weight loss surgery

I'm trying to research weight loss surgery,. and it's so confusing. What made you decide which surgery? I like the sleeve it seems less evasive. I don't know if medicare will pay for it.  It's always nice to hear what other people think about different surgeries. Thanks

 Hi there,

Congrats on researching all 4 surgery options! You are already way ahead of the game of where most pre-ops start. 

I'll share my experience with you. I had insulin-resistance and a really screwed up metabolism. By the time I got around to surgery, even high-restriction diets weren't doing much for me. Because of this, I ruled out the restriction-only procedures (Lap Band and VSG).

I knew I needed malabsorption, so it came down to DS or RNY for me. Below are the reasons why I chose DS over RNY.

1. The DS has the best percentage of excess-weight loss, and best chance of maintaining that loss. If you check out the chart here published by the ASMBS: www.aace.com/pub/pdf/guidelines/Bariatric.pdf, on page 10, these are the reported percentages of excess weight loss with RNY and DS:
--1-2 years: RNY 48-85%, DS 65-83%
--3-6 years: RNY 53-77%, DS 62-81%
--7-10 years: RNY 25-68%, DS 60-80%

The regain or insufficient loss down the road was really troubling to me, especially having had a BMI over 50. Here is a study from 2006 I was referring to, showing that the RNY had about a 35% failure rate for those with a starting BMI over 50 (meaning those people did not maintain even 50% excess weight loss): 
journals.lww.com/annalsofsurgery/Abstract/2006/11000/Weight_ Gain_After_Short__and_Long_Limb_Gastric.18.aspx. 

I know the bad luck I've had with diets, etc in the past. I wanted the odds of success in my favor as much as possible where surgery was concerned. I would have been heartbroken to go through the process of surgery only to end up as still morbidly obese. 

2. Best rate of resolution for most of my co-morbid conditions. Before surgery, I had PCOS (with insulin resistance), Sleep Apnea, Hypertension and GERD. The most troubling to me were the PCOS and Sleep Apnea. After researching, I found that the DS had a better chance of improving everything but the GERD. (RNY has statistically a better resolution for that.) I was willing to take a chance on the GERD, and lucky for me, it has already resolved. My sleep apnea is now gone, as is my hypertension and PCOS. 

3. Can take NSAIDS (Advil, Aleve, Aspirin). Tylenol has never done much for my pain, and I hated the idea of not being able to take NSAIDS for life with RNY. What if I get arthritis when I am older, etc? My mom has osteoarthritis and can't take NSAIDS for a different reason - she has had a few instances of severe pain and had to take morphine and dilaudid, although NSAIDS would have worked better and had much fewer side effects. I really wanted to avoid that fate.

4. No dumping syndrome. Dumping sounds horrible to me, and I didn't want to chance that experience. I've also known post-RNY folks who dump on unexpected foods (not just sugar but fat). I wanted to be able to enjoy a variety of food post-op, including sweets.

5. Fully functional, though smaller stomach, no blind stomach, no pouch/stoma. I really didn't like the idea of a blind, unscopeable stomach that could develop ulcers, etc. I also like the function of the pyloric valve vs. the man-made stoma (i.e. being able to drink with meals, no worries about stoma stretching). I also needed the removal of ghrelin, the hunger hormone. Not feeling hungry all the time, and actually being able to feel full, has changed my life. 

I hope that helps!

Jenna

I really only considered the sleeve and RNY.  Band was completely out, in my opinion, because of erosion, slipping, food getting "stuck" problems, constant fills and unfills, and because I know someone who had the band several years ago and is still fat.  That last isn't exactly based on research, LOL.  I chose the sleeve because

you keep your pylorus (the valve at the end of the stomach that's used to move food into the small intestine) - not so much because keeping the pylorus eliminates dumping syndrome but because the surgery-created stoma that's used between the pouch and small intestine in RNY can develop complications long term such as enlarging or constricting. 

No malabsorption.  Malabsorption scares me long-term, as vitamin and mineral deficiences can cause serious health issues.  Sleevers need to take supplements also, especially B12 and calcium.  B12 because we lose the majority of our stomach, where Intrinsic Factor is created.  B12 needs to combine with Intrinsic Factor in order to be absorbed in the small intestine.  Calcium because we're not eating enough food to get sufficient calcium.  (Most normies don't get enough calcium either, actually.)  If malabsorption is something you're looking for, you might consider the DS, which is a sleeve stomach combined with a rerouted small intestine.  Research more to get the details on the DS.

Malabsorption of calories with an RNY lasts a couple years, then the body figures out how to get the calories it wants from the food you eat, so it becomes more difficult to lose/maintain.  Malabsorption of nutrients (vitamins/minerals) lasts a lifetime.  Not sure if this is true of the DS.

Some RNY patients develop reactive hypoglycemia, apparently a very serious low blood sugar condition that can lead to fainting?  And seizures.  Read Melting Mama's blog, and also google "seizures after gastric bypass."  All I had to do was hear the word "seizure" and that was it for me.

Weight loss between sleeve and RNY are comparable.

But what you really need to decide is what surgery is right for YOU, based on your eating habits.  I'm a sweets/carb addict, and the sleeve doesn't help with that at all - that's all on me.  But I was also a volume eater, which the sleeve does fix.  So now, if I choose to eat a low carb, high-protein diet, I will lose and maintain long-term.  If I go back to my carby ways, I won't.

You're doing the right things around research and finding out what will work for you.  Ask questions on this board, go to the different boards on OH for the different surgery types, go to the "regrets" board, go to the "grads" board, do research outside OH, go to surgeons' seminars, if you can find support groups locally go to them and see what actual patients have to say.  Research the heck out of this, it's a life changing decision, and welcome to the board!

you are confused,,,rny is malabsorptive,,,just in a different way

 
My whole blog is for newbies that want to research options:

wasabubblebutt.blogspot.com/2010/03/which-surgery-type-is-right-for-you.html

Medicare will not pay for the sleeve alone but it will pay for the DS (Duodenal Switch) which is the sleeve and a malabsorption component.

Medicare paid for my DS so if you have any questions feel free to PM me.

You can find out more about the DS at www.DSFacts.com

~Becky

Here's what I tell people about how I chose the DS:

I was originally on track to have RNY back in 2002, but got derailed after preop testing revealed that I had pulmonary hypertension. It's a long story, but it's on my profile if you'd like to read about it.

Even though I was off the track for RNY, I continued to attend the program my then-surgeon required of all his patients. I'd paid for it, so I figured I could benefit from it anyhow :-).

I saw some disturbing trends there. This was a big group, as several surgeons sent patients to it. There was, of course, a cadre of very successful patients (all RNY). They finished their year of program and went on with their lives, and as far as anyone knew/knows, all is well.

There were a surprising number of people, though, who fought and fought and fought to comply with what was expected of them, and the weight didn't come off well. At every meeting, there was word of someone else in the hospital with this or that problem--usually an ulcer or a stricture.

I listened to stories of dumping episodes, of getting food stuck episodes, of the mental/emotional challenges of having to live on highly restricted diets.....and I thought, "There's not a chance in hell I could live with this." (I should add that I have a major vomiting phobia. I'll do just about anything to not vomit. Not a good thing in some cases.)

Well, time passed, I got fatter and sicker, and eventually (again, story in my profile), it came out that the pulmonary hypertension was caused by the fat on my torso squashing my heart and lungs. It went from, "You cannot have any surgery at all," to, "You must have surgery or die."

I came back here to OH, feeling desperate because the lap band wouldn't give me enough weight loss to have any real hope of curing what was ailing me, and the RNY seemed to me like foolish butchery for not enough good results.

Someone told me then about the duodenal switch, invited me over to the DS board, which at the time was pretty much brand new, and the rest was history.

What I like about the DS:

1. 98% cure rate for type II diabetes. This was a major biggie because I had very bad diabetes.
2. Normal stomach anatomy and function is maintained. The stomach is reduced in size, but the normal stomach outlet, the pyloric valve, remains intact and functioning. There is no "stoma" with the DS or the vertical sleeve gastrectomy (VSG).
3. The intestinal changes that are done in the DS "jump start" the body's metabolism. Mine was shot to hell from a lifetime of PCOS, dieting and other factors.
4. I'd already done many years of low fat, low carb, highly restrictive dieting and I knew I sucked at it. The DS gives an eating quality of life that I find easy to live with: eat a primarily animal protein based diet. I'm a happy carnivore :-). I had to learn to restrict my carb intake, but it was a lot easier to do when I could eat meat, cheese, fish, eggs, etc. with abandon, with little regard for fat content. (DS'ers only absorb about 20% of the fat they eat, so for most of us, fat is almost a "free" food.)

I felt so strongly about the superiority of the DS to any other procedure that I traveled and paid out of pocket to have it done, rather than have the RNY done fifteen minutes from home and covered by insurance. It's been four years, and so far, so good :-).

Please come over to the DS board and visit with us there. Lots of folks will be happy to tell you about their experiences.