Roux-en-y or Sleeve

Has anyone out here been torn as to which survery best fits their needs?  I am halfway through my classes and will have to make a decision as to the type of surgery I prefer.  I need to lose 100 pounds and want to know if the sleeve can accomplish this, or would the Roux-en-y  be a better choice. 

Yes, the sleeve can accomplish a 100 lb loss. See my ticker. I'm only 7 1/2 months out and still a work in progress. I'm losing 2-3 lbs a week at this point and am confident I'll make goal by next April - by which time I'll have lost at least 144 lbs. I hope to lose a little more, at least 150, but we'll see.

Read other posts and look at other tickers - there are huge numbers of 100 lb+ losers on this board.

I never considered a bypass because I didn't want the modified stomach and stoma and the intestinal re-routing. A sleeve has the normal plumbing but a greatly reduced stomach size. I can only eat a few oz at a time. Some considerations with RNY: the stoma can stretch and food goes straight through; patients can develop reactive hypoglycemia because of this. The intestines often adapt after about 2 years to reabsorb the calories that have been malabsorbed. Between the two of these issues, risk of substantial regain is increased.

Unfortunately, though the intestines relearn to absorb the calories, they continue to malabsorb certain nutrients. Bad trade off.

I have been thrilled with my sleeve.

I was never interested in the bypass. I am in Saskatchewan, Canada, and in my province the bypass is the only thing that is covered by our health care. I paid $13,000 out of pocket to go to Mexico to get a sleeve INSTEAD of getting a free bypass. I didn't like the idea of that phantom stomach just floating around in there. What if it ever had cancer, it can't be scoped? I also have asthma and have to take steroids sometimes, which is apparently not OK on a bypass. I just found the thought of completely replumbing my entire digestive system to be completely offputting. I want to still be able to absorb minerals and nutrients -- I just want help eating less. I have over 100 lbs to lose too, and this is the route I chose. Good luck.

 Hi Barbara,

I am just under 6 months out and have lost 100 lbs already! 

I can't tell you which surgery is best for you, but I can tell you why I chose the sleeve.  1 - less likely to dump (I really hated the idea of dumping), 2 - no phantom stomach (with R n Y part of the stomach can not be scoped), 3 - I can eat pretty much anything just very small portions, 4 - the part of the stomach that produces hunger hormone (gherlin) is removed so I don't feel very hungry, 5 - the part of the stomach that remains is not very stretchy - so you would have to work at stretching out the sleeve.  I love my sleeve and the control it has given me! 

Good luck making your decision!

Hey Lucy!!

So GREAT to see someone local to me here!!  Dr. Singh is doing my sleeve at St. Agnus in 3 weeks!!  I am so excited I can't even stand myself!!

Thanks for posting!!  Hope to see you here again!

Maria

You are going to love St A's. The new wing is beautiful! Both Dr Singh and Averbach are top surgeons! Congratulations on making the best decision of your life - you're gonna love your sleeve!

I never seriously considered the RNY (or the bands.) The RNY and VSG both offer similar weight loss performance - the various studies around put the average weight loss for both in the 70-75% excess weight loss range, while the bands are down in the 45-50% range and the DS is in the 85-90% range. Likewise, the RNY and VSG have similar regain resistance, while the DS offers better performance in that regard in exchange for its greater cost in complexity and lifestyle changes. However, while the RNY and VSG have statistically similar weight loss, they differ substantially in their cost (beyond the financial) in that the RNY extracts a much higher toll in long term lifestyle and medical treatment restrictions.

As noted by others, while the RNY may malabsorb calories for a while (my doc doesn't even give it that much credit) it will continue to malabsorb minerals for life. This is particularly troublesome for women as they age and encounter problems with iron levels and osteoporosus with normal functioning metabolism - malabsorbtion of iron and calcium only compounds these common problems. Further, due to the construction of the RNY pouch and its connection with the intestines (the part of the intestines that are joined with the pouch is not resistant to stomach acid like the duodenum - the intestine immediately below the stomach in the normal, and VSG/DS anatomy -  so that joint is continually irritated by stomach acid and never fully heals; consequently, it is not unusual for there to be minor constant blood loss at this connection, further compounding the iron issues of the RNY. This is also why NSAIDS can not be used by RNY patients for pain/inflammation relief.

The final nail in the RNY's coffin from my perspective is that if it doesn't work, it is a very complex procedure to revise it into something that does work better, typically the DS, and there are only about a half dozen surgeons in North America who are qualified to do such revisions, while the VSG can be fairly easily revised to a DS (some would say "completed" as the VSG is the basis for the DS and is sometimes done as the first phase of a two stage DS.)

As you can see, I am also in the 100 pounder class, and have lost that fairly easily in about seven months with the VSG and without depending upon any fad diets to help it.

Good luck in your decision and your journey,

Just wanted to note that I've had the DS for 8 years now, and I disagree with the statement that the DS has a 'greater cost' in terms of lifestyle changes. Pre-op, I never took vitamins; post-op, I take them four times a day---instead of prescription medications.

Not a bad lifestyle change at all. (*grin*)

Greater cost than the VSG I should have said more clearly, though the differences may be marginal depending upon individual outcomes (my wife is a 6+ year DSer, so I'm quite familiar with the trade-offs and potential problems. Overall the DS is better in those tradeoffs than the RNY which typically adds in greater food restrictions along with the NSAID restriction for no great benefit over the VSG and generally much less benefit than the DS.

Overall, yes, not a bad tradeoff for the benefit, though I don't think that the RNY would have been a worthwhile tradeoff for me. That poor cost/benefit ratio for the RNY is one of the reasons that our doc doesn't do them anymore (though he is one of those few who you want to see about revising a failed RNY!)

For ME, taking the vites four times a day is a lesser cost than restricting myself to 1800-2000 calories a day, which I think is pretty typical for Sleevers. I'm more of a 3000-calorie girl. (*grin*)

But different strokes for different folks!