Can NOT decide between the VSG and RNY! How did you choose

[almosthome 91]

1. VSG can be converted to duodenal switch (DS) if the initial weight loss is insufficient. In both cases, the pylorus remains intact, so food is let out of the stomach gradually. Both have a much lower risk of dumping syndrome than RNY, and the weight loss outcomes of DS are even better than RNY.

2. More foods tend to be tolerated after VSG/DS than after RNY, mainly due to the intact pylorus and size of the stomach. VSG also allows regular nutrient absorption and doesn't cause as many embarrassing bowel/gas disorders.

3. Weight loss can be more gradual after VSG than RNY, which can result in somewhat less loose skin. No guarantees!

4. RNY is a better option for people who graze or eat junk food/fast food, though, because the sleeve only controls portion size and sometimes hunger, not eating frequency or food quality.

5. RNY may also be better for people with reflux, as VSG can worsen it over time.

[snowkitten 371]

I just received the approval from my insurance and I will be receiving a date soon, and up until this point i have said I wanted the RNY! However now I'm second guessing my decision and want to know how you all concluded on which surgery was best. I'm just concerned that their are not enough long term stats on the VSG which is what led me to picking the RNY. Are any of you 5+ years post op from the VSG and can tell me how you have done thus far. My only concern with the RNY is losing weight too quickly, I want a more gradual weight loss believe it or not!! Please help

I have numerous reason for choosing the sleeve.

1. The risk for malabsorption was unacceptable. I have cvid which already causes a Protein deficiency.

2. Because of my cvid (common variable immune deficiency) I have a very high chance of stomach cancer. Having a left over stomach that isn't easily accessible to scope (think every couple months) would be asking for trouble.

3. because the RNY leaves the stomach in the body, it doesn't decrease the ghrelin hormone like the sleeve does. Decreasing my hunger is a big thing for me. Another side effect of cvid is stomach issues. I'm used to having diarrhea. I'm afraid that if I have the RNY I will still be constantly hungry, but because the pouch is so small I'll eat the WRONG things (like chocolate) and because I'm used to dumping syndrome it won't deter me.

4. Rerouting my whole system just freaks me out

5. The sleeve has nearly comparable weight loss stats (and if u look at the 2+ year studies it actually has more)

6. the sleeve also changes how the guts bile acids bind to a receptor called fxr. In the absence of fxr weight loss occurs. So aside from restrictive and hormonal changes the sleeve causes a change in your metabolism. That's huge for me!

7. I don't like the idea that I might not be able to absorb needed medications

8. If I find the sleeve doesn't help, I can revise it to add the malabsorption part.

I suggest writing out a pro/cons list and going with what feels right to you. Good luck!!

[Dallas_P 34]

I too originally chose the RNY procedure but had the decision made for me to change to the VSG based on my endoscopy which showed that I had polyps in my stomach and there would be no way to monitor them if I chose RNY. Even before that I was struggling with the complexities of the RNY procedure with the rerouting of the intestines, complications such as ulcers were much higher, and the issues with possible malnutrition and side effects like dumping syndrome. The VSG does seem like a much simpler procedure with results that seem to be as good as the RNY. In the end both procedures have very good results and I don't think you can go wrong with either. It's a hard decision to make and I wish that surgeons would be a little more proactive in helping us with the decision. Good luck with your decision. In the end these are just tools. You can be equally successful with either procedure if you commit to sticking with the diet and exercising.