VSG vs RNY

How did you decide which surgery was best for you? I think I want the VSG so I can lose slower. I have about 120lbs to lose and am already on supplements for Vit D and B12 so don't want to cause more issues with nutrition. But my regular doctor believes that a bypass works better for people than the VSG. Any suggestions would be appreciated. Thanks

I wanted RNY because if I was going to have surgery I wanted the one with the best results. I ended up being pushed a bit for VSG because the doctor I chose only did VSG for self pay. I only have ~100 lbs to lose and did like that I would not be rerouting my intestines. After doing some research I was convinced the VSG would be successful for me.

I'm so glad that I chose this one!

Here's what I wrote for my blog about why I chose VSG. I lost 140 pounds fairly smoothly. Then my life sort of went to **** due to my dad's health and I've been maintaining since May. I've still got about 60 pounds I'd like to lose but I have complete confidence that I can and will lose that weight once I start working at it again. (I know this because when I do work at it, I lose weight. It just hasn't been a priority for a while due to too many other things.)

The four WLS are - sleeve, gastric bypass (RNY), lapband, and duodenal switch. My insurance covers the first three, but not the DS.

I ruled out the lapband immediately because the only people I know who have had it are miserable or have needed it removed. The complication rate is atrocious and it only lasts for 10 years or so. It's billed as being a "reversible" surgery, but the damage it can cause, like from erosion into your esophagus, is permanent. So no lapband for me. Here's an article on that topic.

The choice really boiled down to RNY or VSG and I chose the sleeve for a number of reasons. (Even if DS had been an option, I would not have chosen it.)

1. I really like the simplicity of the sleeve. All it does is remove 85% of your stomach. That's it.
2. I dislike the idea of having my intestines rerouted.
3. The "good" malabsorption that the bypass gives (of fats) is a temporary thing that only lasts for a few years whereas the "bad" malabsorption (of vitamins and minerals) lasts for forever. That's not worth it to me.
4. The sleeve is restriction only, no malabsorption. This also means that I CAN eat anything at all. Fats and sugars won't screw up my bowels the way they can for the bypass. (Of course I still need to make healthy choices, but that's a choice, not something that my surgery requires.)
5. With the bypass, you're left with a remnant stomach that can't be scoped. That scares the crap out of me. First, the idea that I have this weirdly connected non-stomach but then to not be able to get it checked out with an endoscopy if there's a problem? Eek. Do not want.
6. My understanding is that complication rates with the bypass are significantly greater, especially longterm due to malabsorption. While I will be taking vitamins for the rest of my life, chances are that I won't end up in the hospital if I stop because the sleeve has no malabsorption involved.
7. For the most part (and there are exceptions) the people I know with the sleeve look and seem healthier than the people I know with the bypass. That's nothing scientific though.. just a gut feeling. (Edit: This is based on people I know IRL, I know many healthy RNYers on the forums.)
8. The sleeve leaves you with a fully functional pyloric valve at the bottom of your stomach whereas the bypass gives you a stoma which can stretch over time.The four WLS are - sleeve, gastric bypass (RNY), lapband, and duodenal switch. My insurance covers the first three, but not the DS.

I ruled out the lapband immediately because the only people I know who have had it are miserable or have needed it removed. The complication rate is atrocious and it only lasts for 10 years or so. It's billed as being a "reversible" surgery, but the damage it can cause, like from erosion into your esophagus, is permanent. So no lapband for me. Here's an article on that topic.

The choice really boiled down to RNY or VSG and I chose the sleeve for a number of reasons. (Even if DS had been an option, I would not have chosen it.)

1. I really like the simplicity of the sleeve. All it does is remove 85% of your stomach. That's it.
2. I dislike the idea of having my intestines rerouted.
3. The "good" malabsorption that the bypass gives (of fats) is a temporary thing that only lasts for a few years whereas the "bad" malabsorption (of vitamins and minerals) lasts for forever. That's not worth it to me.
4. The sleeve is restriction only, no malabsorption. This also means that I CAN eat anything at all. Fats and sugars won't screw up my bowels the way they can for the bypass. (Of course I still need to make healthy choices, but that's a choice, not something that my surgery requires.)
5. With the bypass, you're left with a remnant stomach that can't be scoped. That scares the crap out of me. First, the idea that I have this weirdly connected non-stomach but then to not be able to get it checked out with an endoscopy if there's a problem? Eek. Do not want.
6. My understanding is that complication rates with the bypass are significantly greater, especially longterm due to malabsorption. While I will be taking vitamins for the rest of my life, chances are that I won't end up in the hospital if I stop because the sleeve has no malabsorption involved.
7. For the most part (and there are exceptions) the people I know with the sleeve look and seem healthier than the people I know with the bypass. That's nothing scientific though.. just a gut feeling. (Edit: This is based on people I know IRL, I know many healthy RNYers on the forums.)
8. The sleeve leaves you with a fully functional pyloric valve at the bottom of your stomach whereas the bypass gives you a stoma which can stretch over time.

Ask your doctor to give you specifics about why he believes RNY is better than VSG. The most recent statistics do not support the old theory that RNY patients were more successful long-term than VSG patients.

What I've observed is that docs who aren't comfortable with VSG are the ones who don't do many of them. And of course you want to go to a surgeon who has LOTS of experience with the procedure you choose, regardless of why you choose it. And my personal feeling is that no doctor should be pressuring you more toward one or the other unless there's good medical reasons for it in your particular case.

Why do you want to lose slowly? You can lose fast and still make sure you maintain proper nutrition. It really isn't difficult.

We see people wanting to lose slow once in a while, for a variety of reasons. They end up not losing nearly as much as they wanted, and kicked themselves for it.

Get the weight off as soon as you can. It gets harder and harder as time goes by.

I went with VSG because I didn't want issues with absorbing vitamins/minerals. I also liked VSG because it's simpler and there's less that can go wrong (not to say things can't go wrong though). Also, and this probably sounds dumb for WLS, but I love food and I love to cook and RNY would be more disruptive to something I see as a genuine pleasure of my life.

I don't have that much weight to lose though and I don't have any co-morbidities and I'm young-ish. If I had twice as much to lose or I wasn't as healthy I might have looked harder at RNY.

I didn't like the idea of not absorbing nutrients like the Bypass ...to be honest I didn't care so much about being fat as much as I did about my health and diabetes. I was 5'7 and 300 lbs and it was wrecking my joints and the diabetes was bad. I chose the VSG because folks on here and other places said it was a fast recovery and it also helped with the hunger. I'm glad I did, already my Blood sugar is better, stopped some of the Diabetes meds and 1 of the Blood pressure meds and it has only been a week. Of course I don't feel better yet but already am losing weight fast, as of today I lost 8 lbs..1 lb more from yesterday and it was 10/7 the date of surgery. Also the sounds of them messing with intestines and the side effects of dumping syndrome etc scared the bejesus out of me.

I chose the vsg over the rny, at the 5 year mark I think the results between the 2 are about even, with the rny with a slight edge, but the malabsorption of nutrients is for life with the rny & I wasn't crazy about that. Whatever edge I might get with the rny wasn't worth it to me, & I had plenty to lose. The rerouting of my intestines didn't appeal to me, nor the remnant stomach that couldn't be scoped.

However if you have severe gerd, the rny would be the better choice. The vsg would only make that worse, if the gerd is caused by a hiatal hernia that can be repaired at surgery, it might be ok but you'd really have to check with your Dr. My gerd was very mild & likely caused by the hiatal hernia that was repaired at surgery. No issues so far. I'm happy with my choice.