Roux En Y or Sleeve?

Tonight I went to my first meeting. It was a support group meeting. I guess it's one of the requirements prior to surgery. Anyway, I have a Drs Talk meeting next week then we should be starting the testing phase. I am flip- flopping between Roux En Y and the sleeve. I don't have diabetes or any other extreme health issue. I just have to get this weight off. I have early arthritis starting in my hips and it is just too hard to go up and down stairs with all this extra luggage I have. Any comments or suggestions would be appreciated. I really have to get off the fence.

Traci

You mention that you don't have any extreme health issue, but there is one health issue that might be rather mild but generally makes RNY a much better option than sleeve, and that is acid reflux. If that is not a consideration, though...

 

I will be 6 years out in August, and although I have been very happy withe the results​ of my RNY, if I had the choice NOW (the sleeve was not availale 6 years ago), and both surgeries were overed by insurance, I would opt for the sleeve.  My primary reasons:

- IMO, losing the weight a little bit faster with the temporary caloric malabsorption of the RNY for 12-18 months (the major benefit of RNY) isn't worth a lifetime of lack of vitamin absorption, taking vitamins three times a day every day for life, and having to have extensive blood work done at least every year, sometimes more frequently.  Although the vitamin regimen gets to be a matter of routine, I have to admit that -- after "only" 6 years of doing it -- it is kind of a drag.  There is also almost no information available on what happens to RNY patients when they get into their 70s and the body doesn't absorb nutrients as well just because of the aging process, so I do worry a bit about malnutrition issues and vitamin deficiencies at that point.

- The inability to sake NSAIDs after having the RNY can be very problematic for people with arthritis (which you mention having).  Be aware that although many people experience significant improvement of pain in their knees/ankles/feet once they lose weight, if the arthritis is already moderate to severe, you may get very little improvement, and not being able to take NSAIDs makes life much more difficult (pain and limited activity makes maintaining the weight loss more difficult).  After RNY, the only anti-inflammatories that do not pose the risk of creating ulcers in both the pouch and the blind remnant stomach (which is accessible only via surgery and therefore cannot be treated with many of the usual ulcer preparations) are steroids, and those can only be taken on a limited basis because of their side effects.  You will also be limited to taking only Tylenol or prescription medications for pain since everything else available over the counter  is an NSAID.  Although NSAIDs also pose a potential risk of ulcer in sleeve patients, the risk is less and, more importantly, because they remove the remnant stomach, there is no possibility of ulcers there (which is the greatest concern for RNYers). I had moderate arthritis in one knee, and severe arthritis in the other (which I did not know before surgery) and I got very limited pain relief despite losing 190 pounds.  Living without NSAIDs when you have significant arthritis pain is difficult.  I just had my left knee replaced (after waiting as long as I could bear to because I was scared of the surgery), but I will likely replace the right knee much earlier than I would have if I could still take Aleve, Celebrex, Motrin, etc. for the inflammation and pain.

The possibility of experiencing "dumping" from eating too much sugar if you have RNY is also often viewed as an advantage... That getting sick if you eat too much sugar or too many carbs -- or the fear of getting sick -- will help "force" you not to eat foods that are high in sugar and calories.  Only about 30% of RNYers dump, though, so if you go into surgery COUNTING on that to help you stay on track  the odds are against you.

For some people, one of the drawbacks of the sleeve (and the DS as well) is that they do remove the rest of your stomach.  The chances that you would ever NEED it are very slim, but it is possible.  If your sleeve becomes unusable due to illness or injury, they would have to do what they do with people who have to have their stomachs removed dues to cancer: create a "stomach" out  of art of the intestine.  Note, though, that even with the RNY where the remnant stomach remains, putting it back into service is difficult surgery (even without in-doing the bypass, which is an even more difficult surgery).

Also, studies are showing that even though RNYers lose more quickly, the weight loss is comparable by 2 years out (but RNYers still have the edge).  By 5 years out, however, the amount of weight loss that is being maintained depends MUCH more on individual people's eating habits than on which surgery they had.  The amount of weight loss at 5 years out varies widely even within a single surgery type. No matter which surgery you choose, if you continue to make good food choices and continue to burn more calories than you consume, you will maintain the loss; if you don't continue to make good food choices, or go back to eating the way you did before surgery, you will gain weight back. 

You can be successful with either surgery. (You can also NOT be successful with either surgery!)  It is just a matter of which surgery "fits" you better, and which concessions you are or are not willing to make.

Lora

Very good comparison.  My sister and I have surgeries 4 weeks apart.  I was may 23/13 and she is going in. Today.  I opted for the sleeve as that is what was offered where I am and she was referred for the rny.  I was worried at first that she would quickly surpass me and we are 11 months apart so although we are mid 30's we are still "competitive"...   I will keep you updated with progress.   One of my reasons for choosing the sleeve was the absorption issues.  With the sleeve my anatomy was left the same minus 70ish% of my stomach being removed.   I take a multivitamin daily however I did before too....  But that is all.  Also with your stomach being a muscle it can stretch out a bit larger as time goes by and you are closer to healthy/normal weight.  This is what my doctor said......  So I'm hoping that my body inside will be fine when this is done and I can live a normal life.  My sister however will have to inject herself with vitamins for the first while and then take them orally for the rest of her life.  

Excellent points Lora. I suggest sleeve. One more thing the doctors do not mention is that the RNY quadruples your risk of developing alcoholism, substance abuse, mood disorders such as depression and bi-polar, suicide and suicide attempt, as well as other problems such gambling and shopping. This is in people with absolutely no prior problems or indication there might be a problem.

But there is no documented increase in such issues with restrictive only procedures such as lap-band and sleeve.

It is my contention that long-term malabsorption is causing slow onset nutrient deficiency. And the bypass of the duodenum and jejunum makes it impossible in some cases for even high quantity supplementation to compensate. Nutrient absorption in the intestines is not uniform. Rather it is segmented with the duodenum being the sole location of nearly 100% of calcium, iron, magnesium, B-vitamin absorption. I have yet to read a study that documents how much extra calcium is required to compensate for the loss of the duodenum. Developing an adequate supplementation regime is not easy as many surgeons imply. So many have become dependent on iron injections to treat pernicious anemia because they absorb no iron no matter hiw much they supplement.

There have also been increased cases of peripheral neuropathy related to B-12 and copper deficiency.

Talk to your doctor but verify by doing your own research. Just keep in mind that surgeons do not specialize in nutrition nor the physical and psychological manifestations of nutrient deficiency.

I have a blog and Facebook page dedicated solely to this topic. Avoid the RNY at all costs.

You had me until "iron injections for pernicious anaemia"   No!   Pernicious anaemia is an auto immune disease - a lack of intrinsic factor is not pernicious anaemia and most RNY'ers produce at least *some* intrinsic factor but choose to get shots because of the convenience.   They can actually get enough B12 from sublingual tablets.

Pernicious anaemia is most commonly treated with cyanocobalamin which is a synthetic form of B12. 

I have had Pernicious Anaemia since my 30's (it's hereditary) - I am now 50 -  and it comes with all sorts of other difficulties that RNY'ers do not get with their possible lack of surgery depleted intrinsic factor!

Thank you so much for the clarification. I will absolutely research this thoroughly. I have been fortunate to be able to keep my iron under control with liquid iron but many have written to me that there doctors told them they weren't able to absorb iron anymore. And many RNYers rely on sublingual B-12 rather than IM injections.

I relied on their terminology of pernicious anemia but the more accurate term I suppose is iron deficiency anemia which one if the most common nutrient deficiencies. I think its the most common deficiency simply because it is easily picked up on standard bloodwork. Whereas serum bloodwork for nutrients like magnesium cannot detect a deficiency since the body makes sure the blood levels are stable. I look at iron deficiency more as the canary in the mine shaft-an indicator.

Thanks again for the correction.

I agree 100% with everything else you wrote - I also have iron deficient anaemia which is treated with iron infusions every 12-18 months because I cannot absorb even supplemental iron.   This is most definitely caused by the bypass!

Given how far out you are and with hindsight being 20/20 would you get the RNY again or choose sleeve?

I think I would go with sleeve.   I too get transfusions, including micronutrient therapy which is an IV ****tail of C, calcium, magnesium, etc.   I use it as a supplement to try make up for what I'm not absorbing via supplements.    But that isn't what I was told.  My surgeon said two multi-vitamins, calcium citrate and monthly B-12 would be sufficient.    Not true (at least in my case and many others).

I would have still got the RNY.    Most of the sleevers I know, who are my age, live on (what seems to me) a starvation diet and I'm not anywhere near willing to do that.  They also have to supplement vitamins and minerals and have trouble with GERD, which thankfully I have never had - even when pregnant!    I think I would have been successful, because I am a very rule driven, controlled person, but I think I would have been miserable not being able to eat relatively normally in the long term!   I would have considered a DS but I don't believe this is a good surgery for the majority of people - it requires A LOT of long term dedication and is not without its problems with regain (however it's sold)!

Despite the malabsorption of micronutrients, which for me is easily managed, the RNY really has worked for me.   I don't believe there is such a thing as a perfect surgery among those presently offered.

I have never recommended a surgery for anyone because I think people need to come up with their own choices AFTER serious research - all too often I see people on here and the Main Board who do little to none and then spend months whining and complaining about how hard it all is - because they really had little clue what to expect!  Why would you let a surgeon alter your digestive system with no clue what it means for the REST OF YOUR LIFE?  Scarey!

For what it's worth, my surgeon brought up the NSAIDs/sleeve thing and he doesn't allow them for anyone.