Stalls in weight loss with RNY?

Hi Vet's and newbie's alike...

I'm currently 430lbs Pre-op and finalizing my requirements. Soon I'll have to make a choice about which procedure I want (RNY vs. VSG) and I was wondering about the journey you all have been on. 

One of the things I frequently hear from VSG peeps is that they had pretty frequent stalls in losing in the beginning. I haven't been reading as much about the experiences of the RNY peeps but from what I have read the stalls are more towards the middle and end if at all. Most haven't mentioned stalls at all and if so just a bit of a hiccup as opposed to the speed bumps I am learning about in the VSG results. 

If any of you feel comfortable sharing your experience I would greatly appreciate learning more about how the process has gone. 

Thanks!

I too was very torn on which one of those two to have done. I finally decided to have the RNY...due to several reasons...The sleeve patients have a 45% higher chance of regaining weight vs. the RNY...( i felt that 45% was to high of a chance to take of regaining my weight with all the research I had done and money I was going to spend for the surgery I wanted the one that was going to be the most effective and have the more lasting results) ..they are only removing a part of your stomach which means leaving the part that can re-stretch back out a lot more than the RNY.....the rny actually bypasses pretty much the entire stomach. (yes RNY can re-stretch too, but it bypasses the part that absorbs many neutrients..which the sleeve does not do) With the RNY you have dumping syndrome which I feel is really a blessing in disguise because it keeps you in check of when you have over done it.....you will have loosing platue in the RNY as well. I have about 4 friends that all had the sleeve with in a month before and after my RNY....I have lost more weight than ALL of them..yes we all loose at our own pace, AND CANNOT BASE THAT OFF OF ME....but they are all able to consume more food per serving than I can at 1 year out. I am so happy that I went with the RNY over the Sleeve.....Just my thought and opinion......most important is that you have to be at peace with your decision and comfortable that you made the right choice!!! Good Luck!!!

Can I ask where that 45% statistic comes from?  I've not seen that before.

I don't believe the sleeve is any more likely to stretch than the RNY pouch is.  and we absorb very few nutrients in our stomach, whether we've had VSG, RNY, or no WLS at all.

Also, many people with RNY do not dump.

Thanks!

I appreciate your insights and it's certainly given me some questions to ask my nutritionist and surgeon. :)

B

Hi WANT2B-

Thanks for your thoughtful response. 

I hadn't heard of that stat about VSG'ers having a higher %/risk of regaining than RNY peeps. So I'll be sure to check that out with my team, thanks for the 411! 

B-

There is nothing inherent in the sleeve that would make regain more likely (or greater in amount) than the RNY, so please don't base your decision on that "statistic". If anything, it is the other way around (see my explanation below).

Lora

This is absolutely wrong.  If there were no "inherent reason" then they would not have different statistics.  They are different operations with different mechanisms of action so of course they have inherent differences that affect long-term success.

No, long term success depends solely on maintain ing healthy eating habits.  The malabsorption from RNY is gone after the first 18-24 months.  I have done a significant amount of research on the statistics because part of my responsibility when doing pre-op psych evals is to make sure the patients understand what they are "in for" with their surgery and that their post-op expectations are realistic, and I have yet to see a single, peer reviewed medical study that indicates the is any significant difference in long term weight maintenance between RNY and VSG,  

if you can cite such a study, I will be happy to read it.

Lora

RNY EWL:  72.6 ± 14.9 % after 2 years, 69.7 ± 15.1 % after 5 years, 66.8 ± 7.6 % after 8 years, and 67.1 ± 11.9 % after 10 years.

http://www.ncbi.nlm.nih.gov/pubmed/23526083

SG EWL: 55.0 +/- 6.8%.

http://www.ncbi.nlm.nih.gov/pubmed/20094819

That is a substantial difference when you're talking about someone who starts at 400+ pounds.  It can be the difference between still being morbidly obese at the end of your journey or not.

First, note that the sleeve study was of only 26 patients.  Hardly a significant statistical population.  Nevertheless...

Your contention was that the rate of regain was significantly higher in those wo have VSG vs those who are RNY.  Even if we use the somewhat dubious numbers in the VSG study you cited, the regain in the significantly larger RNY population was 6% from year 2 to year 5 (72-66, but note that the variability on the 2 year figure is almost 15%, double that of the statistic at 5 years). The status for the VSG was 60.3 +/- 5% at 2 years, so the regain was 5% from year 2 to year 5 (60-55).  

I would hardly consider the difference between a 5% regain and a 6% regain to be significant ( and the higher percentage was for RNY, anyway).

If you want to argue that, based on these numbers, the overall loss with RNY is greater, that is another matter.  Using the statistics above (and, as I said, a study of only 26 VSGers is a very limited study, and I am surprised that the NIH would use that one rather than something with a larger study population), it shows the average RNY loss as 11 or 12 percent, depending on whether you use the 2-year or 5-year figure.  Yes, 10% is a significant amount of weight for someone who starts at 400 pounds (40 pounds), but 1) other studies show very different numbers for the whose starting weight is in the SMO category (BMI over 50)  -- DS blows both RNY amd VSG out of the water -- and 2) the lifelong post-op requirements and potential complications of RNY over sleeve have to be evaluated against the small difference in statistical ending weight.

Lora