Should I switch to RNY?

[Foxbins 625]

7 hours ago, sleevegirl88 said:

@Foxbins is it pretty manageable with heartburn meds?

Yes--20 mg of omeprazole in the am and 20 in the pm and I'm fine.

[Sosewsue61 3,185]

I had acid reflux very seldom prior to surgery - if I had pepperoni or something, I had a hiatal hernia and it was repaired during sleeve surgery. I am almost 1 year out and occasionally take a pepcid - maybe once a week and that is usually from eating something more greasy or very spicy. Will this change, who knows?

I picked the sleeve, I did not want malabsorption. The 3 people I know with RNY have all had Iron infusions, and one has an ulcer in her 'unused stomach' portion - 7yrs out, one also has B Vitamin deficiencies. They are dealing with it and still mainly happy.

Anyone can regain if you don't follow the rules, but following the rules is a lot easier after surgery. Good luck.

[TX4everLinds 115]

I just had my sleeve on 9/5/18 so I’m a month and 4 days out. This month has been difficult but it’s nothing I didn’t read about beforehand. Somehow the gerd/reflux took me by surprise bc I’d never had it before. I’ve been out on nexium for 90 days and everyday things get better. I have high hopes it is short term while healing, but it was a real struggle when I didn’t know what was going on. I chose sleeve bc I did not want severe dumping. I had seen others sweat and dump and even fall asleep in carb comas on holidays after just a bite of pie. I wanted nothing to do with that. It affects everyday life. GERD does as well but is treatable and (I’m hoping) temporary! I also did not want my intestines changed at all. Gastrointestinal system is so important I just preferred to leave it how God made it! My 2 cents from a fresh sleeve. I did not think I felt hunger at all but think maybe now some of my nausea was actual hunger. Keep in mind I was (and still am) figuring out how to meet Protein and Water goals. It is very difficult and during healing your body sorta takes over. You have to follow its lead. Good luck!

[Frustr8 7,886]

And a Happy 5 weeks out My Surgery,Day Buddy! May we,continue to Heal and Heal Well!

[sleevegirl88 54]

@CrankyMagpie thanks for the links, im going to check those out!

@GreenTealael thanks girl! ill keep yall posted on what i decide

@JohannaLea true, ive seen that a lot and i wonder why some people go back to old habits idk if its bc it is a habit or that they thought this was a cure not a tool like it should be and though "hey ill lose all this weight and still eat what i want" i recognize this is a tool and have seen a therapist to work on my over eating issues and get help to see why im doing these things. i see the tool as help but not a solution, you have to change how you eat and look at food as a lifelong commitment

[sleevegirl88 54]

@Foxbins thanks ill defn pick up soon as a precautionary

@Sosewsue61 thats how mine is before only when i eat super spicy or super greasy foods, i just normally choose not to eat those foods otherwise no problems what so ever

@TX4everLinds yea i saw that about the carb coma..one girl in this VSG/RNY group im in (she had RNY) out of nowhere a few years post op she said she took a bite of cake at a baby shower and started to feel bad so she left and ended up passing out and wrecking her car in a ditch.. she said she and the car was fine and luckily no one else was involved but she said it scared her bc it could have been way more serious and she just wanted to warn people to be careful bc dumping at any point is very serious

[KimTriesRNY 1,853]

3 hours ago, Sosewsue61 said:

Anyone can regain if you don't follow the rules, but following the rules is a lot easier after surgery. Good luck.

This. I think this is so true.

Regardless of the surgery you choose, I honestly feel this is what does it. You are either ready to make the changes and succeed or not.

Some of us experience vastly decreased hunger, some of us not. But the actual amount of healthy food you can eat...it is so small. This coupled with modest exercise, you will succeed. If you find a way to eat around either surgery though, and expect to still have it work you will be disappointed.

Go with your gut, make the right choice for you.

[sleevegirl88 54]

@KimTriesRNY so true 100%, thank you!

[catwoman7 11,212]

50 minutes ago, TX4everLinds said:

severe dumping. I had seen others sweat and dump and even fall asleep in carb comas on holidays after just a bite of pie. I wanted nothing to do with that. It affects everyday life.

I would say that's a very rare case. Most of us don't dump at all, and for those who do, it would take a lot more than a bite of pie to dump. I'm not doubting what you're saying, but that would be a very extreme case.

[TX4everLinds 115]

Here’s what I’ll say: Having any of these surgeries is like becoming a parent. You don’t “get it” until you’re already in it. You can’t prepare enough. Everything’s different despite all your preparations. It’s an organic thing that you have to live out and there’s no quick fixes. No one can really advise you specifically bc each case is slightly different. Or drastically different. You just have to prioritize your hopes and make your choice and then live strong with it. It’s a no regrets business bc you can’t go back. Nothing is ever the same. But the payoff is worth it. IMO so far.

[TX4everLinds 115]

Ps. Obviously the bite of pie was likely after a few bites of other carbs. And this was very early post op. But some people do dump severely. My aunt being one of them. May have to do with age or consistent non compliance. I don’t know.

[SteveT74 359]

Hi SleeveGirl88. Having GERD isnt' the same thing as having reflux every once in a while because you ate some food that disagrees with you. When they are discussing GERD as a contraindication for VSG, they are talking about people that have it regularly at least one or two episodes a week that don't necessarily have anything eating greasy food. You also don't seem to have any co-morbidities and a relatively low BMI of 40 (the average bariatric patient has a BMI of 42.5). If you're goal is weight loss, I would probably go with the VSG. While RNY may have slightly better total weight loss numbers and slightly lower regain rates over 5 years, the differences aren't really statistically significant--particularly for someone with your BMI. You'll do great with either the sleeve or the RNY and you're not going to get much of a weight loss advantage going with an RNY. There have been a lot of comparative studies that have been published over the past two years that support this conclusion. In terms of weight regain, some people start to see it earlier in the process with the sleeve but in the limited number of long term studies that track people beyond 5 years--there really isn't a long term statistical difference. What does seem to make a difference your starting BMI. Whether you're a sleeve or an RNY, if you start the journey with a BMI of 40 or less, the chances of you having BMI below 30 after one year is 95% and the chance of you maintaining a BMI under 30 after 5 years is over 75% with either procedure. The numbers for both procedures drop considerable the higher your BMI is at the time of surgery.

The other thing to think about, particularly if your young (under 50), is that you're going have to live with this surgery for a long time. While RNY may have slightly better 5 year outcomes on the whole, the differences aren't really statistically significant. For someone like you, it might only mean a 5-8 pound difference (maybe)--but ultimately, it's probably not much of a difference at all. Ten or 15 years post op, you could be at a point where you have had significant regain with either procedure (hopefully not) and then you have think about revision (since obesity is a chronic condition). With this in mind, you should consider which procedure gives you the most and best options for revision.

With RNY, you're revision possibilities are currently limited. In some cases, the pouch can be made smaller. Surgeons can also increase the length of the biliopancreatic limb to increase malabsorbtion or convert you to a distal bypass. The weight loss benefits of these procedures are disappointing for the most part, but these procedures can help treat co-morbidities. A more aggressive or radical approach would be to reverse the RNY and switch to a totally different procedure, but this is a very complicated and risky procedure that most bariatric surgeons aren't comfortable performing (at least not in 2018). In truth, your options of revision from and RNY are limited and may not be very effective for weight loss/regain.

Options for revision from a sleeve if there is significant weight regain or re-occurrence of co-morbidities are numerous and more effective. Resleeves are common, easily performed and can help get you back on track. Since holds more volume to begin with and the pyloric valve is preserved with a VSG, resleeves seem to be more effective than revisions to a RNY pouch for treating weight regain. A sleeve also can be easily converted to an RNY down the road, but this is usually done to treat severe GERD--not so much for weight loss (although it can be used for this too). The most exiting option with a sleeve is that it can easily be converted to a BPD-DS or modified duodenal switch (also called a loop DS, SIPS, SADI-S), which is still considered an investigational procedure in the United States, but is probably the future of bariatric surgery. This is essentially a VSG with a single long limb bypass that attaches midway down your small intestines (roughly speaking) and has only one anastomosis (one connection point). It gives you most of the benefits of a BPD-DS (which is by far the most power bariatric surgery, but also the most risky), with approximately the same risk factors as an RNY. More studies are needed for the modified DS before it will be widely adopted in the US, but it's being adopted by many surgical centers and long-term RCTs are being done as we write (with excellent short and mid-range results). As a revision from a VSG, the SIPS procedure will be an easy upgrade that will only take about 30-60 minutes and will mostly likely be performed on an outpatient basis in the future (The SIPS bypass is much less complicated and less invasive that the VSG part of the procedure).

In the end, both the RNY and VSG are excellent options that are very effective for weight loss. You can't go wrong, with either one. However, if you like and trust your surgeon and if he or she has been gently nudging your towards the sleeve, you should probably take his or her advice.

Edited October 10, 2018 by SteveT74

[RickM 1,747]

20 hours ago, CrankyMagpie said:

No, it was also a first phase of the RNY. https://link.springer.com/article/10.1381%2F096089203322618669

You are right that I should have included that it was a precursor to DS, though. This article refers to both: https://www.sciencedirect.com/science/article/pii/S2444866416300186#

It is worth noting that the group doing that paper (Inabnet, Gagner, Pomp, et al,) were early adopters of the DS, so they were already well familiar with the VSG as part of that, so this study was contemplating applying what was then a fairly normal two stage DS approach of doing a VSG followed by the switch to the RNY. Most bariatric surgeons of the day were unfamiliar with the VSG, and the more normal approach of two-staging the RNY at that time was to use a lap band as the first stage, as that was familiar ground to most bariatric surgeons of the time. The VSG did not start to become a normal practice in the bariatric world until 6-8 years ago when the insurance industry started covering it more consistently; prior to that is was largely the "property" of the DS world, and that is where most of the early work in moving it toward a stand alone procedure came from.

[Frustr8 7,886]

So which surgery dis you finally choose?

[sleevegirl88 54]

1 minute ago, Frustr8 said:

So which surgery dis you finally choose?

I went with VSG! I’m so happy with my decision! No heartburn what so ever and down 23lbs since surgery and 33 from my highest.