WHY?

[summerset 5,261]

2 hours ago, GreenTealael said:

Is it lack of research or self sabotage?

Or availability? Or insurance coverage? Or wanting the least invasive procedure?

[Orchids&Dragons 9,046]

2 hours ago, GreenTealael said:

I have a question that's been haunting me for a while.

Why would anyone pick the least effective surgery for their particular needs (obesity level, food addiction, prior health issues, other mental health concerns,etc)?

Is it lack of research or self sabotage?

In general, we don't know what other people's needs are. We certainly don't know if they were up-front with their surgeon. And we've seen how many people on this site are in complete denial of their own situations. I think it's perfectly normal to want to do the least invasive option available that will suit your needs, but that requires the patient being brutally honest with him/herself and with the doctor.

[GreenTealael 24,866]

1 hour ago, FluffyChix said:

Yes. The most recent studies are trending toward VSG, short op time, lower complication rate, and they think that malabsorption isn't as great as it was with the longer bypasses from the old days. After about 18mos to 5 years, the malabsorption level is minimal anyway. Microvilli in the gut regrows at an alarming rate so that the body can "clean" more nutrients and calories out of the food that is swiftly passing through the gut. It's an adaption process the body goes through.

Hmmmm I don't like it.

Another member asked why so many revisions, they though it was a way to collect extra coin from failed surgical patients, I thought nonsense, why would a doctor do that? at the time now I'm thinking yeah...

[GreenTealael 24,866]

6 minutes ago, summerset said:

Or availability? Or insurance coverage? Or wanting the least invasive procedure?

Availability for DS Yes that's an issue these days, but insurance coverage for DS and RNY are usually more guaranteed than VSG ,right?

Invasiveness idk it all seems the same when done laparoscopically vs open

But these are things to consider

[GreenTealael 24,866]

8 minutes ago, Orchids&Dragons said:

In general, we don't know what other people's needs are. We certainly don't know if they were up-front with their surgeon. And we've seen how many people on this site are in complete denial of their own situations. I think it's perfectly normal to want to do the least invasive option available that will suit your needs, but that requires the patient being brutally honest with him/herself and with the doctor.

But isn't that what the while process is for, to evaluate for these things? Are people lying to themselves or their teams as a form of self sabotage? Or do they really think they can cheat their way to the win?

Edited August 20, 2018 by GreenTealael

[summerset 5,261]

Just now, GreenTealael said:

Availability for DS Yes that's an issue these days, but insurance coverage for DS and RNY are usually more guaranteed than VSG ,right?

Depends on the country.

Quote

Invasiveness idk it all seems the same when done laparoscopically vs open

Invasiveness not only relates to the procedure - it's also the level of malabsorption. High level of malabsorption after all doesn't only mean "more weight loss because less calories" but it also means "less absorption of Vitamins, minerals and gazillions of micronutrients, including some we might not even know about yet".

[GreenTealael 24,866]

For the record

Perhaps its more complex than just the two categories I chose as answers. I'd like to hear other reasonings too, those were just what I could come up with

[GreenTealael 24,866]

3 minutes ago, summerset said:

Depends on the country.

Invasiveness not only relates to the procedure - it's also the level of malabsorption. High level of malabsorption after all doesn't only mean "more weight loss because less calories" but it also means "less absorption of Vitamins, minerals and gazillions of micronutrients, including some we might not even know about yet".

Very very true

But what comfort does someone who's surgery failed their expectations get if that surgery was never right for them in the first place (not by my standards, by close evaluation of all data)?

Just have a revision? Thats what people are doing ...

[summerset 5,261]

9 minutes ago, GreenTealael said:

But what comfort does someone who's surgery failed their expectations get if that surgery was never right for them in the first place (not by my standards, by close evaluation of all data)?

I think this is the problem: you won't know if it's the right procedure for you until you had it for a while.

People are absolutely gung-ho about the whole WLS thing, motivated, enthusiastic, unstoppable, indestructible... until this honeymoon phase (that every diet in the past had as well) is over and the darker sides and ho-hums show their faces. The thrill is gone and there you are with maybe a lactose intolerance, pooping issues, adhesions, GERD, diarrhea, malabsorption issues even though you're taking your Vitamins etc. etc. etc.

Was the lap-band the right procedure for me? Well, at first it seemed like it, but after some years it became clear that it wasn't. (However, it was also the only WLS procedure that you could get covered as a young woman back then if you were lucky enough and/or persistent enough with getting on the nerves of your insurance company, that is. Nobody even talked about the DS in these days).

Now I have an MGB - do I know if it's the right procedure? Or would the RNY have been better? No one can tell. I made the decision together with my surgeon. It might be that I will need a different anastomosis later (GERD, reflux, don't ask...) or it might not be.

[t1018ross 116]

I think the people who truly research their options, have open, honest discussions with their doctor, are honest with themselves about making permanent lifestyle changes, and have realistic expectations and goals are the most successful, regardless of which surgery you choose. I chose VSG because I didn't want the problems of malabsorption and I didn't want to deal with dumping syndrome. This is not because I wanted to go back to eating whatever I wanted. I had my gall bladder removed several years ago and experienced dumping with almost everything I ate for about a year afterwards. It was horrible. I also didn't like the idea of switching my anatomy around. I like that with VSG the digestive process is still the same. I also educated myself on the procedure and have realistic expectations of the outcome. And, if I'm being honest, I do like being able to "cheat" on special occasions without worrying about dumping. My restriction keeps me from going overboard and I'm able to resume my regular diet after without going into a downward spiral of bad choices.

[skylw6 153]

I Just had a The sleeve . Of all the choices out there my surgeon believes it was best for me and has the best king rate success.

A co worker had the lap band recently because he was not allowed to have the others based on a family history of colon cancer.

I don’t think it’s self sabotage as maybe there are just factors that make other surgeries less ideal for some.

[t1018ross 116]

8 minutes ago, summerset said:

I think this is the problem: you won't know if it's the right procedure for you until you had it for a while.

People are absolutely gung-ho about the whole WLS thing, motivated, enthusiastic, unstoppable, indestructible... until this honeymoon phase (that every diet in the past had as well) is over and the darker sides and ho-hums show their faces. The thrill is gone and there you are with maybe a lactose intolerance, pooping issues, adhesions, GERD, diarrhea, malabsorption issues even though you're taking your Vitamins etc. etc. etc.

Was the lap-band the right procedure for me? Well, at first it seemed like it, but after some years it became clear that it wasn't. (However, it was also the only WLS procedure that you could get covered as a young woman back then if you were lucky enough and/or persistent enough with getting on the nerves of your insurance company, that is. Nobody even talked about the DS in these days).

Now I have an MGB - do I know if it's the right procedure? Or would the RNY have been better? No one can tell. I made the decision together with my surgeon. It might be that I will need a different anastomosis later (GERD, reflux, don't ask...) or it might not be.

I think you're absolutely right. You can do tons of research and have realistic expectations but you won't know how the surgery will work for you until you go through it. No one can predict how your body will react. I think the best you can do is educate yourself and have good discussions with a surgeon you trust.

[AJP 132]

My ins covers the different types. I had actually wanted the sleeve. My surgeon told me to research rny. With my pcos said I'd have better results with rny. So went home, did the research and the data indicates he was right. Ugh so I went with the gastric bypass 😀

[Orchids&Dragons 9,046]

1 hour ago, GreenTealael said:

But isn't that what the while process is for, to evaluate for these things? Are people lying to themselves or their teams as a form of self sabotage? Or do they really think they can cheat their way to the win?

I think we've seen enough posts to know the answer to that one.

[Missouri-Lee's Summit 1,256]

There is one thought I can't get out of my head. What are the long-term effects of weight-loss surgery? Because WLS is still in its infancy in many respects, none of us can predict the outcome of our decision when we become old and frail and we are in need of all the nourishment we can get.

We've limited our bodies to benefit us now, but later... what about then? What struggles do we face when every spoonful might count. I love older people to pieces. I enjoy their company. I'm genuinely interested in what they have to say about their lives, past and present. I've also noticed that many older people don't eat much. If the little I eat now is only partially being absorbed, what will happen when I get older... when I'll conceivably need all the nourishment I can get to live a long and healthy life?

Let's hope that knowledge keeps pace with our surgeries. Heck, there are still unknowns about which medications are poorly absorbed as well as other unknowns about how our bodies process various Vitamins and minerals. Are we creating ailments that didn't exist on the same scale before millions of people embarked on these surgeries? Outside of pregnancy, I can't recall ever being concerned about a nutritional deficiency (well, except for Vitamin D, but that's because I abhor the sun and I'm too stubborn to spend even the lousy ten minutes required to absorb what I'd need.)