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VSG vs RNY

Dravens_Mommy
on 6/1/12 8:29 am - VA
Since Febuary I have been gearing towards the RNY. However, all this talk about the sleeve recently has got me thinking and I have to make my decision in 1 week when I schedule surgery. Why did you choose VSG over the RNY? Do you lose weight at approximately the same rate? Thanks.
doggz109
on 6/1/12 8:38 am, edited 6/1/12 8:38 am - CA
VSG on 01/12/12 with
1.  Don't want my guts re-routed.  The sleeve is a smaller version of our natural digestive system (with some tweaks of course....but keeping my pylorus valve was VERY important).

2.  Don't want dumping.

3.  Rate of re-gain from RNY scared me.

4.  Reactive hypoglycemia from RNY scared me.

5.  FInally - maybe this is superficial.....at my pre op support groups......all the RNY people looked sick and all the sleeve people looked healthy.  Take that as you will.
Krazydoglady
on 6/1/12 8:58 am, edited 6/1/12 8:59 am - FL
If choosing between the two, I would certainly go with the Sleeve.  RNY relies on malabsorption of calories which ends after a period of time while the malabosption of nutrients does not.  RNY bypasses the pylorus which regulates the speed at which food leaves your stomach leading to dumping.  RNY also leaves a blind stomach. The sleeve preserves the pyloris (slowing transit compared to RNY) and removes the stomach so it's not just sitting there potentially ulcerating getting cancer without being able to be visualized with an endoscope. Equally important is the fact it removes the tissue of the fundus that produces MOST of the hormone that regulates hunger, Ghrelin.

VSG is sometimes referred to as a restriction only procedure. That's only true to the extent that it does not reroute the intestines.  The sleeve works through three actions which are permanant:

1) Restriction - It is very hard to stretch a properly made sleeve. The tissue left behind is not stretchy. One study that is often misquoted suggests the sleeve volume doubles over time.  The comparison, however was to the volume at 3 days post-op. At 3 days post-op I could 1oz of applesauce.   At 16 months post-op, I can eat 2-3oz of 'dense' protein and 1/2 cup of things that are squishy like cottage cheese.  I eat out with my husband, regularly, and I eat small amounts of REALLY good stuff.

2) Hormonal regulation in the stomach -- 75% of the body's Ghrelin production takes place in the 'Fundus' or stretchy part of the stomach. That is the part of the stomach removed during VSG.  Other parts of the body including the intestines will make up some of the difference, but studies show long-term, only 50% of the hormone compared to pre-op levels.  Ghrelin regulates hunger and again, studies show that higher levels of ghrelin impede weight loss. That is by design. When you are in a calorie deficit, the body produces more ghrelin to make you eat more which is why bypass and band patients have higher serum ghrelin levels post-op than they did before they started. By removing the Fundus in VSG or DS, that mechanism is short-circuited

3) Hormonal regulation in the intestines - Because the sleeved stomach is a high-pressure system, gastric emptying and intestinal transit are faster than with a 'normal' stomach by about 50%.  This causes quickery satiety through triggering the "Ileal Brake."  When undigested fat hits the intestines, the body gets a hormonal signal to stop eating.  

The two hormonal components are the reason VSG is thought to be as effective against T2 Diabetes as RNY although DS remains more effective than either.  One study I read, however suggested the cure rate for T2Diabetes for indidivuals who had it less then 10 years was similar to that of DS whereas DS was more effective with long-standing diabetes by a good margin.

With DS which is VSG+duodenal switch, those three mechanisms are still in place although Ghrelin levels tend to be a little higher from what I've read due to mroe of the fundus being left, but there is an added benefit of the malabsorptive component.  Mal-absorption requires a lot more dilligence in terms of following lab-work, vitamin regimin, etc. 

I am a happy sleever. I can eat pretty much anything I want just in relatively small quantities. My main dietary restriction is simple carbs which is pretty much what you have to restrict to maintain with any WLS.   I'm in maintenance at 1500-2000 calories on any given day, and I'm 44,  5'2, 128-130lbs on any given day.

Carolyn  (32 lbs lost Pre-op) HW: 291, SW: 259, GW: 129.5, CW: 126.4 

        
Age: 45, Height: 5'2 1/4"  , Stretch Goal:  122   

 

USAF Wife
on 6/1/12 9:15 am
This is just a copy/pasted reply, and is outdated. BUT, it has all my reasons and especially very important information as to why I'm elated I chose VSG over RNY for my revision from the band. Tatum is now 7 months old and I'm 20 weeks pregnant again.

This is my standard reply when this question pops up every couple of days. I won't try to sway anyone one way or another, but I'll give you my reasons for choosing VSG over RNY for my revision from the band. You can also check out the revision, failure, and food issue forums on here to get an idea of some long term RNY patients. For me, it was never an option. The cons outweighed the pros.

The VSG was my 2nd, and final WLS. I could have easily had RNY, but I fought to have VSG as my revision from the band. Some factors I considered in deciding on VSG. The pouch that RNY offers is similar to the pouch with the band. Least to say, a pouch sucks, I love having a normal tummy, just less capacity and still fully functioning.

1) No blind stomach left behind that can be difficult to scope yet can still get ulcers and cancer.

2) 2 years max on calorie/carb/sugar malabsorption, but a lifetime of vitamin/nutrient malabsorption. This process is called adaptation, and it happens with intestinal bypass surgeries.

3) I had a pouch with the band, and it sucked. I'm pretty fond of my pyloric valve and the sleeve let me keep it. I love having a normal functioning stomach, just smaller in capacity.

4) Regain stats and #of RNY patients seeking revision truly scared the poop out of me

5) I have too many friends in real life that struggle with vitamin deficiencies post-RNY, and most of them either never got to goal, or have gained back a significant amount of their weight.

6) The long term complications with RNY were too numerous for my comfort level. Pouch or stoma dilation, strictures, vitamin/nutrient deficiencies, ulcers,

7) I researched gastrectomies that had been performed for stomach cancer and ulcer patients, and found comfort in the long term results and minimal complications of patients that had lost most or all of their stomachs had dealt with over several years.

8) I was a volume eater, and knew a restrictive only procedure would work for me. That was my thought process when I got the band, and I thought I could beat the odds on complications. Sadly, the band only lasted 8 months before I had to revise.

9) I did not want to have food or medication restrictions. I chose WLS to have a "normal" life, and I think it's normal to eat a couple of cookies. With RNY, I wasn't willing to go through the possibility of dumping if I wanted to have a couple of cookies, or a slice of cake on occasion. The big scare for me is medication restrictions for life. NSAIDS and steroids are a NO GO for life with a RNY pouch. I realize that I may never be diagnosed with a condition or disease that requires steroid use, but it is possible. I want the best long term results with the least amount of complications. Malabsorption is not anything to play with in my mind, and I was not willing to take that risk.

I lost all my weight in my ticker with the exception of 7lbs with the sleeve, and I did it in 10.5 months. The 115lbs fell off the first 6.5 months, and then the rest I lost as I was getting into maintenance over another 4 months.. It's been a fabulous journey, and I'm easily maintaining with zero issues for nearly a year at this point. I want to add that every WLS regardless of your choice will require discipline. Only a percentage of RNY patients dump on sugar/fat, pouches and stomas stretch, then you have the medication restrictions. I'm not trying to convince you, but these were my concerns when I knew I had to revise from the band. I started at 263 the day of my revision and today I weigh 127lbs. I bounce on the scale 125-130lbs any given week, and I couldn't be more ecstatic!

Best wishes in your research!


I delivered my daughter 3 months ago, so this part is a bit old, but pertinent. I was able to have a spinal block and an uneventful csection delivery with zero clotting issues. And, I was on 60mg of Prednisone for over 30 days, plus received IV boluses of steroids as well, and then 3 days of steroids via iv while in the hospital after delivery with zero gastro issues.

P.S. I wrote this before pregnancy. And, just as an update, I'm 8.5 months pregnant and thriving.  I have zero issues consuming enough calories/protein/carbs to support my body and another developing human. My labs have remained stellar throughout the pregnancy, and life is pretty good. I am over 2 years out at this point, and couldn't be happier with my decision to have VSG over RNY for my revision. It's been an amazing journey.


P.S.S.
Since the pregnancy, I have been diagnosed with a genetic clotting disorder and the ONLY treatment (zero cure) is a daily aspirin therapy. With VSG, this treatment is possible, if I would have gone with RNY my doctors (surgeon, 2 ob's, PCM) are unsure how this condition would have been treated especially during the pregnancy. Grant it, I only take a baby aspirin every day of my life, but it is an NSAID. Least to say, when my high risk ob found out I had a partial gastrectomy and NOT RNY, he was elated because there really is zero other option for treatment at this point, and the aspirin therapy is working well with my platelets and if all goes as planned, I will be able to have an epidural for my c-section instead of having general anesthesia. Maybe a small issue to some, but being awake for the birth of my daughter is top priority for me.

As a very recent addition; as of 10 days ago, I was advised I would have to be given a steroid(dexamethasone or prednisone) to help get my platelet count up as they have dropped. If I would have had the RNY, this would NOT be possible, and pretty much general anesthesia would be required for the csection. We're looking at other options for delivery such as a spinal block instead of a full epidural, but the doctors are positive the steroids will get my numbers up. At any rate, if I would have chosen RNY, I would surely not be able to have steroids. Looking back, I can't tell you how grateful I am that I was able to choose VSG.
Band to VSG revision: June 3, 2009
SW 270lbs GW 150lbs CW Losing Pregancy Weight Maintenance goal W 125-130lbs


1london
on 6/2/12 3:12 am
VSG on 07/27/11 with
USAF wife,
Great info as always...but I had to shout out a BIG CONGRATULATION!!!!  How wonderful!
Tatum will be thrilled to have a little brother or sister (I know she already has a big brother). :)   So happy for you all.
Best wishes to the family!