deciding which procedure is right for me!!!!!

I went into my surgical constult thinking I was sure about the lap band.  I came out of the office  feeling like the RNY was probably where I was headed. After talking to some people I know have had the band, I hear many of them state they are not satisfied with the amount of weight loss,and the dissatisfaction with going to get fills on a monthly basis. I am concerned with the recovery time and how long I will be off work.  There are so many things to think about, and I am feeling confused.  Does anyone on this site have some words of wisdom to share or opinions for or against either of these procedures??  

Please be sure to read Joanne's thread (made several hours after you posted).

Please research ALL of your options.

Have you read the Revisions forum here on OH?  You'll see that the lapband doesn't work for a lot of people. It's not just a matter of weight loss. The band can cause a number of very nasty health problems. (I know this from my own horrible experience.) 

Look into the VSG procedure, if you need restriction only.
The Duodenal Switch and RnY are malabsorptive.

If I could do it over again, I'd opt for the VSG (sleeve), personally.

Only you can decide what will fit your life... read until you wanna puke! Go into Information Overload before you make a decision, seriously. There is so much you need to know before making a decision that will alter your life permanently.

Good luck to you. I hope whatever you choose works well for you!

You're asking about the two most widely known procedures, but do you realize there are 4 weight loss surgeries?  The two you left out are the sleeve (VSG) and the Duodenal Switch (DS).

Many surgeons dont offer these surgeries, so they will not tell you about them, or they will try to down play them.  However, these surgeries have many advantages over either the LapBand or RNY.

Please read the post I made this morning, on the link below.  It contains a link to a video presentation done at the American Society for Metabolic and Bariatric Surgery this year.  It discusses revisions and why there so many failures of the LapBand and Gastric Bypass.  It presents evidence that these failures are not the fault of the patient (as is the common stereotype) and more of a limitation of the procedure at treating the patients obesity.

To summarize some key points in the presentation:

LapBand
-Functions like a diet.  There is no reduction of hormones that cause hunger.
-Results are bi-modal, meaning some people have good results, some dont lose much weight at all.
-People who do well are young, active, and able to exercise
-People who dont do well are older, less active, and higher BMI (studies show BMI>46 do not do well with LapBand.
-Tighter fills dont necessarily result in more restriction and less hunger, but can likely cause damage to your esophagus.
-The "sweet spot" of the fill is difficult to find, resulting in lots of trips for adjustments - which may not be covered by insurance
-25% or more are not satisfied with weight loss
-Simplest procedure to do initially, but higher maintenance and removal / reoperation rate.

RNY
-Good at initial weight loss but not long term weight maintenance.
-Trend is for regain 3-10 years out.  (When people report success here with RNY you really need to look at how far out they are)
->30% regain a large amount of weight
-Weight regain is mechanics of surgery, and thought to be caused because the RNY bypasses the pylorus (the valve between the stomach and intestines that regulates the passage of food).  This causes dips in blood sugar and extreme hunger.

The two surgeries that preserve your pylorus and a normally functioning (but smaller) stomach are the VSG and DS.  The video discusses how these will become the emerging "gold standard" of weight loss surgery.

Revisions for failed weight loss surgeries are more risky, more complicated, and may not be covered by insurance.  Think twice, cut once.

I understand your concern about being out of work and down time for your WLS, but take the time you need.  You are not just chosing a procedure, you are chosing your new digestive system for the rest of your life.

http://www.obesityhelp.com/forums/amos/4421112/Cant-Decide-B etween-a-Band-and-Gastric-Bypass/

Some things you need to consider when choosing which form of WLS, if any, is right for you:

Your health. Do you have any co-morbidities, or a family history of any? PCOS, insulin resistance, diabetes, high cholesterol, GERD, arthritis, asthma, etc? Each of the four procedures has a different effect on co-morbs, so you need to figure out which one will have the best impact on YOUR health issues. For example---the RNY is the very best at curing GERD, but it makes taking NSAIDs VERY risky. So if you have mild GERD and severe arthritis, is possibly curing your GERD worth never being able to take an aspirin again?

You diet history. Do you lose weight easily as long as you can control your portion size? If so, a restriction-only surgery like the Band or the Sleeve might work well for you. But if you're someone who has to fight for every pound you lose, you probably have a super-efficient metabolism. In that case, a malabsorptive procedure will probably work best for you.

What kinds of foods do you prefer to eat? I'm a big fan of meat, cheese, nuts, seafood, butter, cream, gravy, rich sauces, and, yes, cheesecake. (*grin*) I chose the DS because it allows me to eat pretty much all the fat I want---and only absorb 20% of it.

www.obesityhelp.com/forums/amos/4421112/Cant-Decide-Between- a-Band-and-Gastric-Bypass/

This is Joanne's very good post that addresses your question.

Be your own advocate.  Research, research, research.

~Becky

Here's what I tell people about how I chose the DS:

I was originally on track to have RNY back in 2002, but got derailed after preop testing revealed that I had pulmonary hypertension. It's a long story, but it's on my profile if you'd like to read about it.

Even though I was off the track for RNY, I continued to attend the program my then-surgeon required of all his patients. I'd paid for it, so I figured I could benefit from it anyhow :-).

I saw some disturbing trends there. This was a big group, as several surgeons sent patients to it. There was, of course, a cadre of very successful patients (all RNY). They finished their year of program and went on with their lives, and as far as anyone knew/knows, all is well.

There were a surprising number of people, though, who fought and fought and fought to comply with what was expected of them, and the weight didn't come off well. At every meeting, there was word of someone else in the hospital with this or that problem--usually an ulcer or a stricture.

I listened to stories of dumping episodes, of getting food stuck episodes, of the mental/emotional challenges of having to live on highly restricted diets.....and I thought, "There's not a chance in hell I could live with this." (I should add that I have a major vomiting phobia. I'll do just about anything to not vomit. Not a good thing in some cases.)

Well, time passed, I got fatter and sicker, and eventually (again, story in my profile), it came out that the pulmonary hypertension was caused by the fat on my torso squashing my heart and lungs. It went from, "You cannot have any surgery at all," to, "You must have surgery or die."

I came back here to OH, feeling desperate because the lap band wouldn't give me enough weight loss to have any real hope of curing what was ailing me, and the RNY seemed to me like foolish butchery for not enough good results.

Someone told me then about the duodenal switch, invited me over to the DS board, which at the time was pretty much brand new, and the rest was history.

What I like about the DS:

1. 98% cure rate for type II diabetes. This was a major biggie because I had very bad diabetes.
2. Normal stomach anatomy and function is maintained. The stomach is reduced in size, but the normal stomach outlet, the pyloric valve, remains intact and functioning. There is no "stoma" with the DS or the vertical sleeve gastrectomy (VSG).
3. The intestinal changes that are done in the DS "jump start" the body's metabolism. Mine was shot to hell from a lifetime of PCOS, dieting and other factors.
4. I'd already done many years of low fat, low carb, highly restrictive dieting and I knew I sucked at it. The DS gives an eating quality of life that I find easy to live with: eat a primarily animal protein based diet. I'm a happy carnivore :-). I had to learn to restrict my carb intake, but it was a lot easier to do when I could eat meat, cheese, fish, eggs, etc. with abandon, with little regard for fat content. (DS'ers only absorb about 20% of the fat they eat, so for most of us, fat is almost a "free" food.)

I felt so strongly about the superiority of the DS to any other procedure that I traveled and paid out of pocket to have it done, rather than have the RNY done fifteen minutes from home and covered by insurance. It's been four years, and so far, so good :-).

Please come over to the DS board and visit with us there. Lots of folks will be happy to tell you about their experiences.
 

 

P.S. You couldn't have paid me enough money to convince me to get a band. The bands have the worst weight loss stats, the highest complication and reoperation rate of any of the procedures. Not a CHANCE that I would ever have gotten one of those things.

Today, several years out and involved in a lot of ongoing reading of new information about life with RNY, I feel the same way about the RNY. The ONLY procedure I would consider besides the DS is the VSG.

 I was sure that lapband was what I wanted.  My surgeon said that he would do the lapband, but that I should plan to have it revised to RNY when I did not lose weight with it.  I was afraid of RNY, but finally said to go ahead and do it.  After the surgery, I did not know what all of my worrying was about.  I don't dump,  lost all of my excess weight very quickly, feel wonderful and am full of energy and healthy.

I never knew how my intestines were hooked up before surgery and nothing feels different after surgery.  Even though it is not supposed to happen I eat a lot of food now and don't gain weight.  I believe I still have malabsorption going into the beginning of year 5.

Research, research, research and keep an open mind even after you have made a decision...I always thought I would have the RNY but changed my mind 2 weeks before surgery (with my surgeons input as well) to the VSG....couldn't be happier and I have a lower risk of complications.
Good luck!
Nancy