To super sleeve or not is the question help!

[joyfuljoy 3]

OK VSG family! I have done my research concerning the TGVP ALSO KNOWN AS THE SUPER SLEEVE

I have struggled with my weight since I was 12. I'm currently 5'4 at 208. My goal is to get down to 185 before surgery, with healthy eating and exercise. I want to use the sleeve as my tool to get me to my goal weight of 130. I'm going through belt weight for my procedure with Dr Jose Rodriguez. I want the hunger thing to not be a concern but I'm not sure if that's the case with the super sleeve. I'm taking adipex to cut my hunger but I definitely can't stay on it forever. Therefore, should I just get the regular sleeve? It's still a relatively new procedure which makes me skeptical! God forbid, but what if I have complications at home and none of the doctors will touch me because it's new and they have no clue. Help y'all!

Edited July 3, 2010 by joyfuljoy

[JillianMarie 0]

I had to quit Adipex after surgery. You will feel very sick if you take it after the VSG. What are you talking about the super sleeve vs. regular sleeve? I don't quite understand.

[delawaregal 2]

I did not know about the sleeve pilication procedure until after my surgery. It is appealing because it is reversible, but is is so new that very few have been performed it and there is no outcome data at all as far as I know.

I am glad that I had the regular sleeve. If I were younger I might have waited a few years to see how this newer procedure goes but I am 59 and did not have time to wait.

[Tiffykins 673]

There's a difference between the Super Sleeve, and the TGVP. They are 2 different procedures.

The TGVP is being called the "sleeve killer", but the super sleeve is being advertised as a "tighter/smaller" sleeve.

There is no long term ghrelin plasma level with the TGVP as there is with the VSG. Also, ghrelin is produced in other parts of the body, and some VSG patient do not experience complete hunger resolution.

With the big stretchy part of the stomach left behind, I can imagine that the ghrelin is still going to be produced. I experienced some hunger resolution when I had my band early out when I had restriction. Once the restriction started wearing off, my hunger returned even after meals. Several RNY, and band patients say they still have the same ravenous hunger they had pre-op. Luckily, I've lost all of my hunger.

Here's the studies with ghrelin plasma levels in VSG vs. Band and VSG vs. RNY patients.

LapSF Educational presentation to FACS - includes some 2 year results

LapSF Two Year Study LapSF Five Year Study - abstract only

LapSF Five Year Study - presentation (requires Windows to play)

Literature review on the sleeve - requires $$ to get the full text unfortunately

Sleeve best for over 50 crowd Video of a sleeve with lots of education discussion Video of a sleeve that is more about the operation Ghrelin levels after RnY and sleeve Ghrelin levels after band and sleeve Diabetes resolution in RnY vs. Sleeve Comparison of band to sleeve - literature review

Here's the explanation of the super sleeve and TGVP.

ProMedica Bariatric surgery consulting - Bariatric research

Protocol 01/2008: Laparoscopic total gastric vertical plication (TVGP)

Purpose: This research study is being done to determine whether TVGP can provide similar weight loss to other restrictive procedures in super-obese patients (BMI>50Kg/m2).

Study Type: Observational

Study Design: Case Control, Prospective

Status:Active

Estimated Enrollment: 100 patients

Study Start Date: 30 January 2008

Estimated Study Completion Date: 30 January 2011

Estimated Primary Completion Date: 30 January 2009 (Final data collection date)

Preliminary results announced to: 26th Pan-Hellenic Congress organized by the Hellenic Surgical Society, in Athens, Greece (November 12-18, 2008) and Euro-Mediterranean & Middle East laparoscopic meeting. SFCE-MMESA 2008. Bordeaux-France (November 13-15, 2008)

Laparoscopic total gastric vertical plication: The "physiological" gastric shrinkage.

Laparoscopic total gastric vertical plication (TGVP) is a new restrictive tecnique for the treatment of morbid obesity. This operation may be considered as an advancement of the well-known sleeve gastrectomy and it is carried out with the use of pure non-absorbable surgical sutures. In TGVP the gastric capacity is diminished without gastrectomy or foreign implants. Due to the lack of gastric strictures TGVP does not cause any food intolerance nor impair patient's dietary habits. The resultant weight loss is satisfying (50-55% EWL) while in comparison to the other modern restrictive bariatric techniques (laparoscopic gastric banding and sleeve gastrectomy) the advantages of the TGVP

are the minimal risk of acute or late complications as well as reversibility: gastric sutures withdrawal will get the stomach back to its normal form.

TGVP 4 months weight loss.

September 2009 update.

WEIGHT LOSS AFTER LAPAROSCOPIC TOTAL GASTRIC VERTICAL PLICATION. 16 MONTHS STUDY.

Other key words: gastric greater curvature invagination, gastric folding.

The aim of this study is to evaluate the effectiveness of a new bariatric technique (laparoscopic total gastric vertical plication - LΤGVP) in a personal 52 obese patient series. Patients decision/consent for this type of operation was based on the following criteria: minor surgery, reversibility, fast recovery, absence of implants. Mean preoperative weight and body mass index (BMI) were 119.36 +/ 18.22 kg (range 88-157) and 41.50 +/ 4.58 kg/m2 (range 35- 55), respectively. RESULTS: There were no serious complications; the only late side-effect (> 6months) was mild GER which affected 8/49 patients (16.32%). Three patients failed loosing weight due to gastric sewing disruption (one of them had a successfull reoperation 3 months later). This happend in our early experience. These 3 patients were excluded from statistic analysis. Mean follow-up was 9.33 +/ 3.39 months (range 6 -16). The mean postoperative weight loss was 29.36 Kg, mean excess weight loss (EWL) was 62.50%, while mean BMI dropped to 31.18 +/ 4.02 kg/m2. Thirty-nine patients (80%) lost more than 50% of the excess weight, 45% lost 61% or more, while one out four patients lost more than 70% of excess weight (range 71 -120%). CONCLUSION: LΤGVP is a safe and effective restrictive bariatric operation. In comparison to the published results from gastric banding studies, weight loss after LΤGVP comes sooner and is more intense, at the same time interval.

Excess weight loss frequency 6-16 months after LTGVP%EWL

number of p'tnts

Less than 50%1020,4%50 - 60%1734,6%61 - 70%1020,4%71% or more1224,5%n=49

Weight loss after LTGVP in comparison to three published LAGB series.

IMPORTANT NOTE

Laparoscopic total gastric vertical plication is introduced and investigated in Greece and Cyprus from the Promedica Ltd. Only our trained Bariatricians have the knowledge

and the experience to perform safely this procedure. To submit your questions, please click here.

------------------------------------------------------------------- Completed projects

Protocol 09/2005: Laparoscopic "tight" sleeve gastrectomy.

Purpose:This research study is being done to determine whether "tight" sleeve gastrectomy (super sleeve) is a safe and efficient bariatric procedure.

Study Type: Observational

Study Design: Case Control, Prospective

Official Title: Laparoscopic "tight" sleeve gastrectomy. Mid-term results.

Status: Completed

Enrollment: 96 patients

Study Start Date: 30 September 2005

Study Completion Date: 30 September 2007

Final results published in: Obesity Surgery 2008 Jul;18(7):810-3. Epub 2008 Apr 8) [Medline]

Laparoscopic sleeve gastrectomy (LSG) is a new bariatric technique which has a unique feature: it combines a satisfying gastric restriction with appetite suppression. LSG significantly reduced ghrelin levels due to resection of the gastric fundus, which is the predominant area of human ghrelin production. In other words, LSG has a physiological advantage over other restrictive procedures such as gastric banding or vertical banded gastroplasty, which does not influence the ghrelin-producing cell mass. Furthermore, in LSG no foreign material is implanted avoiding complications such as band migration, erosion and infections. The risk of peptic ulcer or dumping is low, while absorption of nutrients and orally-administered drugs are not altered as may transpire after gastric by-pass.

What is super sleeve?

Laparoscopic sleeve gastrectomy is not so simple as any other gastrectomy. There are some important technical details, unknown to inexperienced surgeons. Gastric tube size influences both the degree of weight loss and weight stability. A large sleeve predisposes to gastric dilatation and weight regain. Inexperienced surgeons tend to create large tubes (:001_wub: or to leave back large remnants of the gastric fundus. A standardised technique with a gastric capacity less than 100 mL (A) is mandatory in order to get the patient achieve a durable weight loss. The sleeve should be "super" which means a small gastric sleeve diameter and a higher degree of restriction. In our hands, with the gastric capacity been restricted to 60-80 gr and Ghrelin (the appetite hormone) totally suppressed, the resultant weight loss is predictable and comparable to this achieved with gastric by-pass (60-70% EWL), without any serious complication or side effects (e.g. Vitamin mal-absorption). We introduced super sleeve in our bariatric program, as the most effective and safe bariatric solution even for the super-obese patients.

-------------------------------------------------------------------

Future projects

Protocol 04/2009: Natural Orifice Transluminal Endoscopic Bariatric Surgery techniques (NOTES). The future possibilities of bariatric surgery are rich as many new techniques and devices for weight loss surgery are being developed and employed. In general, the majority of these techniques focus on proven surgical concepts of restriction and malabsorption, but with a less invasive approach.Natural orifice approaches (NOTES) that are considered the new frontier for bariatric surgery,are already used for revisional bariatric procedures e.g. to reduce a stoma size or to repair a fistula. In some cases, endoluminal revision may help minimize some of the difficulty in standard revisional surgery. De novo primary bariatric surgical procedures via a natural orifice are currently under development.

Research is the key to advancing health care. Health partners and pharmaceutical / medical device companies are welcome to finance the research in bariatric surgery field throughout our network.

[JillianMarie 0]

Tiffykins- I am really confused. My doctor supposedly used a 34 bougie for my surgery, does that make it a "tight" or "super sleeve"?

[Tiffykins 673]

Tiffykins- I am really confused. My doctor supposedly used a 34 bougie for my surgery, does that make it a "tight" or "super sleeve"?

Just my personal opinion, this "super sleeve" talk is just a marketing ploy. Sorry, but surgeons have been using 32fr to 40fr for over 5 years at this point. There's nothing super about it. It's the standard, and what has been used for stand alone VSG patients. When they were using 50fr+ for stand alone VSG it is in preparation for 2nd DS procedure to be done later, and then the results were great with the VSG alone. This is when surgeons started honing technique, documenting results, and weight regain. They saw higher % of weight regain with sleeves over 40fr, and more complications with anything smaller than 32fr.

To me, all this "super sleeve" talk is nothing more or different than the marketing crap that is spewed about the "new realize or lapbands" that are supposed to be better than the ones they were putting in people 3-10 years ago.

[JillianMarie 0]

ah i see, thats why i havent heard anything about the "super sleeve" Thanks again for all your wisdom Tiffykins!

[KabinKitty 11]

Jillian,

I have to ask, is that you wearing a pink dress in your avatar picture? Are you holding a trophy? Just curious.

[JillianMarie 0]

Jillian,

I have to ask, is that you wearing a pink dress in your avatar picture? Are you holding a trophy? Just curious.

Haha yes that's me, that was at my sister's college graduation last May. I wasn't holding a trophy I was holding a Protein Shake LOL. Shouldn't have been in the picture for sure, but I didn't have anywhere to set it down at and didn't want it to spill all over the floor if I set it down!

[Beccatatqueen 11]

Hey all,

My only suggestion is to really be careful and make sure you are giving the right advise when it comes to different types of surgeries. I see that everyone is doing this out of the goodness of their heart however, I see a lot of information that is not correct.

I had the GP's which is the newest procedure. It is Gastric Plication or Gastric imbrication. Gastric meaning stomach and Plication or imbrication because the stomach stays put. There is not stapling or removal of the stomach. Now as far as the hormone Ghrelin is concerned. Yes, this is a hormone but it is much more complex than the information given. First, although we know that this hormone is known to work with our brain causing gravings there are two hundrend more just like her out there that we haven't even started to recognize or name yet. The restriction is the same with Gastric Plication as it is with the VSG. These surgeries are not the same because VSG involves stapling and removal however the restriction is the same. Think of it this way.....you can remove Grelin from the expressway but there will be two hundred more cars out there just like her.

The cons to GP's is that there are not long term statistics however, once again there were not long term statistics on the Sleeve and band in the beginning. If you do your research you will find that this procedure is reversible, very few complications if any, the continuous weightloss continues even after two years and no leakage because of no stapling and I will continue to have my stomach. Like with all these weight loss surgeries this in only a tool. I have heard success stories with all and I have heard those who have continous issues with leakage and so forth. This procedure is becoming what some doctors including John Hopkins Hospital is calling a happy marriage between both Gastric bypass and lap band without the complication. Beaware that GP's is not for the lightweight......If you look at a two year statistic on all these surgeries you will find that they all end up losing about the same. As long as one find themselves with no complications or cheating.

Before choosing any weightloss surgery first, find a doctor that fits you. One that will answer your questions, supports those willing to make a change and one that is not in it for the money. Second do your research, all doctors are different....my first one I fired after jumping through hoop after hoop not to mention appointments set that they forgot to set. It took GOD hitting me with a baseball bat before I fired this doc and went to one that was everything I had been looking for. Some doctors are known to take advantage because they know that we are at our lowest point and desperate. Now, before I get any unhappy people writing me.......there are many great doctors out there as well. I am telling you to do your research for yourself. Not every doctor is for the same person.

We are all in this spot for one reason and that is to fight the FAT. I send well wishes to everyone and hope that they start their journey soon to a new healthier individual. For those who have had it do I wish you nothing but success.

Other than the Gastric Bypass which I don't believe in at all and believe that someday soon this will be the thing of the past due to how dangerous it is. I believe that the Band, VSG and Gastric plication all have pros and cons and that you have to find the one that fits you.

If you have any other questions regarding Gastric Plication feel free to email me. Also, Dr. Brad Watkins of Cincinnati Weightloss Center in West Chester, Ohio is the surgeon that just completed my surgery yesterday morning and his office and he would be great at answering question.

Edited July 15, 2010 by Beccatatqueen

[Tiffykins 673]

Hey all,

My only suggestion is to really be careful and make sure you are giving the right advise when it comes to different types of surgeries. I see that everyone is doing this out of the goodness of their heart however, I see a lot of information that is not correct.

Could you be exact where you see incorrect information? I'm only questioning this because I'm the only one that replied with any specific information about the 2 procedures mentioned.

I provided links for all of the information in question, and if you have other cited resources please share so everyone can be educated.

My comments about ghrelin are directly related to the stomach tissue particularly the fundus remaining, and not about the restriction changing with the TGVP. Ghrelin also causes more than just "cravings". It causes actual hunger pangs, anxiety, and a whole slew of other issues that are not always resolved with the fundus removal (which I included in my reply as well).

Just one of the many out there.

ScienceDirect - Biochemical and Biophysical Research Communications : Ghrelin increases anxiety-like behavior and memory retention in rats

Ghrelin increases anxiety-like behavior and memory retention in rats

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Valeria P. Carlinia, Mar?a E. Monz?na, Mariana M. Varasa, Andrea B. Cragnolinia, Helgi B. Schi?thb, Teresa N. Scimonellia and Susana R. de Barioglio, , a

a Departamento de Farmacolog?a, Facultad de Ciencias Qu?micas, Haya de la Torre y Medina Allende, Ciudad Universitaria, Universidad Nacional de C?rdoba, 5016, C?rdoba, Argentina

b Section of Pharmacology, Department of Neuroscience, Uppsala University, Uppsala, Sweden

Received 14 October 2002.

Available online 27 November 2002.

Abstract

Ghrelin is a peptide found in the hypothalamus and stomach that stimulates food intake and whose circulating concentrations are affected by nutritional state. Very little is known about other central behavioral effects of ghrelin, and thus, we investigated the effects of ghrelin on anxiety and memory retention. The peptide was injected intracerebroventricularly in rats and we performed open-field, plus-maze, and step-down tests (inhibitory avoidance). The administration of ghrelin increased freezing in the open field and decreased the number of entries into the open spaces and the time spent on the open arms in the plus-maze, indicating an anxiogenic effect. Moreover, the peptide increased in a dose-dependent manner the latency time in the step-down test. A rapid and prolonged increase in food intake was also observed. Our results indicate that ghrelin induces anxiogenesis in rats. Moreover, we show for the first time that ghrelin increases memory retention, suggesting that the peptide may influence processes in the hippocampus.

Author Keywords: Ghrelin; Anxiety; Memory retention; Step-down test; Open field test; Plus-maze test; Food intake

I'm not being snarky, or trying to instigate any type of hostility, but I want to make sure that the information I do offer is not only correct, but that it is understood, when I write "my opinion, I imagine, my thoughts." That is exactly what it is, nothing more, nothing less, and if there are conflicting opinions that's one thing, but I do not believe I've given any incorrect advice based on the research that is available on this procedure and my personal experience with 2 WLS procedures.

[Beccatatqueen 11]

Tiffykin,

I am not disputing what you said exactly as what I have seen others say both on Lapband.com and Sleevetalk. I want everyone to be aware of all risk. You can go to 50 different doctors and all of them have different opinions about all these surgeries. My suggestion is that anyone interested in learning about weightloss surgery that they need to do research and find the one that is best for them. Each to there own on what best fits them....however I find that everyone needs to go in first knowing the difference about each surgery along with the pros and cons. On the sight "Calling all TGVP" Everyone will find an interesting email from Dr. Watkins on TGVP. My concern is that everyone needs to be aware and find the best match for them. Although individuals are giving information sometimes this information is not always correct. Hope this clears up if you felt fingers were being point at you.

[educationrulz 18]

I'm very concerned that some people who are planning to get surgery, or may have already gotten it, don't seem to understand the difference between plication and "super sleeve". Although the info from one of the doc's websites that has been posted here by several different members explains it - if you read very carefully - it still seems that the docs website uses the term "super sleeve" in a misleading manner.

At some point, a person could go in asking for the "super sleeve" thinking they are get the less invasive plication procedure and wake up to find out their stomach is gone. As others have said, be clear about what you're asking for and getting. If you are even mildly confused, make the doctor's office explain it to you until it makes sense - and call them out on using the correct terminology!

[NotSoLittleMermaid 14]

Hi I am new to VST and so thankful for ALL OF YOU! I feel like you've helped me avoid landmines (especially those who have had revision surges - thanks so much for sharing!!) I want to find out everything I can about Gastric Plication Surgery. 1) Where & when did it originate? 2) Approximately how many people have had this surgery worldwide/US? 3) Please tell me your experience if you had it.. 4) Any links to articles I can research? (Found a few, but hungry for more..) 5) Anything about PRE & POST OP diet I would love to know.. THANK YOU SO MUCH!

I am 34 with BMI of 32, got about 60lbs to lose. My parents are obese and I've been told another 20lbs=diabetes most likely for me. I have tried to eat way less and make my stomach smaller..it is helping, but I am realistic that it definitely isn't the same as surgery. This new procedure sounds perfect and like a decision made much easier! I've been considering WLS for about a month now.. How long does the average person take to think about it and then schedule?

[NotSoLittleMermaid 14]

Hi I am new to VST and so thankful for ALL OF YOU! I feel like you've helped me avoid landmines (especially those who have had revision surges - thanks so much for sharing!!) I want to find out everything I can about Gastric Plication Surgery. 1) Where & when did it originate? 2) Approximately how many people have had this surgery worldwide/US? 3) Please tell me your experience if you had it.. 4) Any links to articles I can research? (Found a few, but hungry for more..) 5) Anything about PRE & POST OP diet I would love to know.. THANK YOU SO MUCH!

I am 34 with BMI of 32, got about 60lbs to lose. My parents are obese and I've been told another 20lbs=diabetes most likely for me. I have tried to eat way less and make my stomach smaller..it is helping, but I am realistic that it definitely isn't the same as surgery. This new procedure sounds perfect and like a decision made much easier! I've been considering WLS for about a month now.. How long does the average person take to think about it and then schedule?