OneStepAtATime

Two Weight Loss Surgeries?

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Hey everyone!!!!! 

I just went to orientation on 3/22/18 and met with the surgeon the same day. 

I wasn't sure on if I wanted the sleeve or the RNY, the Dr. suggested that because my BMI is so high (62) that I should have the sleeve and if my acid re-flux/heartburn is worse or I do not have the desired weight loss results I could have the RNY why done 2-3 years after. 

Has anyone heard of this being done? 

I definitely do not want to go under the knife twice. I only am required to lose 13 lbs, I definitely want to lose more than the required to help lower my BMI. 

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@OneStepAtATime My surgeon told me he thought the sleeve was a better idea for me and if I had problems with acid reflux ( which I do, I am on meds for it ) or getting down to my weight that RNY could be an option later. I told him if this is just a tool then I should be able to get to 180 and he said yes. I am not going to have another surgery either.

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Thank you for your response!

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This is almost verbatim what my surgical team said to me. I also do not intend to have another surgery, barring any as-yet-unseen complications. But there are people who have revisions for complications, or even to jump start weight loss again. Some of them are on this forum, even. I don't know that it seems necessary to go into a sleeve assuming you'll need a revision, though. That's like worst case scenario. 

I lost 52 pounds pre-op, and probably could have switched to RNY at that point if I wanted to, but since I've never had any acid issues, I didn't see why I'd want to. If you're able to achieve a major loss before surgery, that might help if you're really set on RNY.

 

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Given your high BMI, I would think that the RNY gastric bypass is more appropriate in that it usually produces a quicker weight loss which should make it easier for you to lose your excess weight and reach your goal weight. 

By the way, if you have diabetes, then a gastric bypass usually is more effective at making you able to drop the need for medicine.  

In any case, be an informed consumer and pick the weight loss surgery that is right for you. 

We are here to support you. 

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There are pros and cons to both surgeries of course. I highly recommend you ask as many questions and research as much as possible for both surgeries. The great thing you have going for you is that you are still young. If you would like my two cents worth in just a few words, the sleeve will give you a invaluable tool to help you reboot your food and lifestyle choices, giving you a sense of control back in your life. It will help you loose weight, but you have to do the work to make sure it will continue to work for you after approximately two+ years. (I had a VSG and lost 70 pounds so far since December - and continue to work daily at the old habits that I had that caused me to get as big as I did. It is doable, especially when you are surrounded by supportive people like the TT team!)

The bypass will help you loose weight a bit quicker, and will make you stick to your plan whether you want to or not. What I mean by this is dumping syndrome, intestinal obstructions, plus the added benefit of some malabsorption due to the way your new GI system is set up. 

Either option is great really, just make sure you are informed. Figure out what you need for continued success. Personally, although I feel like the VSG saved my life and my sanity, if I was given the option of a bypass I would have greatly considered it. There are many people on here that have success from both WLS, so please ask about ANY questions you have to help you decide what's best for you :)

And a big congratulations on taking the first few steps on having a happier ,healthier life ;)

Edited by Ladybugzzz86

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Definately pick the surgery that best fits your needs.  Use the first year after surgery to establish new habits.  Anyone can lose weight but it’s maintaining that is hard.  You can defeat either surgery one bite at a time.  

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5 hours ago, Res Ipsa said:

Given your high BMI, I would think that the RNY gastric bypass is more appropriate in that it usually produces a quicker weight loss which should make it easier for you to lose your excess weight and reach your goal weight.

FYI, my surgeon (and others, it seems) often recommend sleeve for BMIs on the higher end because it's a shorter surgery and therefore safer. I get that RNYers lose weight faster (although I think my stats look pretty good, if I do say so myself), but there's something to be said for a lower risk surgery for high risk individuals. 

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59 minutes ago, kristinwitha_k said:

FYI, my surgeon (and others, it seems) often recommend sleeve for BMIs on the higher end because it's a shorter surgery and therefore safer. I get that RNYers lose weight faster (although I think my stats look pretty good, if I do say so myself), but there's something to be said for a lower risk surgery for high risk individuals. 

That is a great point. Thank you. 

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For what it's worth, my stats are were nearly identical to yours - except you're a lot younger! But I had Barrett's esophagus, so my surgeon recommended RNY and had no qualms about performing it - he didn't even require any presurgery weight loss (though I did lose almost 60 lbs before surgery just doing low carb).  Do you have co-morbidities that would make RNY more dangerous for you? 

You should definitely just go with sleeve if both you and your surgeon are more comfortable with it - there's unlikely to be a need for a second surgery, you can get where you want to be with whatever tool you choose!

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Stick around here, and you likely won't need two surgeries ;)

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7 hours ago, Ladybugzzz86 said:

What I mean by this is dumping syndrome, intestinal obstructions, plus the added benefit of some malabsorption due to the way your new GI system is set up. 

intestinal obstructions??!! I don't think so... :blink: With RNY, you are missing your pyloric sphincter at the place your stomach pouch connects to your small intestine, so stuff slides through more quickly.

With RNY, some people do get dumping syndrome (I don't, or haven't yet, for better or for worse) but it's not something you can rely on to keep your eating in check. The fear of it kept me really really careful for the first year, but even after having a few sugary things, I haven't experienced it. Well, once in a very minimal way after a protein bar in the early days (3 months out). I have to rely on my ability to say "I don't eat sweets."

Definitely some studies show that malabsorption of calories comes into play in the first year, although others show it goes away after that (and some that it continues after that - these things aren't settled science yet). 

There are certainly pros and cons for both surgeries, but both can definitely lead you to success if you work within the rules and guidelines set for you by your surgeon. Assuming no strong indicators like diabetes or GERD, they're both great options.

 

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52 minutes ago, Jen581791 said:

intestinal obstructions??!! I don't think so... :blink: With RNY, you are missing your pyloric sphincter at the place your stomach pouch connects to your small intestine, so stuff slides through more quickly.

With RNY, some people do get dumping syndrome (I don't, or haven't yet, for better or for worse) but it's not something you can rely on to keep your eating in check. The fear of it kept me really really careful for the first year, but even after having a few sugary things, I haven't experienced it. Well, once in a very minimal way after a protein bar in the early days (3 months out). I have to rely on my ability to say "I don't eat sweets."

Definitely some studies show that malabsorption of calories comes into play in the first year, although others show it goes away after that (and some that it continues after that - these things aren't settled science yet). 

There are certainly pros and cons for both surgeries, but both can definitely lead you to success if you work within the rules and guidelines set for you by your surgeon. Assuming no strong indicators like diabetes or GERD, they're both great options.

 

My apologies. I can only speak to the one case that I have seen where a friend post RNY binged to the point of hospitalizing herself. Ended up developing a small bowel obstruction, which required surgery. She was told that it was due to eating too much too fast (not chewing enough). They were surprised that she was able to even keep it down. 

But from the research I can see that it is normally caused by hernia, adhesions and/or stricture. Makes me wonder if she possibly had one of these also - not that the food overload didn't help. Any who, thanks for pointing that out!

 

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Thank you everyone for your input. I really appreciate it!

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9 hours ago, Kio said:

Do you have co-morbidities that would make RNY more dangerous for you? 

Not that I’m aware of. I have sleep apnea and acid reflux. 

Based on what I learned during orientation, people with a BMI of over 60 have a higher chance of complications with the RNY. 

Edited by OneStepAtATime

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2 hours ago, OneStepAtATime said:

Not that I’m aware of. I have sleep apnea and acid reflux. 

Based on the in I learned during orientation people with a BMI of over 60 have a higher chance of complications with the RNY. 

I suggest that the next time that you see your surgeon you have a serious discussion with him/her about how to weigh (no pun intended) the three key issues here:

1.  The amount of any increased surgical risk for you by having a RNY gastric bypass rather than a sleeve. 

2.  The difference that the two surgeries would have with respect to your acid reflux (a gastric bypass almost always cures acid reflux as stomach contents willflow easily into the intestines, while a sleeve will almost certainly make any existing acid reflux condition worse).

3.  Which type of weight loss surgery gives you, in their experience, the best chance to lose your excess weight and keep it off in the long term. 

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11 hours ago, Res Ipsa said:

I suggest that the next time that you see your surgeon you have a serious discussion with him/her about how to weigh (no pun intended) the three key issues here:

1.  The amount of any increased surgical risk for you by having a RNY gastric bypass rather than a sleeve. 

2.  The difference that the two surgeries would have with respect to your acid reflux (a gastric bypass almost always cures acid reflux as stomach contents willflow easily into the intestines, while a sleeve will almost certainly make any existing acid reflux condition worse).

3.  Which type of weight loss surgery gives you, in their experience, the best chance to lose your excess weight and keep it off in the long term. 

I agree with @Res Ipsa.  I was at your BMI on my first surgeon visit, and when I told him I had acid reflux and Barrett's, he told me the sleeve was like "an acid cannon" that would be firing at my esophagus.  He's a past president of the ASMBS, so I trusted his judgement on that.  He didn't seem to have any concerns about additional risk for me even at a BMI of 60, and as of 7 months out I haven't experienced any complications. 

So while I do think the sleeve would do just fine for you, I think it's worth further conversation with him to understand why he thinks the risk of one RNY now is greater than the risk of two surgeries, one now and one later. 

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