RNY now VSG?

[SeattleCat 0]

I am scheduled for what was supposed to be an RNY surgery on 8/18, but after seeing my surgeon for my pre-op appt., he now says I might have to have a VSG. He won't know until he goes in. He needs to see if my surgery for pyloric stenosis at age 6 weeks old, and my C-section, have left any adhesions.

Has anyone else had this happen? I thought I'd better read up on VSG, since it might be a possibility. I've heard that you don't lose as much or as fast as the RNY. Does it cure diabetes like the RNY?

Looking for any information. Thanks! :clap2:

[shanda7182 5]

I am scheduled for what was supposed to be an RNY surgery on 8/18, but after seeing my surgeon for my pre-op appt., he now says I might have to have a VSG. He won't know until he goes in. He needs to see if my surgery for pyloric stenosis at age 6 weeks old, and my C-section, have left any adhesions.

Has anyone else had this happen? I thought I'd better read up on VSG, since it might be a possibility. I've heard that you don't lose as much or as fast as the RNY. Does it cure diabetes like the RNY?

Looking for any information. Thanks!

I went through the same thing. I have not had a sleeve yet but I will in about a month. I initially looked into the more popular surgeries RNY or Lapband however, I had an intestinal repair surgery @ 9mos old so the doctor told me that I may have too much scar tissue to perform the RNY. Therefore,I started looking into the sleeve. From what I have read about VSG it seems to produce similiar results to RNY, but the surgery is less drastic. Ive also been told that the weight lost with the sleeve is "slower" than RNY but the sleeve patients catch up with RNY patients in the end. Of course, "Slower" doesnt mean that its "slow", I guess compared to some very drastic weight loss with RNY in the beginning. From my research and experience (im a nurse), ive learned that RNY patients have stalls and plateaus as well. So everyones body and weight loss experience is different. It just depends on how much you have to loose, etc. People who have lower BMIs may have a slower weight loss than a person with a BMI that is higher. For example, when I weighed 300 lbs, I lost the first 75 lbs very quickly (in 6 mos) but the other 25 lbs took 6 mos. Thats just how the body works. Its not bad. Im saying all of that to say, either surgery will give you the results that you are looking for, if you comply with the post op rules.

Also, good luck with your surgery and weight loss.:clap2:

[Malaika 50]

Welcome Seattlecat.

I don't know much about the RNY other than you experience malabsorption and you don't have that issue with the sleeve. From the little I do know, I would have chosen the sleeve over the RNY - they don't have to reroute your intestines with the sleeve. As for the weight loss, I had surgery on 6/12 and have lost 31.8 lbs.

[shanda7182 5]

Welcome Seattlecat.

I don't know much about the RNY other than you experience malabsorption and you don't have that issue with the sleeve. From the little I do know, I would have chosen the sleeve over the RNY - they don't have to reroute your intestines with the sleeve. As for the weight loss, I had surgery on 6/12 and have lost 31.8 lbs.

Wow, that is great VAngel, Congrats on 31.8 lbs! You will be @ goal in no time.

[Malaika 50]

Thanks Shanda ... the scale finally moved after 2 weeks ... it didn't budge - not even .1 ... I was happy to see it move this morning!

[shanda7182 5]

Good 4 You. I cant wait to be a sleeve sister!

[MacMadame 81]

If your surgeon makes a small enough stomach, then your weight loss should be similar to RnY at 1 year out. My surgeon's practice showed a chart at the 2nd Sleeve Consensus Summit that shows this and they have other data that shows that from 1 year out, weight loss is pretty much the same.

However, the sleeve surgery is not standardized at this time so you really have to go by your own surgeon's stats and success rate. If he's making the stomach bigger, or doesn't have the same angle of His, etc. then it changes the stomach emptying time and your restriction level and that can have an impact on your weight loss.

I have some links here to help research the sleeve that you may find helpful.

[SeattleCat 0]

Thanks everyone for the input!

From what my surgeon said, you don't lose as much as with the Sleeve (70% compared to 80-85%), and you don't get the dumping syndrome. I kinda want the dumping, so I won't eat the wrong things. I'm so afraid of gaining the weight back! Also, I would think weight loss with the sleeve would be harder, since more of it is under your control (what you eat), since you can eat anything (even sugar and fat). That really worries me, too. :crying:

[Tiffykins 673]

The regain stats, and the malabsorption of the RNY completely turned me off of that surgery.

I was a band to sleeve revision. I've lost 55lbs in 2 months, I've had some complications, but for the most part, I am doing quite well with my weight loss.

I've personally known 3 people who had RNY 5+ years ago, and have gained back most of their weight. I truly love the sleeve restriction. I made good food choices before, but in large quantities. Now, I'm making the same good choices, just in smaller portions.

All WLS demand a lifestyle change. The RNY is a good choice for some, but for me personally the sleeve was the best option for my lifestyle. With all the information out there for the sleeve, I think you'll find that the sleeve has a great success rate.

With the dumping comes, misery. Your body will adjust to the dumping, so RNY is not a quick fix for bad choices.

[i1Linda 15]

Two other things to consider:

1. With the sleeve, your surgeon removes the part of the stomach that produces ghrelin (the hormone produced in the upper portion of your stomach that helps stimulate your brain that you are HUNGRY). With less (or none) released, you are typically not as hungry. With RNY, that part of your stomach remains and continues to produce the hormone.

2. With the sleeve, the part of your stomach that remains is less elastic and doesn't stretch much. With RNY, the part of the stomach that remains is the elastic/stretchy part. If you overeat, it will stretch out over time and let you eat more than you should.

These are two additional factors in my decision to have the sleeve.

[MacMadame 81]

Here's a study showing that diabetes resolution is as good with the sleeve as with RnY:

SpringerLink - Journal Article

Also, here are my surgeon's stats for the sleeve:

BMI 35 - 45 : 82.2%

BMI 45 - 55 : 73.4%

BMI 55+ : 52.1%

Their RnY stats are:

BMI <55 : 70-80%

BMI 55+ : 50-60%

So you can see that the initial weight loss is very comparable.

But you can't just look at that. You have to look at regain too. My surgeon says about 10% of his sleeve patients with a starting BMI of 50 or less regain an average of 10 lb. (Same with DS.) With starting BMI's above 50, it's 15% who experience regain. But about 25% of RnYers regain an average of 25 lb.

The reasons are many:

-The pouch in RnY is made from the stretchy part of the stomach and so by the end of 1 year, bypass patients can eat more than sleevesters on average.

-The stoma also stretches out over time a little and that means food sits in your pouch for a shorter time leading to less feelings of fullness

-Somewhere in the 12 to 18 month timeframe, your body learns how to absorb the calories that it used to not absorb. So you can eat the same amount of food as the year before, but your body gets more calories. (Yet, you malabsorp the micronutrients forever.)

Also, according to this study:

Weight loss, appetite suppression, and changes in ...[Ann Surg. 2008] - PubMed Result

RnYers do not get a significant reduction in ghrelin, the hormone that controls your appetite. This is a killer for some of us and it's why some bypassers end up regaining all their weight back - their brains tell them they are hungry all the time, just like they did pre-op.

For me, I wanted the surgery with the absolute best hunger control. That means VSG or DS. Those are the only two where the part of the stomach that produces ghrelin is removed.

[SeattleCat 0]

Wow, a lot more great information. Thanks!

I thought that with the RNY, since the stomach is divided, that the part of the stomach containing the ghrelin is cut off, therefore reducing hunger. Is this not true?

[Tiffykins 673]

Wow, a lot more great information. Thanks!

I thought that with the RNY, since the stomach is divided, that the part of the stomach containing the ghrelin is cut off, therefore reducing hunger. Is this not true?

I've heard that hunger is just as apparent after RNY as it was before surgery. Also, the pouch stretching is a very common occurrence. If you check out obesityhelp.com on the revision forum, you'll find a lot of RNY patients that are years out looking at revisions because of weight regain.

I don't want to try to convince you, or dissuade you from RNY, but I seriously researched my options for 3 years. I chose the LapBand first, had complications and revised to the sleeve 8 months later even though several people tried to convince me to go with RNY.

[Oregondaisy 2,021]

I know at least 20 people who have had RNY and have gained all or most of their weight back. It's great in the beginning, but the dumping syndrome does go away, and their stomachs are stretched to the point that they can eat quite large portions compared to a sleeved stomach.

[i1Linda 15]

Wow, a lot more great information. Thanks!

I thought that with the RNY, since the stomach is divided, that the part of the stomach containing the ghrelin is cut off, therefore reducing hunger. Is this not true?

Ghrelin is produced by cells in stomach wall called GOAT cells. The majority of these cells are located in the part of the stomach called the fundus (top right). With a RNY, that's the part of the stomach that remains intact. With a sleeve, that part of the stomach is completed removed. RNY patients can see a reduction in hunger because there is less stomach and therefore less ghrelin but the reduction is not as significant as what they see with VSG patients.