RNY vs. VSG

Ok as most of you know little about me.. lol my insurance will cover either or of these two surgeries. I have placed posts in each respective forum on pros and cons. I know you all will have some form of advice for me as well.

So hey hiddy ho.... here we go...

I enjoy the lack of Mal-absorbtion with the VSG - ( I have been doing a test run to see if I needed it or not and I am thinking no... I have not had sweets or fat issues since June)

I do like the faster (not always) weight-loss of RNY

I do like the idea of my "plumming; staying more intact with the VSG (but it would not bother me if I had to have it done.)

So what says you ladies and gents?

 

(btw no co morbids litterally none I swear my DR. Has worst stats then me and hes a tiny little man!!! LOL)

katrina that's personally decision because only you can decide i had vsg starting weight for me was 258lbs i knew in my heart no disrespect to those who had rny that rny wasen't for me i think if you are over 300 you should think about rny but if your under i think you can work your sleeve to get to goal with the sleeve i feel like i'm kidda normal my co worker did the rny she was 309  she had rny 8-6/09 she having all kinds of issue voimting vit deficiens she only 32 rny is good choice for many people esp if you have diabeties but if you have no issue then you should think about vsg cont doing option and losing weight and you will make the right decision for you no disrespect to rny people there are many who have done this procedure with no problems

See thats the funny part. I really dont care but if I dont tell my surgeon I will go in blind and be surprised like christmas morning.... LOL

I was over 300

My heaviest was 313 back in May since then I have been losing. I am down to 288 but surgery wont be until after Christmas maybe new years. I am trying to get to roughly 250 or under before then....

Katrina, it's great that you're looking at your options carefully, but best to look at all the options, not just the ones your insurer prefers to cover. You are losing some weight pre-op, which is great, but started high, and you might do well to take a look at the duodenal switch (DS). If you are dead set against malabsorption, it isn't the right choice, but if you want the highest percentage of excess weight loss (on average), the best maintainence of that weight loss, and (for others, I get that you are in good health) the best resolution of comorbidities, the DS is the choice. It also avoids all the pouch issues of the RNY - no dumping, strictures are rare, you can take NSAIDs, you can drink liquids with meals, etc.
     You may already know this, but the VSG is the top half, so to speak, of the DS. The switch part creates more malabsorption than the RNY, which is why the weight loss maintainence and post-op diet are better. With the DS, you do need to supplement vitamins and calcium, and get regular lab work to check levels. This is an important committment, but not burdensome. Malabsorption doesn't equal malnutrition, and nutritional deficiencies are not common among people who are compliant with the supplementation requirements. People who are not compliant do get into trouble - true for RNY also.
     Since you live in CA, you have the ability to appeal your insurer's denial of the DS to the DMHC (dept of managed health care). For the past 4 years, every denial of the DS has been overturned by the DMHC. This means you CAN get the DS paid for by your insurer if that is your operation of choice.
    Come on over to the DS forum and learn more about it. Whatever decision you make, it's best to be well informed. If you would like any articles documenting the excellent longterm results of the DS for both weight loss and overall health, send me a pm.

Larra

If you are dead set against malabsorption, it isn't the right choice, but if you want the highest percentage of excess weight loss (on average), the best maintainence of that weight loss, and (for others, I get that you are in good health) the best resolution of comorbidities, the DS is the choice

I am very close to dead set against Malabsorption but not if it means I cant have my WLS. I dont have Co-Morbidities either not a single one. - But you saw that already  ;)

My insurance wont cover DS its one of the only surgeries it wont cover. They dont just block it out, but have reasons they told me. Its cause as of right now their surgons dont have enough practice on it and not enough "class" research on it. Who knows in a few years they might.

I had asked about the DS when I started my trip. They said if I wanted the DS then I could have the VSG started, and self pay with another DR for the second half. But that people are loosing enough on their own to not need the Switch part.

Like I said I am not all to worried which I get as long as its (with my efforts) prolong my life to watch my son grow up.

Katrina, just to clarify, your insurer can be made to cover the full DS by appealing to the DMHC. If they don't have a surgeon with the experience to do it, they will then have to send you out of network to a qualified DS surgeon, and pay for the full DS out of network.  So you wouldn't have to worry about an unqualified surgeon operating on you, you wouldn't have to have 2 operations, and you wouldn't have to pay later for the second part.
    I live with malabsorption, and have for over 3 years. Everyone with the RNY, which is by far the most commonly performed wls in the USA, also lives with malabsorption, though to a lesser degree. The overwhelming majority of us do fine with it - the key being to be compliant with vitamin and supplement needs and regular lab work (once a year for me) to make sure levels are good. 
    There is ample evidence in the medical literature for the safety and efficacy of the DS. Some insurers choose to ignore this evidence rather than establish a DS program, and there are some surgeons who are comfortable performing RNY and do not want to change their practices. They may be in their best interest, but not the best interests of their patients. It's interesting that they are suggesting going with just the VSG, because there is no longterm data available on it, none beyond 4-5 years, and the 4-5 year results are already showing a falling off of weight loss, in other words weight regain. On the other hand, there are 10 and 15 year studies for the DS showing excellent maintainence of weight loss. What good does it do to lose the weight, only to gain much of it back? So here they are telling you there isn't enough evidence on the DS, while there is far less evidence - none, to be precise - for the longterm results of the VSG.
     There will be some people who will be successful with VSG. I believe that, as with other purely restrictive operations, the successful people will be those who needed the least help to start with, in other words, with the least degree of MO and least prior metabolic damage. Those of us who need more help need malabsorption. I can only recommend that you take a long, hard, honest look at yourself and ask if the VSG will be enough not just to get you to where you need to be, but to keep you there. I would not have been for me.

If you would like to see some great articles on the DS for yourself, just send me a pm.

Larra

 

Hi Katrina,

I'll chime in here about my gastic sleeve experience, which I have no regrets about :) I started out weighing a couple pounds more than you at 315 and by the time I had my surgery I was 272 and now almost 8 weeks later I am 245...that's a total of 70 lbs since January!!! The weight comes off steadily and since you don't have any co-morbidities then you are in better shape than many who have WLS. It's certainly a personal decision - and as for me, I've had no problems tolerating anything and I recovered from the surgery just fine. Good luck in your journey, whatever you choose to do!!!

Take Care,

I love the fact that I have a normal functioning stomach, not a stoma which "can" be prone to problems like stretching.  The speed in which you loose weight is conditional upon your metabolism.  I have seem VSGers SPEED through their weight loss like some RnYers and also those who are turtles like some RnYers.

Good luck, feel free to check out my blog about my VSG journey.

Ms Shell