VSG or RNY? Help please!!

Hello everyone! First off, I am very nervous about having any type of surgery! My BMI is 52, I am pre diabetic, have sleep apnea and an enlarged heart. I have never had any type of surgery, but I can't seem to lose and keep weight off on my own :(  I also have a bad gallbladder which will be removed at the same time as weight loss surgery. I wanted to have RNY, but my surgeon seems to be leaning towards VSG?? I am utterly confused! I tend to snack on sugary things ( food and drink ), so I was hoping for the help of dumping, although I want what will give me the best overall results of course. Thoughts....opinions....experience...appreciated! Thanks

Just wanted to let you know only about 30% of RNY patients dump. So that will not be a helpful deciding factor for which surgery you want. This really is a personal decision. I am sure others will chime in. I only needed a restrictive procedure so I got the sleeve. I did not need my intestines rerouted. I was a volume eater and wanted to eat less. I also like the removal of the hormone ghrenlin which for me greatly diminished hunger. I did not like the thought of a blind stomach you have with the RNY. Plus the malabsorption of food only lasts about two years. I also wanted to retain my polyuric valve. I say research the two and see what works best for you. Also why is he leaning towards the VSG? He knows your medically history so most likely is leaning that way for a reason.

Thank you for your comment! I am not quite sure why he is leaning towards the sleeve as opposed to the rny.  He does both types of surgeries.

Well don't be afraid to ask him why. He may give you some really good reasons.

What are the reasons that your surgeon gave to you for leaning towards the VSG over RNY?  Does your surgeon perform both procedures? Make sure the reason for your surgeon leaning towards one procedure over another is for your benefit and not because he/she doesn't do the other procedure.

Don't make your decision for a RNY based on dumping.  I had my RNY in 2001 and dump but not every RNY WLS'er dumps.  You can also eat around dumping if you want.

My suggestion is to research both procedures and your behavior patterns.  Do you need only restriction (VSG) or do you need the malabsorption and restriction of a RNY?  Check out the pros/cons of each procedure.  The malabsorption of the RNY helps at the early period of post-op but diminishes.  The malabsorption can also cause deficiencies which can become a problem.  Another consideration is that the VSG is that it is the first part of the DS procedure.  If you ever wanted to revise, you'd already have part of that procedure.

Check out the RNY and VSG message boards.  Post to members about why they had the procedure that they did.  

Thanks for your input!

At your BMI, the VSG will probably get you only halfway to your goal.  WTF is he thinking? 

IMO and most docs, the combination procedures (restriction and malabsorption) are the better choice for those with BMI's of 50+.  While there are a select few who do marvelously with the VSG alone at your BMI, most will have a second surgery down the road, and why bother with that?  This is your decision, and I strongly urge you to keep towards the RNY, but even stronger to learn about another procedure, the duodenal switch.  The DS has the best statistics for loss and lowest for regain yielding the greatest chances for the higher BMI's to get down to a normal weight.  There is a captive audience of DSers if you find us up on the Forums menu.  Not all docs do this procedure, but it's well worth a look.  The goal is to get only one surgery.

Thats what I am thinking as well...maybe the VSG will not work as well as far as how much weight I need to lose. I am curious about the DS...I have heard a lot of good things...and I know of a surgeon at the Cleveland Clinic that does that surgery. I will be meeting with him next week. The surgeon I have already consulted with only does VSG or RNY.  And I'm not sure if my insurance would cover DS...but I will check into it. How much longer does the DS surgery take? I am so scared of being operated on, but at this point it's necessary! Thanks

My procedure took about 2 hours and was done open.  If you get it Lap, it takes a little longer but I promise that you'll sleep through the whole thing either way.  Insurance coverage for the DS is much more common than it used to be, so it's worth a call.  There is a board of DSers here on OH, and lots of info about it on dsfacts,com,

Here's what I've posted to my blog about why I chose VSG.  My BMI was 54.7.  It's now at 32.6 and I'm still plugging along :)  

The four WLS are - sleeve, gastric bypass (RNY), lapband, and duodenal switch. My insurance covers the first three, but not the DS.

I ruled out the lapband immediately because the only people I know who have had it are miserable or have needed it removed. The complication rate is atrocious and it only lasts for 10 years or so. It's billed as being a "reversible" surgery, but the damage it can cause, like from erosion into your esophagus, is permanent. So no lapband for me. Here's an article on that topic.

The choice really boiled down to RNY or VSG and I chose the sleeve for a number of reasons. (Even if DS had been an option, I would not have chosen it.)

1. I really like the simplicity of the sleeve. All it does is remove 85% of your stomach. That's it.
2. I dislike the idea of having my intestines rerouted.
3. The "good" malabsorption that the bypass gives (of fats) is a temporary thing that only lasts for a few years whereas the "bad" malabsorption (of vitamins and minerals) lasts for forever. That's not worth it to me.
4. The sleeve is restriction only, no malabsorption. This also means that I CAN eat anything at all. Fats and sugars won't screw up my bowels the way they can for the bypass. (Of course I still need to make healthy choices, but that's a choice, not something that my surgery requires.)
5. With the bypass, you're left with a remnant stomach that can't be scoped. That scares the crap out of me. First, the idea that I have this weirdly connected non-stomach but then to not be able to get it checked out with an endoscopy if there's a problem? Eek. Do not want.
6. My understanding is that complication rates with the bypass are significantly greater, especially longterm due to malabsorption. While I will be taking vitamins for the rest of my life, chances are that I won't end up in the hospital if I stop because the sleeve has no malabsorption involved.
7. For the most part (and there are exceptions) the people I know with the sleeve look and seem healthier than the people I know with the bypass. That's nothing scientific though.. just a gut feeling.
8. The sleeve leaves you with a fully functional pyloric valve at the bottom of your stomach whereas the bypass gives you a stoma which can stretch over time.