sleeve vs rny

went to see the surgeon  for for the first time thinking rny , he does both but suggests the sleeve saying the weight loss is slower but ends up about the same amount in the end . that it is up to you to stay on the plan, I need to lose 250 lbs  and am diabetic

he says that the sleeve is much safer for high bmi people and less side effects

 the info on this site diffrers  from what he says but it might be old info on here I don't know when it was posted 

any opinions on which would be better for me and why , I have 6 months to decide

 

If I had 250 lbs to lise and diabetic (depends on how long) I would not hesitate and choose the Duodenal Switch. Look on dsfacts.com and read on the DS forum, ask questions there.
Also have a look at this thread:
http://www.obesityhelp.com/forums/VSG/4580686/sleeve-or-bypass/
and this
http://www.obesityhelp.com/forums/ds/4581130/Why-did-you-choose-DS/

Of the two, I would certainly go with the VSG as it offers similar performance to the RNY but at less cost in lifestyle and medical treatment options. Weightloss and regain characteristics are similar (the RNY's malabsorption is a temporary effect on calories, but is permanent on the malabsorption of minerals; resolution/remission of diabetes is similar between the two, though many surgeons promote the RNY because that is what they are most familiar and comfortable with.

I would second Wantmylife's motion to look into the DS - if I were a 200+ lb overweight diabetic, that is where I would go. It is a more powerful procedure that makes it easier for high BMI patients to lose what they need to lose, diabetes resolution is better (on the order of around 98% vs. 85%) and regain resistance is better than the other mainstream WLS procedures. There have been quite a few people here who have lost 2-300 lb and more with the VSG, though at this point, we don't know how well they will keep it off over the long term. (Disclosure here, that my wife lost 200+ with a DS, from a mid 60's BMI, and has maintained a normal weight for about seven years so far and he diabetes is a distant memory; I had only 100+ to lose and no diabetes history, so the VSG was the best match for me.) The DS is a more technically challenging procedure for the surgeons to perform which is why a lot of them don't offer it, but that also means that the established DS surgeons tend to come from the top of the class.

The other nail in the coffin of the RNY from my perspective is that it is a very difficult procedure to revise/convert to something else should the RNY not work for you - minor tweaks can be done, such as tightening the stoma or banding the pouch, but nothing that fundamentally changes the way it works which is often what is needed if the original procedure was not compatible with the patient. Converting the RNY to a DS is something for which only a small handful of surgeons in North America are qualified (is it coincidence that Gagner and Rabkin are two of them?) This also leads to another of the advantages of the VSG, since the VSG is the basis of the DS (which adds intestinal malabsorption to the sleeved stomach) it is a straightforward procedure to convert the VSG to a DS should the VSG not be strong enough for the patient, which makes for a very useful "plan B" to have "just in case", much more so than with the RNY.

Good luck on your decision, it's good that you have some time to research and think things over,

thank you for answering I have plenty of time my dr wants me to lose 12% of extra weight and insurance  requires 6 months of dietians meetings  , my surgeon says the diabetes  recovery its about the same with both but the sleeve takes longer   

and the weight loss should help that

I lost 25 lbs before seeing the doctor and dam but that don't count

people on this forum say sleeve or ds and on the rny they say rny so confusing

It is normal for people to support and reinforce the decisions that they have made - that is human nature. A major factor here is that most people on these boards are in their honeymoon phase where everything is going well, and the new hasn't worn off yet. The most challenging issues, once any early surgical complications are resolved, typically come a few years down the road when any regain issues will show up, if they do, and most have stopped posting by then.

You sometimes have to read between the lines to get a better feel for how people are really doing with their choices. One of the factors that swayed my wife's decision when we first started researching WLS 9-10 years ago was the general tone of the message boards - the most prominent issues being discussed on the RNY boards were problems that people were having while the overriding tone of the DS boards was how much better life was after the surgery and weight loss.

Another place to look for insight are the revision boards, where you find those who are farther out who have had problems severe enough to consider revising to another configuration. The most numerous there are, of course, the band failures, but there are those who have had problems with all of the major procedures. Sometimes it's a physiological or surgical problem, but as often as not it is simply compatibility between the patient and the procedure, and getting a good match between the two.

There is a great presentation on this by Dr. Roslin here:

http://www.obesityhelp.com/forums/amos/4416773/quotDoes-the-Patient-Fail-the-Procedure-or-Does-the/

Unfortunately, he doesn't provide that much insight into what patient qualities line up with what procedures, which is one of the points that I was agonizing over when making my decision, but that is something that is worth a lot of sole-searching. One of the most common themes that we hear on the VSG boards as to why we chose it centers around not wanting our intestines rerouted for malabsorption - well, who would? But despite our desires, it is the appropriate thing for some people and some of those who chose the VSG will be going back to get it revised because it did not really meet their needs. Think twice (three times, four times...) and cut once, if at all possible. I do know of a couple of patients within my doc's circle that are double revisers - lap band revised to RNY revised to DS - something we would all like to avoid!

Good luck, research and sole-search!

I had the sleeve done on September 11th 2012 and I have lost 60.1 lbs so far since that date.

I need to lose a total of 220 lbs to be at my doctors goal weight.

i think that 60 lbs in 6+ weeks is awesome.. and I love my sleeve. I am so glad that I decided against gastric bypass even tho the weight loss can be faster then what I am losing (even tho I am losing great)

Its totally your decision I am sure your surgeon will be on board with whatever you decide.

Good luck.

 

My doc stopped doing the DS he said quality of life was bad due to chronic bathroom issues with #2 I know someone who had it she lost all the weight but does have the #2 issues bad do your research....

is it true that the sleeve stops hunger