VSG versus RNY

The ASMBS recommendation against NSAIDs used to be ONLY for RNY. It was more recently adjusted to also include VSG and even the band. This had absolutely nothing to do with the politics or anything else you mention. It is because time has passed, the numbers of people taking NSAIDs long term has skyrocketed, and the complications are rising. No one, WLS or not, should be taking NSAIDS the way most people take them.

A lot of medical studies recently have highlighted the drawbacks to NSAIDs. They aren't harmless. That is why the adjustment in the ASMBS recommendations took place.

More and dire warnings against long term PPI use are coming out as well. A lot of people rationalized complications from reflux that goes along with VSG as no big deal, since you could just pop a couple of harmless PPIs every day. It turns out those aren't harmless either. Far from it.

They are most certainly serious drugs - some docs hold that they should never have been put onto OTC status in the first place, but that's Pharma marketing. EVen for normies they should not be taken consistently without medical supervision. But the blanket recommendations that come from the fails to recognize the different tolerances provided by the different procedures - this is part of the bypass-centricity that has been part of ASMBS (and its precursor ASBS) for ages. From a marketing perspective, there are some docs who don't like ceding an advantage to a procedure that they don't perform and that colors some of their official positions, and many of the unofficial ones. This is a common thing in such medical organizations, where we often see recommendations change with leadership rather than new scientific findings. It is something that needs to be considered and filtered out where possible, and the better docs know how to do that, which is why we can legitimately see recommendations that may be contrary to official doctrine. How many people in these forums (and in legitimate scientific forums as well) criticize government doctrine such as RDA's, etc.? Same thing - there are political as well as technical rationale behind all of these positions.

There is bias, but I think you're 5 or 6 years late. All the bias from surgeons for yhe last several years has been in favor of VSG and against RNY. Except for Canada, and WL surgeon who does RNY also does sleeves. But many will do sleeves and not RNY. VSG is faster, cheaper, and more profitable for tge doctor. Many times they insist on doing sleeves when RNY would be a better fit for the patient.

You've seen this same bias against DS for years. The bias now is far toward VSG and against RNY, not the other way around.

It's a VSG-centric world, and it's not even close.

It is more of a concern for the DS that some have - an advantage ceded to the VSG is by default one for the DS, and there are some who practice in competitive markets who don't like that. But, the overriding dynamic in the VSG industry now is more about the learning curve. Most have gained enough experience with it now that they are (or should be) consistently making competent sleeves. However, culturally most of the industry is still in the RNY world - they haven't advanced up the curve enough to really take advantage of the new tool that they have - they still treat it like a bypass in their dietary progressions, nutritional and supplement regimens and yes, their medication recommendations. How often do we see posts from prospective patients saying their surgeon/staff told them 'their patients do better, or lose more, with the bypass...'? Of course they do - in that practice - what does one expect when you provide a sleeve patient with a bypass diet based upon early caloric malabsorption? Eventually, these things will work them selves out as the surgeons come to appreciate the differences between the procedures. In the meantime, we can get a look toward that future by lokking at the protocols of the surgeons who have been doing sleeves for 10-20 years or more.

As for the OP, you have some contraindications for both procedures, so you and your doctors have to carefully weigh the alternatives and devise a plan of action to address your problems while minimizing potential side effects. The basic billroth procedure that is the basis of the RNY has a multitude of configurations, including not leaving the unused remnant stomach behind, which could address the polyp issue, but not the pain med issue, and of course, also removes some future options. The reflux issue with the sleeve is not a trivial one, either, but does leave more options. The DS is a possible third option, though rare in Canada, as it usually uses a larger version of the sleeve which makes it less sensitive to reflux issues, but still tolerant towards the pain meds. With any of the procedures, including the bypass, I would be inclined to monitor things endoscopically for a while until the effects of the surgery on you can be characterized.

My surgeon also believed that nsaids were ok. I ended up taking a fair amount after the mastectomy and reconstructive surgeries. It did not help reduce inflammation, but did a fantastic job at giving me an ulcer. My surgeon has since reversed his position (prior to my ulcer I believe). Of course in my situation no idea how much the hiatel hernia and gallbladder issues complicated that mess. 

Happy teacher,

Im so sorry you went through so much.  It must have been really hard and painful, no doubt.  My plan is to try and not take NSAIDs daily.  I sure don't want to get ulcers.  That's for sure.  

Thanks for sharing.  I appreciate it!  

Good luck to you! 

Here's what I've written about why I chose VSG - https://www.myvsg.net/2-uncategorised/366-why-i-chose-vsg

I had zero serious complications and I've never regretted my choice.  

Gwen, 

I love your blog!!  I totally relate to everything you have said why you chose VSG over any other WLS.   Although I have heartburn, I am hopeful that with weight loss it will resolve and hopefully my tiny hiatus hernia can also be repaired during VSG.

I too don't want to have my intestines re-routed and have malabsorption issues and no future access to my stomach. 

You've done amazing in your WL journey!!  Thank you for your response and I wish you continued success!! 

My main reason for going with the sleeve is because ever since I was a kid I've had a sensitive stomach (which is weird considering how obese I became). I would have issues randomly and doctors could never figure out why I was so sensitive. It wasn't acid reflux and I'm not allergic to anything and after three rounds of tests over 5 years they jut kind of gave up on trying to find something.

Because I've sometimes struggled with that, my surgeon and I both agreed that the malabsorption from RNY could make it worse and sleeve was the more "natural" way. Plus I was scared of the rerouting.

Another factor was that sleeve produces slightly slower weight loss and being that I'm still in my mid-20's I would have more time to lose the weight before any serious health problems set in.

JTomo08, 

Your reasons make perfect sense to me.  Thank you!!  Best of luck in your continued journey!!