Allow me to think aloud while I also share some information. When it comes to gastric surgery options there are really three options. (There actually are more but I'm only going to cover three here as they are the most common). Keep in mind this is MY knowledge and therefore is quite fallible. :)
1) Lap Band - This is fully reversible. It is a band (silicone I believe) that is wrapped around the top of the stomach which creates a pouch. There is a 'port' that is just under the skin and your doctor can add additional liquid to tighten the band or remove fluid to loosen the band (if, for example you become pregnant and need to eat more). This is only a restrictive procedure. Plusses: it is reversible, it is adjustable, it isn't a major surgery. Negatives: Requires more 'upkeep' (filling of band) and also the band sometimes embeds in the stomach or other complications requiring either removal of the band or a revision to one of the other options. For the non squeamish here is a video of an actual procedure.
2) Gastric Sleeve - This is an operation where they remove a portion (approximately 80%) of your stomach - obviously since they remove the portion of the stomach it is not reversible. Everything else stays intact. Once again, this is only a restrictive procedure. The portion that remains resembles a banana and thus it gets it's name of a sleeve. This is a newer procedure. Plusses: No risk of a band imbedding, no 'rerouting' of your intestines, smaller chance of needing vitamins. Negatives: Overall loss not quite what it is for a RNY bypass. Also, since it is a newer procedure it doesn't have a track record. People do also start with a sleeve and then revise it to a RNY for further loss. For the non-squeamish here is a video of an actual procedure.
3) Gastric Bypass or Roux-en-Y (also seen shortened down to RNY) - This is the 'gold standard' and has been around the longest. A new stomach is created - the stomach is bypassed and a smaller 'stomach' (aka stoma) is created with the intestines. The stoma is connected and rerouted to bypass a large portion of intestines. This reduces absorption of nutrients and calories as well as offering restriction. Plusses: High expected weight loss, has been performed hundreds of thousands of times thus side effects and complications are known, for people who have a problem with sweets - approximately 30% of people having RNY will experience an unpleasant experience deemed as 'dumping' which acts as a further deterrent to sugars offering a better chance of success. Negatives: Major surgery, longer recovery time, side effects of leakage, bleeding, vomiting possible. Because of malabsorption there is a possibility of malnutrition. Thus regular blood tests and daily supplements and vitamins are required. Here is a video of that procedure as well.
So, which one am I considering?
Well, at first I thought I wanted a sleeve. The removal of the stomach scared me - but it is a straightforward surgery with fewer complications and less followup required. It has a quicker recovery time. And from what I can find it generally produces between a 60 and 70% weight loss (whereas bypass produces around 70%). The sleeve does take a little longer because it doesn't have the malabsorption component but long term (2 years) the amount lost appears to be very similar.
So I went and talked to the surgeon. The surgeon asked about my eating habits. I'm not a binge eater. I actually eat pretty reasonably sized meals and I'm the world's slowest eater. My issues are emotional eating and sweets - added with the PCOS that's not a good combination. Anyways, based on that information the surgeon recommended the RNY. He felt like the 'dumping syndrome' would give me the greatest chance of success. It would address my issues better.
Since, then I've been thinking I wanted RNY. But I was recently studying and found the statistic that only 30% of people actually experience dumping. So I have a much greater chance of it NOT happening. And in exchange I have to be worrying about more complications and more follow-up. These are issues because my health insurance will not cover any expenses related to weight loss surgery of any kind (so I will be out of pocket for any complications, follow up blood work, etc). So, the last few days I've been rethinking which surgery I should have. This video discusses the two I'm considering and the differences between them.
I guess more research is in order. If anyone reading this has any input I'd love to hear it. :)
I'm going to split this into multiple comments because the first time I tried to submit it, it was too long . . . . .
ReplyDeleteI know everyone has different opinions on which surgery to have and which is best for them. It's kind of funny in my surgeon's support group because when new people come in wondering about surgery, we say there is "Team Band," "Team Sleeve," and "Team Bypass." We are all just as passionate about whichever surgery we had as others are about theirs. It's always interesting to see why people chose whichever one they did.
I'm truly not trying to sway you one way or the other, but want to express some things about the sleeve that you don't mention. First of all, it's not a "new" procedure. It is newer than the RNY for weight loss, but it has actually been used since the 70s or earlier for stomach cancer and other stomach problems.
Next, we are still encouraged to take multivitamins, especially calcium, but the difference is that since the stomach is still intact there are not problems with malabsorption like with the RNY. I take daily vitamins still though.
next part of my comment . . . . .
ReplyDeleteNext, honestly, the statistics are that overall the loss is the same with the sleeve eventually. I believe what I read before surgery stated that many times RNY patients lose weight faster, but overall the percentage lost is the same with any of the procedures. The one MAJOR benefit with the sleeve versus the RNY as far as weight loss is that because the part of the stomach that is removed is the most elastic part, it is harder for sleeve patients to re-gain weight. It is still possible, especially if people "graze" (eat throughout the day instead of just 3 meals) or eat crappy things still, but it's less likely to re-gain a lot because the elasticity isn't there and the sleeve cannot be stretched much like the RNY can if bad habits persist.
Honestly, I have NEVER heard of people starting with the sleeve and then doing an RNY. There are a lot of patients that start with a lapband and then do the sleeve. I'm not saying it's not done - I've just never heard of that before. No one in my surgeon's support group has ever done that because they're all extremely pleased with their sleeve. There are quite a few that started with a lapband and then had a revision to a sleeve.
last part of my comment . . . .
ReplyDeleteFor me personally, I never wanted a lapband because I didn't want some foreign thing in my body. I do have staples since they removed part of my stomach, but to me that's different. I was not interested in the RNY because I didn't like the thought of having my stomach still in there but not doing anything. I also had heard horror stories of dumping and did not want to experience that at all. I also liked the fact that with the sleeve there is not the issue of malabsorption and that my stomach would still be able to help digest the food and everything. I also had heard too many stories of people regaining the weight with the RNY and I wanted the least opportunity for that to happen.
As you mentioned, they are all just a tool to help us live healthier lives. None of them completely eliminate "head hunger" and our emotional issues and addictions to food. However, if they're used correctly, they can help immensely with our relationship to food. That's one other thing with the sleeve - the part of the stomach that is removed is the part that produces most of the "hunger hormone" so it also helps decrease actual hunger. I personally have never been truly hungry since surgery. I've dealt with head hunger somewhat, but have never been truly hungry.
Anyway, they are just tools and it's important no matter which surgery you have that you learn to use the tool well.
Another great resource for questions and answers online, especially about the sleeve, but also about others is www.verticalsleevetalk.com - it really helped me with my decision and early on in recovery.
The other thing to consider is if you're going through insurance. Some insurance companies will only pay for the lapband and/or RNY and not the sleeve. Some will pay for any of them. Some won't pay for any. I was a self-pay patient because my insurance didn't pay for any of them.
oh, and one other thing..... I'm on FB group for weight loss surgery patients and one person just said they had their first experience with dumping and feel like they want to die! I honestly can't imagine a surgeon saying that dumping could HELP. Everyone I've talked to that has experienced it never wants to experience it a second time. It seems strange to me that your surgeon would say the RNY would be a good choice because of the dumping. I do know people in my surgeon's support group that have had the RNY and love their decision and haven't had issues or if they did they had it once and then took precautions to never experience it again & are still happy they had the RNY. It's just odd to hear a reason for having an RNY like you said your surgeon said.
ReplyDeleteThank you for your input. Since I've been planning an RNY that is where most of my research has been. I think what the surgeon meant is that I would be more likely to avoid sweets (which is my weakness) if I experienced dumping. And thus I'd be more likely to keep my weight off long term and be successful. I will also go check out the vertical sleeve site you mentioned.
DeleteAhhh..... okay.... that makes more sense (in a way) . . . from what I've heard, once you experience dumping it's not something you ever want to experience again, so in that way it makes sense. Still seems strange to me in a way though.
DeleteIt is interesting how different people's plans are too. My surgeon suggests just eating 3 meals a day and only having protein drinks or water between meals. This provides adequate time to get all your fluids in during the day and also prevents "grazing" (eating all day long). In the last couple months, I had gotten off the plan and had started snacking more. Instead of snacking on good things, it was snacking on crackers. I still stayed within my calorie goals and didn't go overboard, but I still wasn't doing what I should've been doing. I stayed at the same weight for a month straight since I was snacking and wasn't exercising much either because of final exams. Once I got back on track and went back to just eating 3 meals and having water or protein drinks between meals, I started losing again.
I have a friend that went to the same surgeon and had the same surgery, but she's decided that for her it's better to eat 5 meals a day. She makes sure they're not junk & for her it helps her stay on track that way. Even though our surgeon told her the same things he told me, she's decided to go a different way and is still successful.
It's also interesting how different surgeons have different plans for going back to regular food and different suggestions on what to do when we stall in weight loss and different plans for how to maintain the loss and different plans on everything! On one FB group I'm in, there is a lady from Europe who had the RNY and her doctor told her that because of the malabsorption issues she should actually eat 300-400 MORE calories than most people so she can absorb more nutrients. I've never heard of any doctor here in the US saying anything like that!! It's just interesting to me how every surgeon is different, even in the same area and especially in different states or countries.
oh, and I also think that you'll be surprised after surgery (no matter which one you decide to do) of how your tastebuds change and how you don't crave the same things anymore. My weakness was always ice cream and crackers & breads. Now I rarely eat bread because it just sits in my stomach like a rock. I rarely have ice cream because it's too sweet now. For the first 8 months or so after surgery, I didn't eat crackers because I didn't want them and wanted to stick to my plan. Even when I did start eating them again, I didn't eat nearly as many as before and not nearly as often. Even when I do choose to eat them, they're not as satisfying anymore as they were before surgery.
DeleteSome people do still deal with the same cravings and habits as before, but many change. Just be prepared for those things to change somewhat regardless of the surgery. Sweets may not have the hold on you they do currently.
I would love it if my tastes changed. I've heard they do with RNY - wasn't sure about the sleeve. Also, I agree about the differing 'orders'...that is part of what makes this all so confusing. Even with my surgeon - I originally booked through a third party before realizing I could book directly with the surgeon and save money. Even though it was the exact same surgeon - the booking party and the surgeon's office gave total different pre-op eating plans.
DeleteThe sleeve has been around quite a while, and is often the first procedure in a two-stage procedure called the duodenal switch. Some people elect to have sleeves done and then eventually have the second part of the DS done at another time. The other thing that having a sleeve allows you to do is convert to a DS if it is necessary for continued weight loss.
ReplyDelete