Reasons why a bypass would be recommended over a vsg???

I'm in month 2 of my pre-op program and initially I thought I wanted a bypass, because I didn't know my insurance covered vsg, and also becase I knew nothing about it.  I told the NP and dietian that I wanted the bypass.  But now I am dead-set against bypass and only want vsg - I'm terrified of not being able to absorb nutrients - especially because my labs have indicated that I am already low on iron and I have a vitamin D deficiency (My level is 11).  Are there any reasons why my surgeon might recommend the bypass instead of the sleeve?  I haven't met with him yet, but I just don't want to get my heart set on vsg if I wouldn't be able to have it and would be told to have a bypass instead.  Thanks!

I don't think your vitamin D deficiency and iron would be a reason to advocate the RNY.  I think they would be reason "not" to have the RNY.  Sometimes surgeons recommend the rny if you have an excessive amount of weight to lose but there are people on this site who have been very, very, heavy and have been very successful.  If you insurance would cover it then I would not recommend doing a surgery that you don't want.  We already have a lot deal with mentally after this surgery, doing a surgery that you don't want could mess with your head even more.  Just have a frank conversation with your surgeon and understand why they are recommending whatever surgery they are advocating before you set your mind definitely one way or the other.

My surgeon recommends bypass for patients with diabetes. Other than that, he lets the patient decide which surgery they want.

Uncontrolled GERD/reflux that's not the result of a hiatal hernia.  That's the only medical condition that I can think of that really gets worse (sometimes) with the sleeve.  If it's caused by a hernia, repairing the hernia can usually solve that problem.

I had Type 2 diabetes before surgery.  It went into remission with the surgery.  Both the DS and RNY have better statistics for putting diabetes in remission, but the sleeve will do it too in the right cir****tances.

I have t2dm and am considering vsg over DS. What have you learned about how well the vsg will cause remission for dm?

thanks!

If your doc is stressing that weight loss will help your diabetes, then the vsg would probably do the job.  The info I got was that your chances of controlling diabetes with weight loss alone was based on how long you had diabetes and how severe it is.  The longer you've been diagnosed and the more potent the medication, the less likely that weight loss by itself will put it into remission.

Thank you very much!  I will discuss everything with my surgeon, of course.  I have no diabetes and as far as I know I don't have reflux.  Do they do a test for that?

As part of my pre-op testing, I had to have an upper GI series. It revealed a pretty severe hiatal hernia. I was asymptomatic - no reflux - so I had no idea. When I had the sleeve done, they repaired the hernia too.

I agree that they test for all of that stuff and if you Dr. doesn't, then get a new one.  I had a Hiatal Hernia moderate, which was discovered after my upper GI and then subsequent EGD. 

I changed my mind from RNY to VSG 2 days before surgery. My surgeons assistant wasn't happy about changing the paperwork but too bad for her, this is a life altering decision and you have to make the right one. For me keeping my pyloric valve and being able to take anti inflammatory meds if, like my mom and gramma, I end up with arthritis was big, but there is much more than just that. Really do your homework. I have read recently that many surgeons believe the VSG will become the new gold standard for wls. My surgeon recommended rny because it has "better results and more historical data" I still went with VSG. it's your body, you need to do what's right for you.