VSG OR RNY?????????????

 Ok when I started this longggg process I was dead set on lap band. As I went through the steps my Dr. helped me realize that RNY would be better for me. So I had my surgery date set for that in March and boom lost insurance. Well now I have it back and I went back to my surgeon and now they offer a third option.......VSG I'm guessing this is the sleeze as he called it.  I don't know much bout this surgery and from what he said there wasn't any long tern data on this surgery only 5 years studies and thats it.  So the long tern affects or effects are unknown.  Now I'm confused on which to choose.  How did you decide between these??? Any info wold be helpful. Thank you, Kerry

Before I had surgery, I did a lot of reading.  Particularly "Weightloss Surgery for Dummies" and a few other books.  Unfortunately, my insurance would only pay for lapband or RNY.  I didn't want the band -- just don't go for that foreign plastic body inside me, but that's a personal choice.  I wish I had been able to have the VSG (vertical sleeve gastrectomy), as it leaves more of your original anatomy intact.  I have ended up with severe hypoglycemia and dumping, with the possibility of nesidioblastosis being considered by my endocrinologist.  This is a rare, occurrence, but it can happen to people with RNY.  Get your hands on as many things as you can to read (visit the library) and then decide for yourself what you want.

Linda

 Thank you for your response Linda :) Yes I have done alot of reading on RNY and the band but not so much on the sleeve because I never imagined it as a possibility as my Dr. office did not offer it. They just recently started offering it and my insurance does pay for it.  I was just worried that if there are no long term studies or known affects of the surgery far out  will I be entering into something blind and have possible problems years out that are not known now since the surgery isn't that old.

Kerry

I know several people who have had the sleeve and they did great with their weightloss.  I'm not sure how they are doing with keeping it off.  There is a VSG forum here.  On the blue bar above, click on forums and then Surgery Type.  Vertical Sleeve Gastrectomy is near the bottom.

Weight Loss Surgery for Dummies has very little info about the sleeve. The copy I saw in B&N was published in 2005.

http://vsgfaq.wordpress.com/

The link above is a collection of info about the vsg.  There's also a board on OH dedicated to it, so you might want to amble over there!

Partial and complete gastrectomies have been done for decades for the treatment of ulcers and stomach cancer.  It's also the first part of the duodenal switch WLS.  Then they noticed that weight loss was a side effect.  You are right that it's been done as a weight loss procedure only relatively recently, but initial findings are that it's as effective as RNY at weight loss.  Maintenance is still a question.

The ONLY acceptable WLS procedures are the VSG and the duodenal switch. Learn more at www.dsfacts.com and the DS forum on this website. Your surgeon will not tell you about the DS, or will tell you bull**** horror stories about it, because he doesn't do it, and he's not going to sell you a surgery he doesn't do. Come learn more about it.

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.
 

 

My 2 cents...Have been around these boards many many years and at support groups.  You really should strongly consider the sleeve...Here are some reason why you should go with it (from an RNYer who is very happy with his choice).  The sleeve was very popular in europe many years ago...it is becoming more and more popular in the US now.  Since you are young you may want to go for it because of the lack of malabsorption.  We are gaining more and more info about WLS and the problems with side effects.  With the sleeve you probably will have less long term side effects with it.  Years down the road (and you may need to think 10-20 years down the road) the sleeve can be converted to a RNY or DS...Not completely but mostly.  I believe the sleeve is the first part of a DS that is never taken to the second step.  With the RNY or DS you will lose more weight and lose it more quickly.  But, (and a big but) you will have less issues with things like iron, calcium, minor nutrient deficiencies...They could plague you for years...with no easy reversal in sight.  I'm a man and my surgeon wanted me to get a bone scan before (baseline) and others down the road...Just because of the malabsorption.  If you had a really high BMI I would say look at the DS or RNY...But since you are young...Look strongly at the sleeve.  Brian

The DS is the most easily reversed of any of the currently performed surgeries. You can be restored from DS to sleeve status just fine.

My surgeon is getting similar results from the sleeve as from RnY and so are many others. But RnY is riskier. The sleeve also provides a significant ghrelin reduction. (In one study, Bandsters had 2x as much ghrelin as pre-op) and in some studies RnYers had no reduction and in others the reduction wasn't as big as it is with a sleeve.

Those things made the sleeve more attractive to me.

The sleeve has been performed for only about a decade as a stand-alone WLS option but it's part of the DS and partial gastrectomies have been performed for decades for other reasons (stomach cancer, ulcers) so we know a lot of about what life is like long-term for people with a sleeve, what complications to expect, etc. I also liked the fact that a lot of early sleevers started out wanting a two-part DS but then never came back for the second part because they didn't need it.

A big issue for me was weight regain. Earlier sleeves were made much larger and regain was an issue. However, that regain started in the 2-3 year timeframe, not the 10 year timeframe. Surgeons responded by making the sleeves smaller and regain became much less of a problem. There is 5 year data with the smaller sleeves and that seems to be enough to know if a surgery is going to have that problem.

Because of that, I was comfortable getting a surgery that didn't have decades of data as a stand-alone WLS.