Why Sleeve vs. RNY?

I'm in the pre-op stage and going back and forth between sleeve vs. RNY.  My co-morbidity's include Diabetes and my surgeon feels RNY is the better way to go.  I feel it might be a bit extreme for the 100lbs I want to lose.  Any opinions?

You just have to compare the pros and cons - for me, it was a no brainer kind of decision. I would have opted for no WLS before I had lap band or RNY

Benefits of sleeve vs. Rny

- with the sleeve, you get a normal functioning stomach rather than a pouch that stretches
- with the sleeve, the pyloric valve controls how quickly food empties into your intestines vs a RNY stoma (aka a hole that stretches and leaves a lot of by pass patients very hungry, very quickly)
- sleeve - no remnant stomach that can cause complications
- sleeve - you can take NSAIDS, its a life time prohibition with the RNY and there are lot of conditions where NSAIDS would be helpful
- Sleeve - no risk of bowel obstructions, blockages, ulcers that come with the RNY surgery

Malabsorption, and potential dumping syndrome may or may not be pros and cons for you - with RNY, i did not see malabsorption was not a "pro" because nutrients only malabsorbed for maybe 18mo -2yrs but life time malabsorption of vitamins is a life time issue and requires a lot of diligence.

Basically, after 18 mo-2 yrs with the RNY, you get a restrictive only procedure, with a stomach and stoma that are stretched. Might as well get the sleeve where stomach is less likely to stretch and you keep your pyloric valve for life.

Im sure there are more reasons, but this sums up my decision to go with the sleeve.

I second everything acb said!

I also was freaked out by the idea of having a "ghost stomach" that was there, could have problems, but can't be scoped.  The idea of my insides being rearranged like that just blew my mind (in a bad way).

I know it's more than possible to lose 100+ lbs with the sleeve - I've lost over 145 lbs so far.

Good luck making your decision! 

I am 8 days post-op.  I chose the sleeve because I did not want my intestines messed with.  I do not have the issue with malabsorption that would have come with the bypass.  My dr. felt it was a much better choice for me and I trusted her advice.

THANK you all for responding so quickly!  That's great information. Food for thought. I agree RNY freaks me out with what they do to your insides.  I think I have to speak to my doctor again.

Thank you!

Hi, This is a tough decision,  And only you can make it. I have 6 friends that have had RNY. 2 kept it off, 3 gained half of their weight back  and 1 has totally eaten her way out of it, and is back to oldweight  but now she has hernia and needs surgery. For me personally, I have lots of arthritis and I don't need any malabsorbtion issues. So I chose sleeve. Good luck

In a nutshell, the VSG and RNY both have very similar performance from the weightloss, regain and diabetes resolution/remission perspectives, but the RNY is a lot more "expensive" when it comes to the lifestyle and medical treatment limitations. Many docs are a lot more experienced with the RNY than they are with the VSG, so they are more comfortable recommending the RNY for tougher cases such as diabetics, and there are also some "defensive medicine" issues for the surgeon that may point him toward an RNY recommendation (while both are similar at around 85% of diabetes cases being resolved, give or take a few points depending upon surgeons and studies, the RNY has a longer history of doing so which means that it is more defensible in court should one of those 15% sue him for the wrong advice...)

If diabetes is a top priority (end even if it isn't) you should take a look at the duodenal switch (DS) to see if it fits you better, as it typically sees around 98% resolution of diabetes and better regain resistance than either the RNY or VSG. It would mean a change in surgeon as yours doesn't offer it (or he would be recommending the DS in your case) but it is worth researching some. The added bonus is that the caloric malabsorption of the DS is long term which is why its' regain resistance is better than the other procedures, should that be an issue with you.

The other main reason that I went with the VSG is that the RNY is something of a dead end, surgically speaking - should it not suit you there is little that they can do to correct it (there are some minor tweaks like banding the pouch or tightening the stoma, but nothing that really alters its fundamental character) and revising to something stronger like the DS is a very complex job, to the extent that maybe a half dozen surgeons in the US and Canada are qualified to do such revisions. The VSG, on the other hand, is fairly straightforward to revise to a DS, or an RNY, should it be necessary in the future.

Like others here, I am not a fan of the intestinal reroutings, but they are necessary for some, and at least with the DS you get some positive long and short term benefits for those changes which are minimal at best with the RNY.

I also chose the VSG because I did not want my guts rearranged. Keeping a functional stomach was also important to me. I have several friends who have had RNY and so far, only 1 has kept it off, but she is a slave to 4am gym time. She spends about 1-2 hours everyday at the gym just to maintain. Yes, we do have to exercise with the VSG, but we don't have calorie malabsorption that wears off. If you look for medical articles, you will find that VSG also helps resolve diabetes in a large number of patients. Also RNY is not a guaranteed fix for it either.

Only you can decide what is best for you and your life. You are the one that will have to live with it, the surgeon won't. Ultimately, it is your life and your body, the choice needs to be yours.

The RNY is too malabsorptive for me. At the end of 2 years--they are left with a restriction only procedure and still have to worry about vitamin malabsorption. How is that a fair trade off? Do you really want to worry about being vitamin deficient--especially when you are elderly? I do have to take vitamins with the sleeve---but I know that it's far less likely to be an issue with the sleeve than with RNY. The stoma stretching as mentioned before--seems to be a big issue. I have my natural pyloric valve and I am grateful to have it. The side effects of RNY? Some of the rarer side effects scared me far too much. Guillian Barre syndrome has been shown to occur in some gastric bypass patients. Do you know the side effects? I do. I know a man who had RNY because he was so large he could hardly walk. Well, he was able to lose a LOT of weight but he wasn't able to utilize the weight loss for walking. He was then thin and unable to walk because of Guillan Barre syndrome. He was so depressed he gained a huge majority of weight back. He still cannot walk. I hope he will one day--there is still a chance maybe. It's been 5 years though. Bowel obstructions--scary!  Many RNY patients report low blood sugar issues. No thank you. I know some of these side effects are rare but they happen far too much for my liking. I am not going to say RNY doesn't work for some people. It really does work well for some people--including my very own sister. She has to get iron and B12 from the doctor quite often though even years out from surgery. However--she's kept the weight off. I just think the chances for serious issues are too high for my personal liking.

The experience of the surgeon is tremendously important if you are deciding on the sleeve.  Ideally, you want the surgeon to provide statistics on how his or her sleeve patients have done--e.g., what is the typical excess weight loss.  I looked at your surgeon's background tab on his OH profile, and he lists numbers for other surgeries but not sleeves. 

My surgeon had data on over 300 sleeve patients, and the excess weight loss for those patients was comparable to RNY.  

Do you have the ability to look into another doctor?

Good luck!