Looking for RNY vs. VSG advice

After years of saving $--due to a specific exclusion on my health insurance policy--I'm ready to pay cash for a surgery.  I have most of the pre-op stuff completed, the only big obstacle left is my own indecision.  I have ALWAYS experienced buyers' remorse, and given the amount of money this involves and the web of other issues related to weight loss surgery, I'm having trouble making the decision.  VSG is a *****eaper, is less involved and seems associated with a wider choice of long-term post-op food choices, but RNY is still the gold standard and seems associated with a higher percentage of weight loss. 

Any thoughts out there?

Hi inperpetuum,

As you can imagine this question has been asked over and over again.  We did a search and here is a link to several posts/threads talking about this subject.  Please let us know if we can help further.

http://www.obesityhelp.com/search/action,search_oh/?q=rny+vs +vsg&cx=000946886326336472648%3Ae-vpeg4uyxw&cof=FORID%3A9

I based my decision on Gerd.  If you have gerd I would do RNY. If not VSG should be fine.  Your surgeon should give you his recommendation based on all your tests and EGD. I went w my surgeons advise, he is the expert. 

Both the RNY and the VSG have about the same long-term success rate---a maintained loss of 60-70% of your original excess weight. Given that your BMI is 68.6, is 60% ENOUGH?

Have you researched an alternate procedure called the Duodenal Switch? The DS has the very best long-term, maintained weight-loss stats for patients of ANY size, but especially so for those of us with a BMI greater than 50. The DS also has the very best stats for resolving or preventing co-morbs like diabetes and high cholesterol, and has the, in my opinion, very best post-op lifestyle.

Both the RNY and the DS cause life-long malabsorption of certain vitamins and minerals, and you're going to need to take supplements forever no matter what form of WLS you choose, even the VSG. What the DS does that no other form of WLS does is make a permanent, drastic change in how your body metabolizes food, and causes you to permanently malabsorb a significant per centage of the calories you eat---about 50% of the protein, 40% of the complex carbs, and 80% of the fats. (No, that's not a typo---for every 100 calories from fat a DSer eats, he only absorbs 20. Bacon becomes a health food.)

If the RNY is the gold standard, then the DS is the platinum standard. Visit the DS board, and talk to as many long-term vets ( or more years post-op) as you can. Read some peer-reviewed studies about patient satisfaction long-term. I think you'll find that the DSers are the most consistently satisfied group of WLS patients.

Have you considered going outside the US for surgery? Dr. Ungson in Mexico is a world-class DS surgeon, who also performs the VSG and the RNY. You owe it to yourself to consult with a surgeon who performs the Big Three.

You may wish to pose this question on the vsg board and the rny board  Great success can be had with both if you stick to your plan and make those lifestyle changes!

Anne

Honestly, with a BMI of almost 69, I would think you would want a surgery with some malabsorption, which would be the RNY. I know that cost is a factor since you are self-pay, but I would second Ms Batt's suggestion that you at least consider the DS (if you have not already, of course).

As far as VSG having a wider range of food choices, MANY people with RNY can eat almost anything in small amounts.

There are many pros and cons to each surgery (VSG you get to keep the pyloric valve but lose the rest of your stomach whereas with RNY you keep the remnant stomach but have the artificial stoma which can stretch or develop excess scar tissue), but dumping -- which is a major difference between the two -- only happens to about 30% of RNYers, so if that is a primary consideration one way at another, upkeep that in mind. What it often really boils down to is whether you are willing to trade a lifetime of vitamin malabsorption for slightly faster weight loss. (Yes, VSGers take vitamins, too, but not 4 times a day like RNYers need to).

If you use the search function and type in VSG versus RNY (or sleeve versus RNY) and you will find LOTS of posts about this topic.

Good luck with your decision.

Lora

You've gotten good feedback, but I haven't seen anyone mention the NSAID issue. 

If  you have problems with chronic pain, or have a need to take NSAIDS like ibuprofen, toradol, aleve, etc or any type of NSAID on aregular or even semi regular basis., the RnY is definitely NOT for you.  You can not risk having an ulcer in your "blind" stomach (you don't want an ulcer anywhere really), and any use of NSAIDS - even nonorally - will put you at an unacceptably high risk.  The risk is systemic and has nothing at all to do with pills sitting in your pouch and causing damage.

DSr's and Sleeve folks don't have a blind stomach and don't have that worry.  I can't emphasize strongly enough how important this is and how critical Anti Inflammatory drugs can be to controlling pain.  SO much pain is caused by inflammation.  Not being able to address the inflammation can be very frustrating and very, very painful.  Especially if you have an existing condition such as arthritis.

Oh, and I am with Ms. Batt and Lora.  Don't neglect to check out the Duodenal Switch.  The sleeve is actually the first part of the switch so you could even do that one is stages if it's better for you financially.  And, t's good to know as much as possible about all of your options.

good luck to you in your journey=)

Thanks for everyone's input.  (And, btw, I'm trying to figure out why the system censored my comment about VSG being cheaper...I think the phrase I used was that it was a touch cheaper...but maybe I typed something naughty instead...who knows.)  In any event, the weird blessing that I have, which provides me little direction for surgery choice, is that the only co-morbidity I have his sleep apnea.  So the "go to" decision-makers of GERD or NSAIDs aren't at play.

I remain indecisive and shall continue to research.

Thanks again.

NSAIDs may not be in play now, but most of us find that as we get older, we need NSAIDs for more and more things. Muscle strain, sprains, headaches, arthritis, fever---you name it.  And you'd be surprised at the things that contain NSAIDs---even Pepto-bismol!

The thing you do have is a high BMI. That doesn't mean that you can't be successful with other surgeries, but it does mean that statistically you're more likely to be successful long-term with the DS.

you said:

Bit  

Cheaper 

look at the first five letters