Trying to decide which surgery is best for me... RNY or Sleeve. Please help

I am trying to decide on which surgery is best for me. I am leaning towards the RNY and my wife wants me to get the sleeve.

First let me tell you a little about me...

46 yrs old, 335 lb CW, 355 HW.... I currently do not have high blood pressure, diabetes, or sleep apnea. But I am sure I will get some of these conditions if I don't do something about my weight. I do have a thyroid condition and take Levothyroxine 200 mcg.

I started to pack on the lbs in my late twenties, after getting married and starting a family. Prior to that I was very active with working out and sports. I did a lot of power weight lifting back then and was 195 -220 range muscular build. But over the past 15-20 years I no longer play sports and do not work out like I did and have been steadily gaining weight. I know that I do not eat correctly as I skip breakfast, have fast food lunches, and very large dinners. I am a flavor eater and love my bread and pasta, if it taste good I know that I over eat way past the point of being full and I am a late night snacker.

My surgeon tells me that he thinks I would do well with either the sleeve or the RNY... I am personally leaning towards the RNY simply because I believe it will keep me in check if I do eat the wrong things it will correct me by dumping and making me feel ill and teach me not to do that again.... However, my wife is scared that the RNY is too restrictive and fears that I would be miserable with such strict diet.

Please help educate us on the choices between the RNY and Sleeve.

This question gets asked often on this site. My best recommendation is to go to the top of the page and click on the small magnifying glass. Type in RNY vs VSG (sleeve). You will find many, many notes on the subject to give you some suggestions and help deciding.

Usually I don't like trying to persuade someone to choose either way, but I can speak from experience when I say I had many of the fears you and your wife are having.

Dumping, or the thought of dumping, does help to keep you in check. It absolutely will keep you away from sugar and sweets, which shouldn't be in your diet anyway post-surgery. To me, what's what helped my choose RNY over VSG. I didn't want to be able to eat things that were not ideal for me. I tried to eat something last night that I knew I shouldn't eat -BBQ chicken wings- and I paid dearly for it. I am extremely thankful that my body rejects food that is not healthy, and I think you will be too.

Personally, I do not feel miserable, nor do I feel like I'm missing out when I see other people eat things I'm unable to. You're going to be able to eat a lot more than you think you can. I had surgery one month ago and I can eat any protein I want, healthy restaurant food, and even some sugar-free sweets (I recommend Peppermint Patties!). I know it's hard telling someone who hasn't been through it yet, but you really have to trust the process. As long as the surgery goes well and everything goes as planned, you're not going to be miserable.

Either way, I'm sure you're going to make the right choice. Just stay away from the pasta, unless it's veggie pasta! :P

Not everyone who gets the RNY ends up being a "dumper" - you may or may not be. It's probably not a good idea to base your success or failure on that one feature.

Each surgery has its pros and cons. They have about the same success rate, assuming the patient follows the appropriate food plan. I can tell you why I decided on the VSG. Primarily I didn't want my intestines re-routed. That seems far more invasive and carries more potential for complications. I wanted a normal digestive process, meaning I wanted to retain my pyloric valve, which controls when and how food moves into the intestines. In addition, I did quite a lot of research about post-op life (not success, just what it's like to live with each procedure). In addition to the possibility of dumping (which I didn't want), there's the possibility of two (admittedly rare) additional conditions that I wanted to avoid. One is reactive hypoglycemia, in which blood sugar fluctuates wildly with meals and is very difficult to control. Those who have it have a very difficult time, not a happy way to live a life. The second is seizure disorder. It's quite rare, and surgeons don't agree that it's caused by the RNY surgery; but there's a pretty interesting correlation out there. Google it and see. I didn't want any part of even the slimmest possibility of that. You should search this site for reactive hypoglycemia, also. Many people have posted about it.

The rearranged guts result in malabsorption of calories and nutrients, which is part of what helps you lose weight. But, like the Dude, the gut abides (haha!), and eventually the malabsorption of calories goes away. However, it is said that the malabsorption of vitamins and minerals is forever, so you will need to be diligent about your supplements for life. VSG patients do need to take supplements for a few years, since we don't eat enough food to get all our needs from it. But eventually as capacity increases, assuming a fairly balanced diet, we may be able to discontinue some of our vitamins. (I still take a complement of vitamins and minerals, though, since I still follow the basic weight loss food plan - protein, veg, a VERY small amount of fruits, dairy, nuts.) The only vitamin I'm aware of that we need to take for life is B12, because the section of the stomach (fundus) that produces Intrinsic Factor (which B12 needs to bind to for absorption) is removed. If you take a PPI, you should probably also take calcium and iron supplements also, to help make up for the lower acidity in your stomach, which will reduce absorption because they both need an acidic environment.

Good luck with your decision!

Exactly this!! Also, love the Lebowski reference.

one thing that convinced me to get the sleeve was that my surgeon said that the vsg was alot safer for heavy weights

I have lost over 150lb my blood sugar is now in the normal range with no drugs

I had a very similar profile to you minus 35 pounds. 300lbs, no commorbidities, Thyroid, 44 year old male, family etc. I chose the Sleeve which I had done one week ago today (down 15 already since clears started 48 hours prior to surgery). Accurate or not, I felt that there were degrees. Lap band, Sleeve, RNY. I had already failed the Lap band and had to have it removed. I felt that with my profile and lack of commorbidities I would be successful with the sleeve. The malabsorbtion associated with the RNY scared me. That being said, I am sure there are people similar to us who have had and been successful with the RNY. For me, RNY was never an option. The bottom line is that this is not going to be like one of those future self driving cars. We are going to have to rely on ourselves for discipline and knowing that we went to drastic lengths to help with our weight loss. We can't rely on the "mechanics" of the surgery, i.e.. dumping, to keep us in line. But this is from someone who is just in week 1, so I haven't even started my honeymoon phase. Good luck with your decision.

II too did not have any comorbidities, and I chose the sleeve. The reason why, was because I already have dumping syndrome from when I had my gallbladder removed years ago. From having it, I did not want to have the increase risk of increasing it. It is the worst thing in the world. For me, it can come on at anytime, and I do not have any specific trigger that I can avoid.

The good news is that both procedures are good choices. And the most predictive factor for success is how well you use the tool you will be given.

But for what it's worth, here's what influenced me personally. And this really is just a personal series of musings. I would have happily done bypass if that was the only one of the two available.

Personally, if I had required more than 150# of weight loss, I would have gone with RNY. Recent studies suggest similar weight loss between sleeve and bypass at two years out, but I would have done bypass for faster initial weight loss. Some VSG people have lost and maintained considerably more weight than that - massive of amounts for a few. For me, it would have been hard to steadily stay in diet mode for much more than 12-18 months unless I was within striking distance of goal. If I still had 50 pounds to lose at 18 months out, I'm pretty sure I would have lost steam and petered out. But I'm only speaking for myself. With only 90 pounds to take me to a normal BMI I thought the sleeve was enough to to get me there.

I felt that either procedure could keep me there if I remained vigilant and compliant in maintenance. Edit: but because I'm more of a volume eater than a grazer, I thought that the 'hard stop' that the saved pyloric valve would give me with VSG would be valuable and it has proven so. There's still a fat person screaming to get out of this body and I suspect there always will be.

Permanent malabsorption of nutrients worried me (I wasn't sure I could be consistent with supplementation, but that hasn't been the case so far) and reactive hypoglycemia scares me, so avoidance of those potential issues led me to choosing the sleeve. But with that said, I had pre existing GERD (a contraindication for sleeve) and still chose sleeve because I responded well to meds. Hindsight factor - at three years out I'm able to manage with a small dose every2-3 days, but I doubt I will ever be able to live without them. So I may have to deal with the potential side effects of long term medication usage. If I end up with some of the ugly stuff as a result, I'll likely wish I'd gone with RNY.

Although I didn't know it at the time, I've since learned that there is a wide variance in how sleeves are formed. My good fortune was that my surgeon was technically skilled at creating tight sleeves and he was interested in maximum (rather than average) weight loss. While some recent literature suggests sleeve size is not a predictor or success, I think there is much that suggests to me personally that it does. Maybe not as much in the first couple of years, but over the longer term I'm convinced it matters. That is, unless I could basically learn to live without the benefit of a lifetime of tight restriction.

I think that successful people with larger sleeves learn to do manage with less restriction over time, but I don't think that's optimal use of sleeve surgery. Some here see this matter differently, but that's what I still believe to be true. Personally, I still count on my restriction to save me from myself, so to speak. Not all the time because I usually watch my portions, but knowing my sleeve will kick my ass in a big way if I overeat usually keeps me in line.

A long winded response, but hopefully my experience gives you some additional things to consider but whatever your choice, it's going to be a good one! Bariatric surgery is the only answer for most of us.

When I decided to get the sleeve, the only thing driving the decision was KISS (Keep It Simple, Stupid). I looked at the lapband, and, between the band, the tubing, and the port, it looked like a mechanical problem waiting to happen. The intestinal re-routing of the RNY didn't appeal to me. I could live with having a large part of my stomach removed since I was obviously eating more than I should have. But otherwise, all my innards were left untouched.

Since then, I've been on these boards, and to enough support group meetings, and know enough other WLS people, to have picked up a few other issues with the various surgeries. If you have GERD, reflux, Barretts esophagus, no sleeve for you! RNYers seem to have a higher incidence of RH (low blood sugar) in the long term. The ban on NSAIDs seems to be more significant with RNYers. Ulcers form more frequently at the false opening/stoma. And, although this may just be my imagination, RNYers seem to be more prone to intestinal blockages/obstructions.

And don't think of dumping as something you want to experience. A lot of people who say they "dump" really mean that they ate something that didn't agree with them. True dumping has you curled in a ball on the floor wishing for death. It's painful. And it can happen with any of the surgeries, or even to a "normie."

But most people tolerate whichever surgery they choose quite well and without any complications. Sleeve or RNY will get you where you want to be a long as you're ready to adopt the lifestyle changes and stick with the new eating protocol. It's really a personal choice for you.