A change in thought...

I've had a reversal in thinking when it comes to the type of surgery I want to have. I was pretty set on having roux-en-y gastric bypass surgery but the thing that I kept in the back of my mind was the potential complications after surgery. I am well aware that an excellent surgeon makes all the difference in the world but you never know what adverse events might occur.

Recent studies have suggested that the weight loss from roux-en-y gastric bypass and vertical sleeve gastrectomy are almost identical and the rate of weight loss occurs at about the same pace. The caveat to this suggests that the patient's BMI be ~50 or less. My BMI is currently around 51 so I am confident that I will achieve the same success.

I have identified several distinct advantages of vertical sleeve gastrectomy (VSG) over roux-en-y gastric bypass (RNY.)

1. Patients feel the "full" feeling with VSG as opposed to a "pressure" type feeling with RNY. Patients must learn the "pressure" feeling and when to stop eating. Until this is achieved vomiting or pain may occur.
2. The portion of the stomach that produces the hormone ghrelin is removed. This is beneficial for reducing the desire to eat.
   
3. The incidents of gastric dumping is basically eliminated due to the fact the pylorus is preserved.
   
4. The overall complication list is drastically reduced due to the fact no anastomotic openings are created and the intestines remain unchanged and intact.
   

I also figured that on average VSG patients enjoy the same amount of weight loss as RNY patients. As with any surgery it is all about how the patient uses the tool (weight loss surgery) and how successful they are afterward. It is quite possible to lose 100% of excess weight after VSG but on average most patients lose 70% of excess weight. For me this translates to a final weight of 220 lbs. Granted this is still considered overweight but it is not morbidly obese at 360 lbs.

Here's the concept I needed to understand. WLS will not cure me from being fat, it will only give me a tool to lose the weight myself. My weight loss is directly proportional to my commitment to changing my lifestyle and eating habits. If I fail to do this the surgery will fail. This is true for any type of weight loss surgery today. Dedication and commitment are all it takes to be successful.

"If you eat fast food after surgery, you have already failed." -me

Also, there is the question of quality of life. Which surgery will afford me the best quality of life? I figure that after my surgery and I have lost the weight I will have a better quality of life with VSG over RNY due to the simple fact I won't have to worry about malabsorption and the other complications that might arise at any time after gastric bypass.

However, what I perceive as good for me may not be good for someone else. There are several different factors that my surgeon considered before recommending VSG:

• My reactive hypoglycemia has a strong potential to worsen after RNY
• My ability to consume Motrin is eliminated. Motrin is superior to Tylenol for treating musculoskeletal and considering my employment Motrin is a necessity.
• My pre-op drive to lose weight. I had already given up bad foods and made several changes to my lifestyle before setting foot in his office.
• My age, health conditions and medical history are all suggestive of achieving great success with VSG.
  

However, if for some reason the need arises to be converted from a VSG to a RNY I will embrace it and continue to live my life.