Scheduled for RNY but considering switching to Sleeve

I am scheduled for RNY on July 16th but am having second thoughts now about if it is the best surgery for me.  The surgeon recommended it because my weaknesses are emotional eating and sweets.  He felt with the dumping that I'd have the greatest chance of long term success.  But researching lately I see that only about 30% of people with RNY actually dump.  So there is a much greater chance that I will NOT.  

I've heard that there is a greater weight loss with RNY vs Sleeve - but only 5-10%.  I weigh 310 pounds and would be thrilled and feel healthy at 175-180 (which the charts say is still too much but I've been there before and was happy).  So I'm not stressing about the 5-10%.  I'm wondering is there less 'excessive' skin because weight is lost a little slower with a sleeve?

Also, what about complications after a sleeve?  And is blood work and vitamins required (since this isn't a malabsorptive procedure)?

My insurance not only won't pay for the procedure - but it won't pay for anything (complications/follow up) related to the surgery.  It seems there are a lot of complications with the RNY and that scares me financially.  

I do like that the RNY has a longer history of success.  I don't want to pay all of the money out of pocket and have it fail or need a second surgery.  At this point I'm relatively young (43) and have no comorbidities (so don't need to consider things RNY being better for diabetes).  I do have PCOS but from what I've read that shouldn't be a factor one direction or the other.

Thoughs?  What swayed you towards the sleeve?

Thanks,  Jane

I switched procedures from RNY to sleeve. I was worried about eventual need for knee replacement, targeted for 2020 or later, and my ability to take NSAIDS until then. I also was worried about reactive hypoglycemia because my blood sugars are not too far out of line at the moment.

My surgeon laid out why he felt the sleevewas better. THe clincher was when he told me that he feels that with the sleeve, I will be much less likely to be in his office 5 years from now complaining of low blood sugars.

I had originally chosen RNY because my parts were still there, just not connected. The removal of my stomach seemed so...permanenet. My appeals process gave me time to review and research, which led me to my questions.

Good luck on your journey!

I'm a similar age (40) with no co-morbidities either and was self pay.

I went to the surgeon with RNY in mind and he suggested VSG, which I knew nothing about at the time, so came home a researched the hell out of it. I really decided to trust my surgeons advice and didn't like the idea of re-routing my digestive system that much.

Like you, I was concerned that I wouldn't lose as much/fast. But, I was a starting weight of 362 and am 8 & 1/2 months out and have lost over 160lbs, which is just as fast as RNY.

So with discipline and determination, the sleeve is just as successful. No weight loss surgery is a magic bullet and if you have emotional eating issues, I would recommend you see a therapist during your journey to address that side as surgery won't fix that.

I'm just thrilled to be where I am and have all my guts in working order...lol

If you are self pay, I would go with the sleeve. I saw what my sister went through after RNY. While she is a successful patient, having lost over 100% excess weight and kept it ALL off for 7 years, she has had complications. Severe anemia and iron infusions on a regular basis. The cost of those infusions are NOT covered by insurance right now. She is going broke from it. Also, she's damn sick and tired of going to the freaking hospital for that crap all the time. It's risky to get an RNY IMHO. There are bowel obstructions and other complications that are scary too after RNY. Intestinal complications etc and more. Mineral/vitamin deficiencies that can get severe. You CANNOT take NSAIDS with RNY, but you can with the sleeve. That's a huge advantage. If I were you, I'd get the VSG hands down.

I too considered the RNY for a little while and had insurance approval for it.  I did lots of research on the sleeve.  Found there is a much higher risk with RNY than VSG.  I was thinking of the dumping as a good thing too.  Found the numbers you did too.  I have seen that the RNY are neck to neck with the sleeve.

My big reason for not going that route was when I learned the RNY mal-absorbs calories for on;y 18mo-2years but, mal-absorbs nutrients (vit&min) for life. So, you need less supplementation. RNY has many more issues down the road than Sleeve.  Sleeve has a shorter recovery time.

Good luck with which every surgery you choose.

when I first went to see my surgeon I thought rny but he said for a heavy weight the sleeve would be safer , all the newest studies have about the same weight loss , just a little slower, it reduces diabetes about the same (DS is better), and the sleeve has less nutritional problems , no dumping

My doc recommended Rny, but I was firm about the sleeve.  At the time of my surgery he also indicated that I would sacrifice 5%-10% of the loss if I went with the sleeve.  At my one year follow up (and I made goal in 8 months) he said that at that point the sleevers and rny  were entirely comparable.  Here were my reasons for being so adamant about the sleeve:

1.  No rerouting or complication risk from rerouting.

2.  Easier recovery.

3.  No pouch, thus no food getting stuck.

4. No dumping (or at least reduced risk compared to rny).  I am a teacher and couldn't imagine dealing with that with a room full of 9 year olds.

5.  No malabsorprtion/less risk of vitamin deficiency.  I forget vitamins a couple times a week, so this was important.  

6.  Gherlin reduced significantly- that turned out to be a huge factor for me.  When I feel hunger I eat way more than when I don't.  It varies by my monthly cycle.  

7.  Everything works normally.  I eat normal food just in smaller amounts.  I tolerate everything and had no issues with reflux.  In fact, I had a hernia repaired that made an enormous difference with the acid issues so I am far better off than what I was before surgery.  

8.  Granted you have the benefit of not absorbing calories for a while, but what happens when you start having to adjust for them.  I was worried that would set me up for regain.  No idea if it would have been an issue for me or not.  

With all that said, my brother in law had Rny and made it to goal also.  He has been maintaining about 2 years longer than me.  He is currently experiencing a slight regain (about 15 pounds).  Also, I am a sugar junkie and I still struggle with it.  I do believe if I was willing to deal with dumping that I would not be struggling nearly as much with that.  With either procedure though it is still up to you- but it is difficult to really wrap your brain around how much the surgery helps and makes it possible until you experience it.

For me, my reasons for the sleeve was I didn't want to put anything foreign into my body (lap band) and I didn't want anything re-routed. I wanted the most normal thing I could have. I only have to take a multi vitamin, calcium and B-12, which I took before my surgery. I also had about 100 pounds to lose. I could have gone back to work in probably 4-5 days had I needed to. I went to my father-in-laws funeral 2 days after my surgery and I was fine (physically). I would choose the same if I had it to do over. I am very happy with my choice. My insurance DID pay for it. You should have your surgeon write your insurance company a letter if this is your choice. I have BC/BS and they paid. One word of caution, whatever surgery you choose, you have to change your life. None of them are a magic fix. Eventually, it is up to you whether you continue to lose and keep it off. Good luck!

I haven't had my surgery yet, but I will in the middle of AUgust I believe.  My husband had the RNY and did wonderful with it, but for me, my decision was very simple, childlike I'd say--as I had a visit with the surgeon, he showed me the picture diagram of the RNY and the picture diagram of the sleeve.  At that moment, I was immediately drawn to the sleeve.  What ever you decide, I'm sure you will continue your research and you will be fine either way.  Best wishes to you, for a happy life!

Thanks for everyone's input.  I do worry about the vitamins/minerals absorption with the RNY as I have a tendency to run low on my D and B12 as is. 

Is the major risk of complication with the sleeve a leak?  That's the one I see mentioned most often.  And it seems like it generally happens early if it's going to happen?   What other complications should I consider as possible future costs out of pocket?   Is regular bloodwork required like it is with an RNY?