Expert: Karla K. - 10/3/2008

Question
I am in my HMO's bariatric surgery program, but am concerned that I might not be able to tolerate an RNY or LB, the only 2 surgeries they generally do. I am 54, 6'2", 335, BMI of 43. However I have rheumatoid arthritis and take nsaids as well as methotrexate. Though weight loss would help the symptoms, the disease will never go away and I will always need these meds. I understand these meds are virtually banned from RNY & LB.

I understand that my plan has recently OK'd a VSG and was wondering if this may be a better option.

Answer
Hi Mark:

You're right in that some surgeons do OK NSAIDs for use with the Sleeve Gastrectomy and Duodenal Switch.  In general, they are banned from the RNY procedure as it is feared that they cause an increase in ulcers in the Roux limb.  I think because of your RA, you should talk with your rheumatologist and bariatric surgeon about which surgery would be best for you.  Because the VSG leaves you with a normal, functioning stomach, it may be a great choice--however, your rheumatologist may feel more comfortable with an adjustable gastric band due to the reversability factor.

Not sure if you've seen this article, but it may be something to take to your rheumatologist.
http://www.arc.org.uk/news/DirectNews/Article.asp?ID=18650770&Year=2008&Month=6&...

"It was found that more than half the patients reported that they had been able to either stop taking or significantly reduce their intake of oral steroids or immunosuppressive medications within 18 months of the process."

Perhaps your surgeon can access a full copy of the article to find out which surgeries worked best with RA patients, or even give the researchers a call.

Hope this helps.

Karla