Why did you pick RNY over VSG?

Hi there! I just had my appt with my surgeon today and got my date- the 17th. Yay! Only 12 more days, I can't believe it! However, I went in there completely confident in my choice to get the sleeve and then I think they might have talked me into bypass. They said that they think I would do great with either but since RNY is the "gold standard" they really try to advocate that one, although the decision is totally up to me. 

So.... I was wondering, what made you pick RNY out of the options? What have been your biggest obstacles? Are there any benefits that you can think of besides a higher % expected EWL and a bit of a quicker time frame? And finally, are you happy that you made this decision as opposed to another surgery type?

I think I will love either, but I just want to make the most informed decision possible before I get on that table. Thanks in advance!

I would've had VSG if I didn't have acid and bile reflux. That was the deciding factor. I would rather not have had intestinal rerouting but I am thrilled I have not had one episode of reflux since my RNY 7 weeks ago. 

My insurance would not cover the sleeve.

Benefits of the sleeve: lower risk of nutritional deficiencies, fewer vitamins to take (probably), may be safer to take NSAIDS, fully functioning stomach with pyloric valve, no dumping, probably much lower risk of reactive hypoglycemia a couple years down the road

Benefits of RNY: probably faster weight loss, though I think the end result is about the same; may be more likely to resolve diabetes; usually resolves GERD (VSG may make GERD worse)

I chose RNY because I wanted the possibility of dumping as a deterrent as I am a sugar lover and am especially attached to "liquid sugars" such as ice cream.  However, the main reason I chose RNY, despite the fact that I don't like the rerouting of the intestines, is that there is no long term data on the sleeve.  

There actually IS some longer term data on the sleeve since it has been being done as a standalone procedure for about 5 years and --even moreso -- as the first part of the DS for people who were satisfied with their weight loss and opted not to undergo the intestinal bypass portion of the DS.

Lora

Yes, I was aware of that, but to me 5 years is not long-term data.  The data that was included as the first part of DS made it a little better, but to be honest, I'm not even happy with the amount of data they have on RNY.  When you read the history of weight loss surgery and the mistakes they made in the beginning...It really hasn't been that long since those days.  RNY may be the gold standard, but there are still a lot of things that are unknown about it's long term effects.  I'm not much of a risk-taker, so I went with the weight loss procedure that had the most data, even if that data wasn't really enough.  But that's just me.

Oh, I definitely agree about the lack of REALLY long term data on all of them (including DS).  Before I had surgery, when my only choice was RNY or DS (since band statistics are so poor overall), I wanted to know what was going to happen when I am in my 60s, 70s, and 80s (hopefully) when the body naturally loses some of its ability to absorb nutrients from food. I don't know if there have been any studies since then, but 6 years ago there was not a single study to answer that question.  Because of that, I opted for the least amount of intestinal bypass with the RNY.

Given that there isn't any REALLY long-term data on any of them, and that the studies seem to show that at 5+ years out, the amount of weight lost and maintained is largely surgery independent (for sleeve and RNY... DS is clearly superior and band is clearly inferior in that respect), it doesn't bother me that there are more limited studies on the sleeve.  I still would have gone with it if I had the option since it is doesn't involve re-routing the intestines.  I do understand your reasoning, though.

Lora

I chose RNY for several reasons.

1. It could eradicate my Diabetes.

2. It is permanent and I need this for me.

3. No dumping with VSG, I need this discipline.

4. I knew my weaknesses and needed the extra help.

My Diabetes is under control (never was) and cut my meds 3/4. Off heart meds. Off lung meds. I have dedicated my food plan to the low-carb, high protein plan, this works for me, everyone is different.Dumped once and vowed to never choose sugar over dumping. It's just not worth it. Too much pain to enjoy 30 seconds of sugar taste. I have been totally convinced I chose the right procedure for me. Good luck on your decision.

What Kelly said, both about sleeve not being an option when I had surgery and the pros and cons of each.  

I have arthritis in my knees (well, in one of them now, since I had one replaced in March) and in a couple of fingers, so I really miss taking NSAID pain relievers and anti-inflammatories.  Between that and the need for extra vitamin supplements with RNY (taking all the vitamins becomes routine, but it can be expensive and, after 6 years, it is kind of a PITA), so if I were doing it again, I would opt for the sleeve.

BTW, according to the most recent study published on the ASMBS web site, the 5-year results for both sleeve and RNY are far more dependent on individual adherence to a new, healthy way of eating after the first two years than on the type of surgery.

Lora

I never wanted a Gastric Bypass and only considered WLS after I learned about the Vertical Sleeve. I read a lot of scientific papers ( although the long term data is limited) and decided on a sleeve. Then I was told that GERD was contraindicated for the sleeve. I then read all the papers  on GERD and the sleeve and even asked my Statistician friend to read the articles - I really wanted the sleeve. However the data was clear - the sleeve is not a good option if you have GERD.

If I had a choice, I would have chosen the sleeve. Your weight loss might not be so fast, but I agree with Kelly and Lora that  your long term success is dependant on life style changes.