How do they decide which surgery to perform on each patient ie rny, sleeve etc

I am curious about this

 While OHIP provides guidleines for the hospitals re payments, some docs do not exactly follow those, some do.  Depends on your doc and the centre and what medical condtions you have that require sleeve/DS vs rny (ie. adhesions from previous surgeries or need for nsaids in future due to chronic arthritis, etc).  

As Ian says, OHIP provides guidelines and surgeons make the ultimate decision based on their experience.  Some of us did a lot of research (well most of us have) and found that what was recommended for us, was not necessarily what we either thought was best for us or what we were comfortable with and had to do a little "encouraging" to the surgeons.  Some are very open to other surgeries - oh I should mention that OHIP automatically starts with their "gold standard" RNY, but there is also the lap band (not covered by OHIP), and the VSG and DS (covered by OHIP) currently available in Ontario.  If you have a particulary high BMI, or diabetes or GERD or a history of requiring NSAIDS etc., etc., you may have some valid reasons to request something other than the RNY, the surgeon might suggest something else or the RNY might be perfect for you. 

I hope this helps!

In Ontario right now, the assumption is that anyone who is referred for bariatric surgery will have RNY unless there is a medical reason that the surgeon thinks makes VSG a better alternative, or the patient seeks out the VSG or DS and the surgeon agrees.

Some surgeons believe in the "RNY as gold standard" line and will not offer alternative surgeries even in cases where the patient has a medical concern such a need to take NSAID medications (we've seen this at HRRH, Ottawa and Guelph especially), and other centres, it seems as though you need little more than knowledge of and a preference for VSG to get it approved (Hamilton seems to be easiest), and other centres fall somewhere in between, or it varies from surgeon to surgeon.

I say, do you own research on RNY, VSG, and DS and decide what is right for you. Back up your reasons with studies and medical information. Then aggressively go after it. If necessary, get a second opinion, or third from different surgeons. Don't settle. This is how I got approved for my DS.