Hi, I'm new to this and have lots of questions regarding whether it would be better to have the VSG or the RXY.  I am at 47% BMI and need to lose about 150 pounds.  I'm scared that by choosing the VSG, I won't be successful.  But I'm also afraid of the long term malabsorption effects of the RXY.  I'd appreciate any advice.  I can't find long term data on the successs of the VSG and have never met anyone who had had it.  Most of my friends or co-workers have had the RXY.  If anyone can help, provide advice or resources, I'd be grateful! :)

Here's a link to a very good article about the different choices

 

Http://www.obesityhelp.com/articles/choice-of-bariatric-procedure-a-philosophy-obtained-in-20-years-of-bariatric-practice-2

the newest studies are finding about the same weight loss with both vsg and rny , but with the sleeve you can take nsaid pain killers and other meds that you can't take with rny

 the vsg is a simpler and safer surgery than the rny, and has less side affects than the rny , ds or the band 

 there is less info about the sleeve because it is a newer surgery, but it used to be done as the first part of the ds but worked so well that many surgeons stopped doing the second part of the 2 part surgery done for the ds 

 like any of the wls it will only work if you stay on plan, you can cheat on any of them , there are many people that have lost hundreds of pounds with the sleeve

 the sleeve does not normally have problems with dumping or reactive hypoglycemia, which are common with the rny , reactive hypoglycemia can make you pass out which can be dangerous if you are driving

 my diabetes is much improved with the sleeve   and I was taken off insulin and byetta

 my back and knees are much better  which any weight lose would help

I am only slightly hungry at meal times and a few bites stop that , I am never hungry between meals

here are some reasons....I stole this list from USAF Wife! (thanks Tiff!  Lol!) 

 

  1) No malabsorption (which typically only lasts 18-24 months, and then the body grows more villi which allows for calories to be absorbed again)
2) No food restrictions, no dumping (which I know not all RNY patients dump, but I didn't want to deal with it)
3) RNY leaves a blind stomach that can still develop ulcers/cancer, yet can not be scoped
4) I knew that I could be successful with a restrictive only procedure because of my eating habits and lifestyle
5) I had a pouch with the band, and it sucked, I didn't want another pouch from RNY
6) The regain stats, and patients seeking a revision after a few years with RNY scared me. Check out the revision board if you're interested.
7) Ability to eat anything and everything, yet have portion control
8) Little to zero sleeve stretching unlike pouches/stomas that can and do stretch

Oh.....and this too!   Pay attention to the conclusion at the bottom.

 

         

New Data on Weight Gain Following Bariatric Surgery

Gastric bypass surgery has long been considered the gold standard for weight loss. However, recent studies have revealed that this particular operation can lead to potential weight gain years later. Lenox Hill Hospital’s Chief of Bariatric Surgery, Mitchell Roslin, MD, was the principal investigator of the Restore Trial – a national ten center study investigating whether an endoscopic suturing procedure to reduce the size of the opening between the gastric pouch of the bypass and the intestine could be used to control weight gain in patients following gastric bypass surgery. The concept for the trial originated when Dr. Roslin noticed a pattern of weight gain with a significant number of his patients, years following gastric bypass surgery. While many patients could still eat less than before the surgery and become full faster, they would rapidly become hungry and feel light headed, especially after consuming simple carbohydrates, which stimulate insulin production.

The results of the Restore Trial, which were published in January 2011, did not confirm the original hypothesis – there was no statistical advantage for those treated with suturing. However, they revealed something even more important. The data gathered during the trial and the subsequent glucose tolerance testing verified that patients who underwent gastric bypass surgery and regained weight were highly likely to have reactive hypoglycemia, a condition in which blood glucose drops below the normal level, one to two hours after ingesting a meal high in carbs. Dr. Roslin and his colleagues theorized that the rapid rise in blood sugar – followed by a swift exaggerated plunge – was caused by the absence of the pyloric valve, a heavy ring of muscle that regulates the rate at which food is released from the stomach into the small intestine. The removal of the pyloric valve during gastric bypass surgery causes changes in glucose regulation that lead to inter-meal hunger, impulse-snacking, and consequent weight regain.

Dr. Roslin and his team decided to investigate whether two other bariatric procedures that preserve the pyloric valve – sleeve gastrectomy and duodenal switch – would lead to better glucose regulation, thus suppressing weight regain. The preliminary data of this current study shows that all three operations initially reduce fasting insulin and glucose. However, when sugar and simple carbs are consumed, gastric bypass patients have a 20-fold increase in insulin production at six months, compared to a 4-fold increase in patients who have undergone either a sleeve gastrectomy or a duodenal switch procedure. The dramatic rise in insulin in gastric bypass patients causes a rapid drop in glucose, promoting hunger and leading to increased food consumption.

“Based on these results, I believe that bariatric procedures that preserve the pyloric valve lead to better physiologic glucose regulation and ultimately more successful long-term maintenance of weight-loss,” said Dr. Roslin.

You're doing the right thing by doing your research.  Your surgeon can help you make the right choice too.  When it came time to remove my lap band and revise to either RNY or VSG, my surgeon told me a couple of things that helped me make up my mind.

1. Do you have acid reflux/GERD?  If you do, it may get worse with VSG, and the cure if it does is...wait for it...RNY.  I did have horrible reflux, but felt sure that it was caused by my band and a hiatal hernia (turns out I was right - although I was on a PPI for 6 months post surgery, I don't need it much anymore).

2. Going in, I was pro-VSG because I didn't want to have a lifetime of vitamins and supplements to deal with.  Well guess what - the vitamin and supplement regimen is about the same regardless of the surgery you choose, simply because of the smaller amount of food we're able to eat.

3. The NSAID thing?  I don't know - my doc said no NSAIDs after VSG either, but I guess it depends on who you talk to.

4. No matter which surgery you choose (perhaps you should consider DS as well), it's all what you put into it.  This isn't a magic bullet.  If you don't change your eating habits and your entire lifestyle, the tool can only take you so far.  I've seen my brother and a couple of friends do well for the first year after RNY but never change their eating habits, and gain most of the weight back.  I worry about my brother every day since he never took his vitamins and supplements and didn't participate in any follow-up care.  And of course, he won't listen to his sister!

 

I recently went through the same emotions as you are going through.  I did tons of research and my brother is an internal medicine doctor and knows the Bariatric surgeons in his hospital.  Through my research and my brothers coaching I felt the Sleeve was a better, safer long term option for me.  I didn't want to be the one who has issues with vitamin deficiencies in the end and have health risks because of it.  I'm trying to get healthier!  

Good Luck!

I went into my pre-op orientation meeting really sure I wanted to band - I was uneducated about the other types of bariatric surgery.  I quickly realized that the band wasn't for me and started researching the others.

After some research I quickly realized that the VSG was for me and here's why.  The VSG was originally performed on very obese people - people who's bodies couldn't withstand a gastric bypass surgery.  It was the first of a two step process - the VSG would allow the patient to lose enough weight to be able to have the bypass surgery safely.  What they realized was that the success with the sleeve often times was enough and they found they didn't have to perform the bypass.  I looked at it this way  -  if something happens (stomach cancer that runs in my family) or the sleeve isn't successful, I have a fallback position to be able to a bypass if needed.  I'm not banking on this, I want my sleeve to be successful, but knowing there's a Plan B in case something went wrong was reassuring.

In the end, you will know which is the right one for you.  Do your research, talk to medical professionals and network on sites like this.  Being informed is most powerful.

I wish you good luck during your journey.

Thank you everyone for your thoughts and advice.  I really do appreciate it.  I'm trying to make a very informed decision and I'm grateful that my insurance if finally giving me an option and will pay for the procedure at all.  This is the first time in 10 years I've had insurance which will cover these procedures.  This is such a great forum for discussion and so many people with incredible experiences.  Thank you all!