess weight, on average--50-60% for sleeve and 60-70% for bypass. I can live with that difference; it'll still be life-changing.)

They'll know after they do the upper endoscopy whether you have GERD or not. I had a little damage on my esophagus, and they couldn't tell if it was esophagitis or GERD. (It may also have been due to the massive amount of NSAIDs I took for several years.) Since it was a small enough amount of damage, I'm still cleared for surgery and still planning on the sleeve; I'm just starting the PPI sooner than expected. I know they'll keep me on them for 3 months after surgery, but I'm OK with the fact that that could turn into a year or (I hope not) forever.

Ultimately, everyone in this forum is going to be invested in their own choice, the same way that newly married people try to push all their friends to get married. (I can say that without getting in trouble. I'm married. ) We all had good reasons for what we picked, or maybe we didn't but now that we've picked it we need to believe it was the best possible choice. You probably knew that coming in. But just a reminder: this is up to you, and you've gotta do what seems right for your body, in consultation with your surgical team. 👍

[macadamia 591]

I think it is awesome that you are looking forward to a healthier life. Asking people's opinions here is a great way to start thinking about which way to go. However, the best resource is your bariatric team. There are many factors that make one procedure better than the other. Some of these factors can only be found by tests and the experience of the surgeon. For me, I was told by two different bariatric surgeons that the only procedure that would even be recommended was the sleeve. I have had multiple abdominal surgeries and these preclude having the bypass. By discussing everything with my current surgeon and along with my upper endoscopy and a follow-up CT scan, the best option for me is the sleeve.

Good luck with your journey.