Dr. Jossart

The VSG usually improves the symptoms of irritable bowel. No gaurantees though.

This question is tough to answer other than to advise you to be sure to make phone calls to the physician offices to be sure you are getting adequate quotes and information on results. The sleeve is often done with too large of a stomach pouch and leak rates can be as high as 5%(worldwide).

The sleeve is a good choice for you. However, your BMI is close to 50 and you are diabetic. With that in mind, the Duodenal Switch will give you a better chance at losing 150-170 pounds and has a 100% cure rate of diabetes. The trade off would be more side effects from malabsorption, most of which are well controlled with diet.

Leaks usually occur in the first two weeks but can be missed and may present with unusual symptoms over the following months. These symptoms may be persistent abdominal pain, shoulder pain, fevers, prolonged nausea. If any of these symptoms exist beyond a month or so, it is reasonable to have an Upper GI xray, endoscopy or even a CT scan.

Excellent question. The baseline recommendation of 50 grams of protein per day is for someone who is at a stable weight. For those who have undergone weight loss surgery and are in a state of starvation, protein intake should be increased to offset the protein breakdown(muscle mass) that occurs with starvation. That is why the general recommendation is about 70 grams of protein. A larger, more muscular man may need even more(90 grams).

go to pubmed.com and search the terms. You can use Dr. Himpens and/or Dr. Rosenthal as I believe they have both published articles on about 20 patients that were band to sleeve. Interestingly, one of the more common operations now is band to sleeve. More publications on this will be coming out in the next two years.

There may not be any articles on this as most patients with UC tend to be thin from teh disease itself. Your best argument would be that a Roux en Y would not allow for future endoscopies and that is necessary as inflammatory bowel conditions require endoscopies and colonoscopies.

Dietary recommendations vary considerably between programs and physicians. Most surgeons do agree that it is safer to stay on liquids for two weeks after surgery. This lets the staple lines heal. By 3 months, most patients are eating regular foods, albeit small portions(1-2 ounces).

Most surgeons usually ask you to stop that for a few weeks before and to stay off for a few weeks after surgery.

best to return to your doc and have him review

The sleeve has no malabsorption or intestinal bypass. Some protein drinks may cause diarrhea and thus lead to slight malabsorption. Protein drinks are usually only necessary in the early weeks after surgery and not in the long term with this operation. It is best to advance to more regular food items so that you have a sense of fullness. Liquids(i.e. protein drinks) tend to empty fast and do not give a good sense of fullness. There is no data on how much protein a sleeve patient can absorb at once but most sleeve patients in the early months after surgery can consume about 600 calories per day and 60-70 grams of protein. Those who do, essentially never develop protein deficiency like a DS patient might. The only time you would see nutritional problems in a sleeve patient is if they are vomiting.

Most surgeons ask their patients to stop anti-inflammatory medications 1-2 weeks before surgery. The occurrence of ulcers with the VSG is rare and it is usually safe to take anti-inflammatory medications(intermittently, not every day) once the stomach is healed(usually 2-4 weeks).

The general rule is to stop it one week prior to surgery and try to avoid restarting it for a week or so afterwards. Additional narcotics can be used to help with the pain.

Sleeve size is the number one controversy with the VSG. Many patients undergo this operation and are left with too big of a pouch. The optimal pouch size is created with a 32 French bougie and even then a surgeon could staple loosely on the bougie and create too large of a pouch. Given the correct size pouch, most patients with a BMI under 50 achieve a BMI under 26.

There is no clear information on how long to wait. The child will want to be in your lap for up to 3 years. You would want to avoid having a toddler jump on your belly for about one week after surgery. It is probably fine to have a VSG 6 months after a pregnancy

The operation is a Nissen Fundoplication. Severe reflux and the presence of a hiatal hernia may be a reason to avoid a VSG. If a combined VSG and hiatal hernia repair is done, it may work quite well but the rescue operation for persistent aspiration would then be the Roux en Y gastric bypass.

There is still very limited information on ghrelin levels after the VSG. It appears to increase some after one year and patients tend to have more cravings by the third year but not necessarily weight regain. The reason for this is that there may be a slight increase in ghrelin and pouch size that leads to cravings and increased food intake but not enough to regain significant weight. The key is to make the VSG pouch small enough the day of surgery to allow for just the right calorie intake to maintain weight loss 2-3 years later.

There is not very much data on bougie size, pouch size and weight loss. In my experience, which is extensive, a bougie betwee 32-40 French yields adequate restriction. A bigger bougie may yield too big of a pouch and inadequate weight loss.

Good question. The stomach can expand some but I have never seen it dilate and rupture. Some areas can expand more than others(or too much stomach is left behind at the time of surgery) and require another procedure to reduce in size. The term we use for this is re-sleeve.

The staples are very small and are eventually coated with fibrous scar tissue. They can slowly migrate over years or decades but this does not matter because the staple line is healed within a few weeks.

Your doctor should advise you on that.

The answers to these questions are dependent on surgeon experience. These are good questions and you should ask these of your surgeon. In general, leak rates with the sleeve occur from less than 1% up to 5%. Thay may also be more common in reoperations such as band removals. The only thing a patient can do to help avoid leaks is to stay on liquids for 2-3 weeks after surgery. The rest is dependent on technique and tissue quality.

This question can't be answered without more clinical information and test results other than to say the reflux could get worse if the operation is not done properly.

A low weight is worrisome as you may have limited physiologic reserves. Should a patient with a BMI less than 22 or 23 after weight loss surgery become ill, they may lose additional weight and have a difficult time recovering. If your weight is very low and even if you feel good, you should still be seen by your surgeon for lab testing and counseling on how to maintain or increase your weight to a safer, healthier weight. Usually, a year or two of being very thin is followed by a 10 pound weight gain that gets most patients into a perfect goal range.

Good question that actually pertains to all surgery. It is also a tough question to answer well. Worldwide there are probably less than 40 surgeons who have done over 300 sleeve gastrectomies or have done them for more than 5 years. Your best approach would be to directly ask the surgeon how many they have done, for how many years, how big is the pouch and how many leaks. There is probably no one best website that can accurately describe a surgeons experience or outcomes.