VSG or RNY- That is the Question.......

 I would love to have the VSG surgery and am currently have met my surgeon, had the Physiologist  Evaluation, endoscopy and am about to go to my 6 nutrition visit.  At my last appointment with my surgeon he wants me to reconsider the VSG and look at the RNY surgery instead. I don't feel comfortable with the idea of the RNY , when he suggested that to me my head was saying....complications, malabsorbtion, 2 ounce meals ( at first), dumping. Then I think well I should take his advice- he's the surgeon, he knows what I need. So now I'm just as confused as ever. Before I met with his I was 100% decided on the VSG now i'm not sure. I noticed that I'm at a higher weight then most VSG'ers start at maybe I need something more drastic. Suggestions anyone- Help any advice is appreciated!

There are alot if successful VSGers that started out at higher weights on this board! I started out at 450lbs at my consult. My surgeon refused the RNY until I got below a 60bmi which Im glad he did because I have lost 154lbs (124lbs since surgery) and im not even 9 months out. It not the surgery that will lose the weight for you. Its how you utilize your tool and how determined you are to change your life. I wouldnt change my surgery type for anything. I have worked hard and still have a ways to go but I will get there one day at a time. You do what you are comfortable with but after researching the vsg I dont want the long term effects that could come from the rny. I wish you luck on whatever you choose.

"he's the surgeon, he knows what I need."  Maybe not.  Sometimes we need to listen to our intuition. If you want the sleeve, get the sleeve.  I believe there are several people on this board who started where you are and have been very successful.  Your success will be in your hands regardless of the surgery....

You should also be looking at the Duodenal Switch. The DS has the same stomach as the Sleeve, plus an intestinal bypass similar to, but more effective than, that of the RNY---but I bet your surgeon doesn't DO it, so he didn't mention it.

The DS has the very best long-term, maintained weight-loss stats for patients of ANY size, but this is especially true for those of us with a BMI greater than 50. It's also the best at resolving or preventing co-morbs like diabetes and high cholesterol.

The long-term results are about the same, when you compare the RNY to the VSG---and the VSG has fewer potential problems. Keeping a fully-functional stomach has a lot of pluses, like being able to take NSAIDs. And if you go with the VSG, and you DON'T get the results you need/want, it's far easier to revise a VSG to a full DS. Revising an RNY is really tricky, and very few surgeons can do it.

I think most people can lose a lot of weight with any form of WLS. The trick is keeping it off long-term, and the higher your BMI gets, the harder that becomes. (The higher your BMI gets, the more likely it is that your metabolism is extremely efficient.) Hands down, the DS makes maintaining significant weight loss easier, because it actually changes the way our bodies metabolize food. The DS is the only form of WLS that causes permanent malabsorption of a significant per centage of calories.

I chose the VSG because I did not want to worry quite so much about life-long malabsorption of vitamins. Either surgery is a major, life-long change, so you need to be comfortable with your choice. You will be living with it, not your surgeon. Good luck!

Thanks for the advice everyone. I know I need to follow my intuition and in this case it says it's saying hands down VSG- after my surgeons insistence on me doing the RNY I thought well I need to consider everything before I make my decision. My surgeon did tell me about the Duodenal switch and I have done research on it.  My insurance will only cover 1 WLS per lifetime so he's afraid if I'm not happy with my results it would be a big financial expense to convert to the Duodenal.  But you're all right I know it's just a tool and it will be what I make of it. I need to keep saying that to myself lol. I'm meeting with my surgeon next month so I want to do all my research and make a choice by then so I can be 100% confident when telling him. Thanks Everyone :)

You can get approval from your insurance for a two part DS? That is technically one WLS. Then you can start with the sleeve and if you need the malabsorption you can do part 2. If you plan for it at the get go then maybe your insurance will treat it as one WLS and the switch part can also be covered if you need it down the road. If not then you will just keep the sleeve and save your insurance a bit of money!

Houseworth is NOT going to encourage you to have the DS, because he would be losing a patient. You owe it to yourself to at least consult with a real DS surgeon. If you still decide it's not for you, fine---but you really do need to be in a position to make a fully-informed decision, and means understanding how ALL of the surgeries work.

If you get the VSG, converting later to the DS would be fairly simple, surgically speaking, but no, it wouldn't be cheap. If you get the RNY, converting later to the RNY would be highly complicated, risky, and expensive.

I'm a new member so I'm not sure how long it will take to actually post this but here goes. 

I SOOOOO FEEL FOR YOU Casscull30! I'm in the decision stage myself. My surgeon however did not have a preference. He just told me of all the pro's and con's of each one and told me to decide. LOL 

My nutritionist prfered the GSV because of the nutrition risk with RNY. Right now I've chosen the GSV, but I'm worried that it won't help me or that it's not for people in my weight class (pre-op requirement starting weight at 438 current weight now 430) and that I should maybe choose the more "complex" procedure. Plus all of my close friends who have had the surgery liked the RNY and have seen great success. I actually posted another topic today asking folks for the same question sort of. I was asking for people who were in the same weight class with similar experiences to myself, o post their testimonies with having the GSV.

However if your surgeon is pushing for RNY it maybe that he isn't as experienced with GSV and I'd want to choose a surgeon who is confident in his/her abilities. I don't really like that he has been pressuring you to choose another procedure. It's normal to feel nervous but I think you are on the right track with researching as much as possible before hand. Also you can look up your surgeon here to see if someone has written a review on them. 

Good luck!

The Vertical Sleeve Gastrectomy (VSG) is a restriction-only procedure. The RNY has a very small malabsorption component, but the malabsorption of calories pretty much goes away by 18-24 months---the malabsorption of certain vitamins and minerals is forever.

Given your weight, I REALLY think you do need a more complex procedure---but NOT the RNY. You really need to be looking at the Duodenal Switch. The DS has the very best long-term results for patients of ANY size, but the bigger you are, the truer this is. The DS really addresses the metabolic problems that most people who have a really high BMI do have.