Revsion ... MBG vs. RNY

Question
I am a failed lap band patient just a year out and I'm looking at a revision to a more effecting WLS. I have no technical complications, but little weight loss and much difficulty in finding the proper restriction after numerous fills and un-fills. It's been very discouraging and frustrating. The MGB looks to have the most compelling weight loss data and more dietary freedom than the RNY. But the MGB has many opponents and is more controversial. RNY is the "gold standard" but there are many who re-gain. Plus, the greater chance of dumping with RNY is a deterrent. I've had enough of surgeries that inflict pain and misery to lose weight.

I have researched the MGB and I find it to be less risky than RNY. Yet still, so many opponents. How do I know what to trust? The data and published studies on both surgeries? Or the opinions of many well-educated surgeons and physicians? And why do these vary so much? Thanks -SD

Answer
Hi Sara:

Sorry it took me so long to answer, but I was away with no access to email.

One thing to consider in whether or not to choose the MGB or the RNY is insurance coverage.  As I'm sure you probably know, insurance does not cover the MGB.  Your insurance company may cover the RNY as a revision, though...although you'll still have to jump through the typical insurance company hoops.  The good news is that Dr. Rutledge charges only $17,000 for the MGB--which includes removal of your Lap-Band.

As for which you'll be more successful with, honestly, I think you would succeed with either surgery.  Dr. Rutledge has amassed some pretty great statistics on long-term effectiveness and complications with the Mini-Gastric Bypass.  2,410 patients is a very large patient subset.  I think it is his aggressive marketing which turns off some of his competitors, though. I was looking at the MGB back in 1999 when a bunch of RNY surgeons started going after Dr. Rutledge.  I really think it was professional jealousy more than anything.  Since then, Rutledge has had his studies published in peer-reviewed journals, which to me, seems to imply a growing acceptance.

Did you see the study comparing RNY and MGB in 80 patients? http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=pubmed&dopt=AbstractPlu...
One of the keys of that study is that the patients were randomly assigned. The results show the MGB to be slightly more effective at both 1 and 2 years.

"The percentage of excess weight loss was 58.7% and 60.0% at 1 and 2 years, respectively, in the LPYGBP group, and 64.9% and 64.4% in the LMGBP group. The residual excess weight <50% at 2 years postoperatively was achieved in 75% of patients in the LRYGBP group and 95% in the LMGBP group (P < 0.05)."

I can't answer as to whom you should trust. For me, I take most studies and opinions with a healthy dose of skepticism.  I wonder what the motives of the surgeons dissing the MGB are--when I have not seem those same surgeons discount the VBG (Vertical Banded Gastroplasty NOT the Vertical Sleeve Gastrectomy).  The data on the ineffectiveness of the VBG is overwhelming--yet the MGB does not show those results.  So then why go after the MGB?  It doesn't make a lot of sense to me other than to think that somehow Rutledge stepped on somebody's toes...or finances.  But that's just my opinion.

If you haven't already, please join some of the post-op groups for both surgeries as well as complication/revision groups.  Remember that as the volume of RNY surgeries done is greater than the MGB, you will find more unhappy RNY patients.  BUT, there have been enough MGBs done that you should still be able to speak to some long-term post-ops.

I think a lot of this should come down to your own gut feeling as well as finances.  If you trust Rutledge and are happy with the stories you've heard from other MGB patients, then go for the MGB.  If not, go for the RNY.  I really truly believe you'll be successful with either operation. :)  

Good luck!

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