How did you choose which type of surgery was right for you?

Hello,

I'm new and according to my surgeon I am a good candidate for both the Roux En Y and the Sleeve. I understand the pros and cons of both surgeries, but wanted to get some input on how others made their choices and why they ultimately chose one surgery over the other.

Any information would be appreciated.

Thanks!

While you're researching, you should also research the Duodenal Switch. The DS has the same stomach as the Sleeve, plus an intestinal bypass similar to that of the RNY, but more effective. The DS has the very best long-term, maintained weight-loss stats, and the best stats for resolving or preventing diabetes and high cholesterol. Like the Sleeve, still allows you to take NSAIDs, which gets more and more important as we age. (*grin*) And with the DS, the malabsorption of calories is forever. (With the RNY, the body pretty much overcomes malabsorption of calories by 18-24 months post-op.)

I had my DS ten years ago, and I live an amazingly normal life.

I originally went in thinking I wanted a lap band.  I did not want my insides rerouted which is what happens with the RNY and the DS.  I also know several people that had put the weight back on with the RNY.  I sat through the seminar and had never heard anything about the sleeve but when i left the seminar that is what I decided to do.  For me, it was the least invasive and there were too many problems with the lap band.  I researched it some more and then went in for my consult and the rest is history.  While I take a multi vitamin, I am not required to take any other kind of medications.  With the RNY & DS, you malabsorb your food so you have to take vitamins and watch your labs so that you do not have any deficits.  I just didn't want to mess with that.  With my sleeve, I am just as I was before, except that I am healthier, down 122 lbs and am off all of my medications.

Picking your surgery is a personal choice and you really have to go with what will work best for you.  Just know what the requirements will be for the rest of your life and make an informed decision.  With ALL weight loss surgeries, you can put the weight back on but if you take the time to change your lifestyle, you can be very successful for the rest of your life!

Good Luck!

When I was choosing I just made a list of pros and cons for each surgery of the things that mattered most to me. I read studies and learned success and failure rates.

I wanted the best chance to lose the weight.

I wanted the best chance to keep the lost weight gone.

I wanted the best resolution of co-morbs.

I wanted a surgery that retained my own pyloric valve to eliminate.

I wanted the option to take NSAIDS for pain

I did not want to risk dumping

I did not want to risk reactive hypoglycemia

I did know I could comply with the vitamin/supplements necessary after a malabsorptive procedure.

I chose the DS. Unfortunately I had to change surgeons at the last minute as my surgeon I'd already picked didn't do DS, but I'm so glad I did.

Keep in mind that they all limit how much food you can consume.  The sleeve simply restricts food, which is great for some, but not enough for others.

The RNY and the DS have an additional factor that changes your body's metabolism of food.  The RNY is shorter-term than the DS with this, but it adds an extra benefit for those whose bodies fight them tooth and nail for every item eaten.

We are obese for different reasons. so taking these factors into account are important to your long-term success.  The DS is the most aggressive and complex of the procedures, so you're not going to find nearly as many surgeons offering it.  You can throw a rock in any direction and find a decent sleeve or RNY surgeon, though.

I picked RNY over Sleeve because I was having HORRIBLE issues with GERD/acid reflux. Which worked wonders since I haven't had even a second of reflux since surgery 6 months ago !!

I would recommend you consult lots with your surgeon, as I'm sure you are, and do as much reading and research- books, sites like this, articles- as you can, as well as asking as many different people as you can because ultimately it is your own choice to live with and make work. There is no perfect weight loss surgery- they all have their pros and cons, and will require lots of daily attention and work. All of them can be sabotaged with subsequent regain. All of them have the possibility of complications. There are a lot of passionate positions here on this board, but each of us are different with different requirements.

That said, I think both the RNY (Roux En Y) and sleeve surgeries do what they need to do, but require learning new habits, and that is the hard part. The maintenance is lifelong. I personally chose the RNY because of severe GERD, which is not so good with the sleeve. Both have similar weight loss statistics. The DS, which you are not even asking about, is usually only recommended for people with a very high BMI because of its extensiveness and risk of complications and malnutrition. My surgeon won't do it at all because of its risk. Plus I personally can't imagine living with my innards so drastically rearranged- I had a hard enough time getting my head around accepting an RNY and how much that would change my insides.

I am now 3 1/2 years post surgery, and know it was one of the best things I have ever done for myself, not only because of the weight loss, but because my health is so much better.

Good luck with your journey!

Anne, anyone who qualifies for WLS qualifies for the DS. We have many DSers out there who had their surgery with BMI's below 40. After all, it is the most effective surgery for resolving or preventing diabetes and high cholesterol.

Many surgeons don't offer the DS because they don't have the skills to perform it. I've been  told that sewing the duodenum is rather like sewing wet tissue paper.

Quote from AMSBS clinical guidelines, 2013 update: "Physicians should exercise caution when recommending BPD, BPD-DS, or related procedures because of the greater associated nutritional risks related to the increased length of bypassed small intestine."    

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JAMA Surgery Releases for September 17, 2012  Study Compares Duodenal Switch vs. Gastric Bypass for Morbid Obesity   "Although researchers note a relative increase in the use of the DS, this procedure is still used much less in theUnited States compared with gastric bypass. The researchers suggest that is likely due to several factors, including the technical difficulty of the procedure, the higher reported rates of short-term complications and concerns about the longer-term nutritional consequences of a primarily malabsorptive procedure (where absorption of calories and nutrients is reduced)."

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Duodenal Switch vs. Gastric Bypass "There are higher complications with the duodenal switch as opposed to a gastric bypass or a laparoscopic sleeve gastrectomy or a lap band.  There is a higher risk of leak and a higher mortality with the duodenal switch versus the gastric bypass. Also, there are many more nutritional and vitamin deficiencies with the duodenal switch. Duodenal switch patients have a higher incidence of diarrhea after the procedure, as well."    David Buchin, MD Long Island Bariatric Surgeon    

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I think it is essential that a person be as informed as possible regarding the risk/benefit ratio with whatever they undertake, especially in the case of extensive and complicated surgery such as weight loss surgery. Weight loss surgery is also an elective surgery- personal informed awareness is even more important in undertaking it. In the case of the sleeve, the RNY, and the DS, the impact is irreversible. Even if a reversal surgery is performed, it can only be like repairing a broken vase.      

I'm not saying that the DS doesn't have benefits, especially with diabetes type 2 and sleep apnea and long term weight loss. It's just that a person needs to be aware of the costs and to look at the possibility from many different aspects.      

The DS is by far the most extensive and complicated of all the weight loss surgeries. There are only around 50 surgeons worldwide who are willing to perform it and it is by far the least performed of all the available weight loss surgeries- why is that? Clearly it is not seen as a moneymaker, let alone something most surgeons want to undertake. I don't think that has much to do with skill level, either, because many thousands of surgeons perform operations even more complicated and extensive on a routine basis. My Bariatric surgeons won't do it at all, and say the added weight loss from DS compared with gastric bypass is offset by risk of complications that far outweigh any potential benefits.      

Plus the jury is still out with regard to the long term effectiveness of all the weight loss surgeries, impact on long term health, and effect on longevity.       

PROFESSIONAL research backed knowledge and opinion with a PROFESSIONAL qualified Bariatric surgeon, several if necessary including at least one consultation with a surgeon who will not perform the DS and the reasons why, is the primary place people should want to go in making a choice that impacts every aspect of a person's health, well-being, and life. Personal anecdotal experience is all well and good and often useful, but not at all sufficient, should only be used as food for thought, and can only be an opinion, including this one.  

Some insurance policies limit DS eligibility to those with a BMI over 50.  People can try to fight that and get approval if their BMI isn't that high, of course, but may have mixed results on whether they can get approved.

Lora