VSG or RNY

[Purple Frog]

Hello All!
I didn't know where to post this, so I'm sticking it here.

I had my consultation with Ayoola yesterday and he felt the DS was too extreme for me. He recommended either the VSG or RNY depending on the results of my scope. I have LPR, not GERD, and there is concern that it would be made worse by the VSG. The only way to fix development of GERD after VSG would be revision to RNY.

I went to a DS surgeon to get information on all options and kind of feel like I need to trust his judgement about that particular surgery. But, I don't know. What are your thoughts that the DS may not be THE best choice for everyone?
And, I am very torn between the RNY and VSG. He didn't seem to prefer one over the other.

Background: No comorbs, BMI 41. I will be doing a sleep study soon.

 

[Elizabeth N.]

What's LPR?
There's no way on God's green earth I'd get RNY unless I was at severely high risk of esophageal cancer from already-present and rather advanced issues.

There are other DS surgeons. I would get a second and possibly a third opinion.

 

[southernlady]

LPR...maybe http://www.webmd.com/heartburn-gerd/guide/laryngopharyngeal-reflux-silent-reflux

IF I had to chose between the RNY or the VSG, *I* would go VSG. At least you maintain your pyloric valve, can take NSAIDS, etc.

 

[star0210]

I never considered the RNY when I started researching WLS 5 yrs ago. I wouldn't consider it now. That procedure just never made a whole lot of sense to me.
I belong to a Revision FB group and there are three people on that page just this week who are having RNY revisions to either make their pouch smaller because it has stretched out, or to fix their stretched out stoma's, or to add intestinal bypassing all due to regain. Some are even doing band over bypass which is going from bad to worse!

I had the VSG hoping it would be enough. Had I stuck to the program and stayed diligent on my protein and fluids, I probably wouldn't be needing the revision to DS. It's not the surgery's fault that happened...that was my own fault and I've got a bunch of excuses but at the end of the day it's all on me.

There are more and more people who've had the RNY who are trying to get revisions to the DS and some even to just the sleeve.

Does he think the DS is too extreme for you because of your BMI and lack of other health issues?

Here's a question for the Vets...for someone like Purple Frog...would it make sense to just make her cc a bit longer thus making it a little less "extreme"?

 

[southernlady]

I never considered the RNY when I started researching WLS 5 yrs ago. I wouldn't consider it now. That procedure just never made a whole lot of sense to me.
I belong to a Revision FB group and there are three people on that page just this week who are having RNY revisions to either make their pouch smaller because it has stretched out, or to fix their stretched out stoma's, or to add intestinal bypassing all due to regain. Some are even doing band over bypass which is going from bad to worse!

I had the VSG hoping it would be enough. Had I stuck to the program and stayed diligent on my protein and fluids, I probably wouldn't be needing the revision to DS. It's not the surgery's fault that happened...that was my own fault and I've got a bunch of excuses but at the end of the day it's all on me.

There are more and more people who've had the RNY who are trying to get revisions to the DS and some even to just the sleeve.

Does he think the DS is too extreme for you because of your BMI and lack of other health issues?

Here's a question for the Vets...for someone like Purple Frog...would it make sense to just make her cc a bit longer thus making it a little less "extreme"?

1) YOU DID NOT fail your VSG.
2) My BMI was 35.2 (far lower than @Purple Frog ) BUT I had an insulin pump as a type 2 diabetic.
3) YES, the common channel can be customized...mine was. It's 175

 

[Purple Frog]

Does he think the DS is too extreme for you because of your BMI and lack of other health issues?

Here's a question for the Vets...for someone like Purple Frog...would it make sense to just make her cc a bit longer thus making it a little less "extreme"?

Yes.
And, thank you, good question.

 

[Purple Frog]

LPR...maybe http://www.webmd.com/heartburn-gerd/guide/laryngopharyngeal-reflux-silent-reflux

IF I had to chose between the RNY or the VSG, *I* would go VSG. At least you maintain your pyloric valve, can take NSAIDS, etc.

Yes, that's good info for LPR. Thank you.

My thinking is/was (as flawed as it may be), chose the VSG and then I can add the switch if I ever become diabetic.

 

[Munchkin]

Yes, that's good info for LPR. Thank you.

My thinking is/was (as flawed as it may be), chose the VSG and then I can add the switch if I ever become diabetic.

This is what I would probably do. But I would be still asking for the whole surgery!

 

[Purple Frog]

This is what I would probably do. But I would be still asking for the whole surgery!

You mean push for the DS?
I guess I'll ask him about it when I go next month. I'm doing the 3 months of nutritional counseling there to keep everything as uncomplicated as possible. He kept saying I could change my mind at any time, but really he acted like the DS wasn't even an option. Neither was the lapband (not that I asked), but those were the 2 things he crossed out right away while explaining what they were. He said I only needed to reduce my BMI by 15 to be healthy and that it was too extreme. I didn't even think to ask about adjusting the CC.

 

[Elizabeth N.]

A stand alone VSG generally means a much smaller stomach than when done in conjunction with the DS, and that would increase the risk of GERD. I'd be pushing for the DS and getting a second opinion.

 

[Larra]

To mine little mind, LPR is, if not the same anatomically as GERD but with different symptoms, is certainly related and similar. Unless it's severe, I don't see it as a reason not to have a DS, but then Dr. Ayoola is a DS surgeon and I'm not.

HOWEVER - lots of things can be customized. For example, if Dr. Ayoola (or any other surgeon) feels that a tight sleeve would be bad for you given your condition, a looser sleeve can be constructed. Likewise, if he feels a DS is "too extreme" for you - and I strongly disagree on this point as the DS is a standard of care operation for anyone who qualifies medically for bariatric surgery and NOT just for people with extremely high bmi's - the limbs of the switch can also be customized for you, making, for example, a longer common channel. Lots of people with a lower bmi than yours have had the DS and done well with it.

I see 2 problems with RNy. First, while the limb lengths could, in theory, be customized, it is almost always made as a proximal RNY, which means you get almost no malabsorption of calories, and the little bit of caloric malabsorption you do get doesn't last. This means you are totally dependent on restriction, which sadly also doesn't last, and behavioral changes. There are some people who make this work. Lots of others don't. You can't make the pouch any smaller than it's already being made, as it's already just 1 oz big. Any bigger and the operation doesn't work at all. You can't make the stoma any narrower as it would cause a stricture. So you are stuck with a standard RNY

Second, if a VSG doesn't work out for you, it can be revised relatively easily to a DS. Obviously this isn't ideal, as the ideal would be for one operation to do the trick, but we are seeing lots of people with both RNY and VSG needing revisions these days. On the other hand, if you have RNY and need it revised to a DS, that's a very complex, challenging and higher risk operation that only a few surgeons do.

but perhaps the best reason not to get RNY in your case is that it isn't what you want. I felt the same way. It just wasn't right for me, and I could never get comfortable with the idea of it. So take your time, consider all your options, get a second opinion if needed, but bottom line, don't let anyone talk you into something you are not comfortable with. Not even me.

 

[Munchkin]

You mean push for the DS?
I guess I'll ask him about it when I go next month. I'm doing the 3 months of nutritional counseling there to keep everything as uncomplicated as possible. He kept saying I could change my mind at any time, but really he acted like the DS wasn't even an option. Neither was the lapband (not that I asked), but those were the 2 things he crossed out right away while explaining what they were. He said I only needed to reduce my BMI by 15 to be healthy and that it was too extreme. I didn't even think to ask about adjusting the CC.

Yes. Absolutely. And here's why. People who are successful longterm with restrictive only procedures pretty much live on a starvation or close to a starvation diet. Can you live forever like that? Or do you want the freedom of eating what you want every now and then? The failure factor of these procedures is the very restrictive diet. Some work out like crazy so they can eat more normally but it's a crapshoot how long you can do this because we are all ageing. Plus, do you want to spend your whole life in a gym?

Next, there are more than few 'lightweights' who have had a DS and done well longterm. I have been around the boards for a long time, more than a decade and I believe I can only think of MAYBE 15 people who have needed surgical intervention because they lost too much weight. The DS is pretty much self limiting. Quite a few people have forced themselves to eat more or use Creon for a few months to stop losing. And usually those same people are back in three years wanting to know how to lose again.

You know you better than anyone else does. Take some time and really analyze why you are heavy. Are you already dieting like crazy to keep from gaining? How much do you think you would weigh if you ate relatively normally? Are you likely to develop Type 2/high cholesterol, etc? Does it run in your family? Look at other female members of your family. Are they heavy? Will you be successful longterm with a restrictive procedure? You know the answer. Take the time to figure it out. Then do whatever you need to do to get the surgery that's right for you!

 

[Purple Frog]

Thank you, @Larra and @Munchkin, I've read and am thinking.

But, also, here's what I'm thinking... One common thing I've noticed on all the boards (FB boards included) is that limiting carbs/increasing protein (and, of course, limiting sugar) seems to be the main success factors in ALL surgeries. Would you say that is correct? So even with the DS you still have to make the right choices. I keep reading all the procedures are "just a tool".

Munchin, to answer your questions (I know they were probably rhetorical, but if y'all could help me think through this I would greatly appreciate it)

Are you already dieting like crazy to keep from gaining? No
How much do you think you would weigh if you ate relatively normally? Ate normally, like low carb and cut the sugar? Or eat like I eat and no activity? I'm not really sure. 180-190ish. I am an emotional eater. A "fun" friday night for me is Chinese takeout and a movie.
Are you likely to develop Type 2/high cholesterol, etc? Type 2 maybe, because I'm hispanic. My cholesterol is 225, my mother has high cholesterol (medicated and thin). So, unsure.
Does it run in your family? No, not that I know of. MAYBE some my dad's sisters.
Look at other female members of your family. Are they heavy? No, just me.
Will you be successful long term with a restrictive procedure? I honestly don't know. If I have to watch my carbs and fill up on protein with ANY of these procedures in order for them to be successful, then...maybe I could be.

I'll be honest, I am scared of this particular surgery and also feel like a failure for being the fattest person in my family. If I were honest with myself (and you) I would say the sleeve is my choice because of the lack of intestinal rearrangement and it would be more "natural" knowing I still have to do the work, e.g. make the right choices in the kitchen. But, as far as be limited to 800-1000 calories for the rest of my life? No, that doesn't appeal to me at all. At ALL. But, being forced to make smarter choices because of a tool I have been given appeals to me.

To mine little mind, LPR is, if not the same anatomically as GERD but with different symptoms, is certainly related and similar. Unless it's severe, I don't see it as a reason not to have a DS, but then Dr. Ayoola is a DS surgeon and I'm not.

But perhaps the best reason not to get RNY in your case is that it isn't what you want. I felt the same way. It just wasn't right for me, and I could never get comfortable with the idea of it. So take your time, consider all your options, get a second opinion if needed, but bottom line, don't let anyone talk you into something you are not comfortable with. Not even me.

I guess we won't know about my reflux until I am scoped and then I will talk with him again about my options. But, you are very correct that I would almost rather have nothing if my only choice were the RNY. Although, my cousin has one and absolutely LOVES hers and looks and feels wonderful.

If I were diabetic, I'd be pushing for the DS no question.

Those are just some thoughts, but I am still thinking about your responses.

 

[southernlady]

Another thing to consider in your decision is the ability to take NSAIDS.

You are still young enough to not need them regularly altho you may have issues I am not aware of...but arthritis is in MOST of our futures...at least osteoarthritis is. In 2010-2012, 49.7% of adults 65 years or older reported an arthritis diagnosis. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6244a1.htm?s_cid=mm6244a1_w

And genetics plays a part in that as well. So even if you don't have it, look at your older family members...do they? THAT was enough to take the RNY off the table for me. I was already on an NSAID...to get a surgery that I know would never allow NSAIDS again....just not a smart idea.

 

[newanatomy]

Food for thought: I am almost 10 months post-op DS, I am currently eating over 2,000 calories per day and still losing weight. That is why I chose the DS. I like to eat! It was something I had to consider when choosing a WLS. I knew restriction alone would never be enough for me. I have a big appetite and am too food driven.

Now, back to my big bowl of broccoli cheese soup. I make it with real American cheese and heavy whipping cream, yum!