Pre-Surgery reservations

Question
Karla - What type of bariatric surgery did you have?  I am 3 months out from surgery and I have not decided whether I am going to have the Roux-en-Y or the Verticle sleeve.  I have heard so many horror stories and not as many success stories so I'm getting quite nervous.  I need to talk with more people like you that have had the surgery and are successful.  One of the things I have been searching the web for are people that had surgery 10-12 years ago; I want to know what my future will be like.  I know if I keep going without the surgery my quality of like is going to be horrible; so if I have this surgery I want to be healthy for a long time.  It's a big decision and I am afraid that if I can't make lifestyle changes now on my own, how will I be able to follow the changes that must be made to survive after the Surgery? Nervous and just looking for reassurance.  Thank you!

Answer
Hi Deb:

I've had surgery twice--Lap-Band and VSG.  Honestly, it's a really tough choice to make.  When I had my revision, I was trying to decide between a VSG, RNY, or DS.  I knew I did not want to go through surgery again.  The VSG has been good for me.  I'm at my lowest adult weight of my life, yet I have excellent quality of life.  I eat normally.  My type 2 has been in remission for about 2 years now.  The Lap-Band was OK initially, but it was basically surgically induced bulimia for me.  

I think if you're looking at your first bariatric surgery, I would probably look at my history of obesity/dieting, any comorbidities, as well as just your "gut" feeling.  I'd speak with a surgeon who does all the surgeries if possible--Lap-Band, VSG, RNY, and DS.  I'd then look at myself realistically and ask what am I going to be happy with?  None of the surgeries offer 100% weight loss--although some do get there.  In terms of quality of life, VSG is the most normal in terms of what you can/can't eat.  Most people do not have dumping syndrome--although you're still at risk of vitamin issues. (I had very low D, and elevated PTH, at my 6 month check up.)  

Duodenal Switch offers the greatest long-term weight loss--and many people feel that the lifestyle is good.  Because of greater malabsorption, you really do need to watch your protein intake and vitamins (more so than with the VSG).

RNY--wonderful surgery for many, but often the biggest lifestyle change in terms of dumping.  Still, not everybody dumps, and that usually goes away after about a year.  For some people that's a good thing, for other's...a bad thing.  

In terms of potential revisions, VSGs are the easiest to revise.   RNYs are more difficult, and DS revisions (albeit rare) would be the most difficult. (Usually undone, rather than being revised for too little weight loss.)

It's a really tough decision. I remember going into my revision wondering if I should have just gone for the DS.  My surgeon told me he thought I could lose 70-80 pounds with the VSG--which for me, was enough to be happy.  He was right.  For the risk/benefits--it has been great.  Still, I'm seeing more VSGers getting revisions, which I guess is normal, as it's a more popular surgery.  I think realistically, you're looking at about 60% of excess weight loss long-term.  That's great compared to any "diet", but not as great as people often expect. (I find many people expect that surgery=thinness, which isn't usually the case.  Usually it means, you go from morbidly obese to obese or hopefully overweight.)

I've seen a ton of RNY revisions.  What is sad about most is that usually they lost all of their weight, and then regained.  I think that can be harder to deal with than not losing as much as you want in the first place.  They are a more difficult revision, which is why I tend to prefer the VSG for a first surgery.  People either get more intestine bypassed, add a band, or go for a DS.  

If your BMI is over 48-50, you have type 2, or you've always been morbidly obese, then I think you really need to at least speak with a duodenal switch surgeon. (Especially because of the diabetes "cure" rate.)

If your BMI is in the mid-40s or below, you could probably be very successful with either a RNY or VSG.

If your BMI is <42, then I'd go for the VSG.  RNY isn't worth the additional risks and you're likely to be very successful with just a VSG.

Whatever surgery you choose, you're likely to be 1000x better off than without surgery.  You will lose weight.  It might not be 100%, but it probably won't be less than 50% of your excess weight.  :)   More importantly, make sure you're comfortable with your surgeon, his/her experience, and are doing everything you can to prepare for the surgery.  Walk!  Try and eat a bit more healthier--at least add in fruits/veggies, if you can't eliminate foods.  Wash with Hibiclens the night before surgery, etc.

Sorry I can't be of more help!
Karla

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