VSG or Plication

[gettingpissed 0]

Does anybody have regrets getting VSG over the plication surgery?

[sleeveorbust 11]

ABSOLUTELY NOT!!!! I love my sleeve... and I know this is a very uneducated comment to make.. but in a way I feel like Plication is oh so similar to stomach staplingof the 80's.. obviously its a better procedure then that.. but I wanted the whole package and to say bye bye to that ghrelin producing part of my stomach

[TijuanaPlication 87]

VSG isn't necessarily better for getting rid of grehlin than plication. See below for what Dr Brad Watkins posted on the subject.

"Ghrelin, the hormone, gets a lot of attention these days.

Here is what we know about ghrelin:

Ghrelin is one of many hormones involved in appetite. We are learning that appetite is a very complex system and part of our body's survival mechanism. The brain wants us to breathe and eat - these two items are at the top of its list! The drive to eat is a very powerful biological drive.

Ghrelin is a feedback hormone and pressure in the wall of the stomach is what suppresses it. In other words, when you eat, the food activates pressure receptors in the wall of the stomach and ghrelin levels go down. If you haven't had the pressure receptors in your stomach activated for a while, ghrelin levels rise and so does hunger.

The most important way to suppress ghrelin levels is PRESSURE. Cutting out stomach that produces ghrelin doesn't eliminate ghrelin. The parts of the stomach that are left can produce lots of ghrelin but if there is pressure (food in the smaller stomach) then ghrelin levels will be low.

After gastric bypass, ghrelin levels go way down even though the entire stomach remains. After Lap Band surgery ghrelin levels are suppressed in general and get low after eating and the food creates PRESSURE in the small gastric pouch. It is the pressure reducing these levels since the entire stomach is still there.

Keep in mind that the ghrelin levels are a small part of a very complex system. When you talk to plication patients they have reduced appetite particularly after a small meal since the food creates pressure and activates the pressure receptors in the wall of the stomach.

There are probably many pharmaceutical companies working on an "anti-ghrelin" drug but it is likely that even if such a drug is created and works, the other hormones involved in appetite will increase over time reducing its effectiveness.

All this to say, the best way to reduce appetite is to stretch the wall of the stomach and if a stomach surgery has been done to reduce its size (band, bypass, plication, stapled sleeve, etc, etc) then you will get appetite reduction on smaller calories. One of the reasons weight loss operations work so well is that you are reducing appetite through normal biological channels, not a drug with side effects and decreased effectiveness over time.

Many people worry about ghrelin levels. The important question is, "does the operation reduce appetite?" If the answer is "YES" then you have a very powerful operation for weight loss regardless of ghrelin levels. We know that weight loss operations are suppressing things that float around in the blood stream that are yet to be discovered.

Vince Lombardi once said, "I don't give a #{:content:}amp;%! about statistics as long as we WIN!"

Brad Watkins MD "

ABSOLUTELY NOT!!!! I love my sleeve... and I know this is a very uneducated comment to make.. but in a way I feel like Plication is oh so similar to stomach staplingof the 80's.. obviously its a better procedure then that.. but I wanted the whole package and to say bye bye to that ghrelin producing part of my stomach

[MINI-Me 196]

I think it's going to be hard for you to get an un-biased viewpoint on this forum. Many of us had VSG quite simply because plication wasn't being done or not well known.

For me, I think I would have still picked VSG given what I know (and that is very little about plication). I liked the permanence of VSG. I also have concerns about food getting caught in the folds of the plication - will that cause irritation, infection, etc. Plus, there seems to be so few doctors that do this procedure. The same can be said about VSG, but at least it's more "out there" ... my doctor is following my progress to educate himself about VSG for other patients asking for WLS advice.

I love my sleeve - I love the restriction - I love how accountable it makes me. So, I have no regrets. I might feel the same way about plication, but I can't say since that wasn't an option for me.

Best of luck in your investigation and your decision. Best bet? Talk to your surgeon and the both of you decide the best option for YOU!

[Tiffykins 673]

I absolutely love my sleeve. I had a band so I know that hunger came with having that big fundus stretchy part of the stomach. Plus, research doesn't lie. I've attached some links for your review. The interesting ones are listed here, if any of the links do not work, let me know, I've copied and pasted these from my blog on here. You can add me as a friend, and have full access to my blog.

I'm 18 months out, and have zero regret. I eat any and every type of food. I do not diet. I easily maintain, and my labs have been stellar. I am never hungry, never truly physically hungry, I enjoy eating, and have zero medication restrictions. There's nothing I don't like about the sleeve. It's given me a life full of fun, excitement, and I honestly eat and feel like a normal person.

There are links below that show the ghrelin plasma drops and remains lower than that of band and RNY patients that have the fundus left behind producing the hunger hormone. Continue to do your research, ask questions, and just be as fully informed as possible.

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

http://www.iabsobesi...veDietGuide.pdf

http://www.cornellwe...gastrectomy.pdf

Some of this is outdated, but some of it is great information:

http://www.sleeveguide.com/

http://www.ssat.com/...ts/08ddw/O4.cgi

http://www.hopkinsba...tion_sleeve.pdf

Eglin surgeons use small bougies so this is just for informational purposes:

http://www.ncbi.nlm....aultReportPanel

http://www.medpageto...age/ASMBS/20937

http://www.associate..._pg2.html?cat=5

5 year post-op stats

http://www.ncbi.nlm....um&ordinalpos=1

http://www.ncbi.nlm....pubmed/20338286

[PamelaAM 16]

I am totally pleased with my sleeve. I understand what the plication surgery is but can't for the life of me understand why anyone would ever want to keep their stomach around in case they want to reverse the procedure??? Why would someone want to reverse it?

I will be 11 weeks out on Monday and am eating just about anything that I want, just very small quantities. The key for me is that I get just as full as when I was eating huge amounts so there is virtually nothing that I am missing out on.

I am just amazed at how the sleeve has changed my life! I can't even imagine ever wanting to reverse any of it.

[aquamama 0]

I am totally pleased with my sleeve. I understand what the plication surgery is but can't for the life of me understand why anyone would ever want to keep their stomach around in case they want to reverse the procedure??? Why would someone want to reverse it?

I will be 11 weeks out on Monday and am eating just about anything that I want, just very small quantities. The key for me is that I get just as full as when I was eating huge amounts so there is virtually nothing that I am missing out on.

I am just amazed at how the sleeve has changed my life! I can't even imagine ever wanting to reverse any of it.

I see you had surgery with Kaiser. Our Kaiser would not do the surgery unless we lose 10% of our body weight - no exceptions. I lost 16 of my 24 lbs and kept it off for months but could not get the rest off. After 4 years I just went to Mexico. I like you am very happy although only 2 weeks out. I am still figuring out what the signals my body is sending me means - I have pain but do not recognise it as hunger pain but it goes away when I eat. I LOVE the idea of being able to eat anything and yes it is really amazing how little I am eating compared to before. Now my only problem is getting back on board with Kaiser because they essentially told me I would fail without the 10% weight loss and I know I need to be monitored down the line just for health reasons.

[genepha 47]

I am currently banded but my band needs to come out. I wrestled between plication and sleeve gastrectomy

and after speaking with 2 of my doctors, I decided to go with plication. My dr. at Cedars-Sinai will do

a sleeve but he doesn't recommend them. He told me that he thinks the long staple line is too problematic

and he's concerned about leaks and staple line problems. I can not have a RNY (and wouldn't anyway) so

that's not an option for me. I spoke with another WLS dr. and he expressed some of the same concerns

about the sleeve. I really like the sleeve but I really had a hard time with the idea of having 85% of

a good, healthy organ thrown away. If plication was not available I would have the sleeve. Another concern

for me was insurance approval with the sleeve, but it appears that Anthem has started covering it! yeah!

So in case I don't end up with a plication or something happens when my band is removed, I am very

happy that the sleeve gastrectomy is available. I know some VSGers have concerns about their stomach

being removed and they do get over it. I have to say that the positives of both VSG and plication outweigh

any negatives I can think of.

Good luck to you!

genepha

banded Dec, 2001

Awaiting insurance approval for band removal/replacement with self-pay plication

[mp8btpc 33]

I agree with Sleeveorbust, it just seems so similar to the stomach stapling that I knew I wanted something different. Plus at this point there is so little data on it I knew I didn't want to spend my cash on something until I was assured of the results. I think plication sounds like a great alternative but the jury is still out in my book. I would never fault someone who wanted to give it a go though. I don't regret my sleeve at all.

[BlackBerryJuice 349]

I agree with Sleeveorbust, it just seems so similar to the stomach stapling that I knew I wanted something different. Plus at this point there is so little data on it I knew I didn't want to spend my cash on something until I was assured of the results. I think plication sounds like a great alternative but the jury is still out in my book. I would never fault someone who wanted to give it a go though. I don't regret my sleeve at all.

Same here. Re: reversibility, I read that in 6 months, the newly folded stomach will fuse onto itself, so you can't really reverse it at that point. I think that if you are seriously expecting to regret your surgery in the first 6 months, you probably aren't ready to have the surgery, period. The only real upside to it I can think of is that since there is no cutting out and sewing things back together, there probably isn't such a thing as a leak with plication. That said, so few people get leaks if they go to a reputable surgeon and follow post-op instructions, I don't know if this is a major issue. I've seen people bring up the issue of stomach cancer with plication and how it could go undiagnosed for a while if it were in the part that was plicated. I understand the concern, but I don't think it's an actual problem. Stomach cancer is not very common in North America - hence why our doctors don't screen everyone for it - and the biggest risk factor is long-standing H. pylori infection (not very common in North America, either). It's easy to test for H. pylori, so I imagine this testing would be done right before the operation, and infection of the plicated part post-op doesn't seem like a real possibility.

All that said, I'm open-minded about plication - I definitely don't think it's more dangerous than the sleeve - but I just don't know if there's any real benefit to it compared to the sleeve, and given how new and poorly researched it is, I'd rather go with the tried and tested.

[Oregondaisy 2,021]

Dr Aceves is not doing plication because he feels it has more of a chance to stretch out than cutting the excess stomach away. I trust his judgment because he is a fabulous surgeon and I feel he does his research and knows what is best for his patients.

[PamelaAM 16]

AquaMama: I am shocked that Kaiser refused your surgery because you didn't lose your 10%. I didn't lose anything from the time I started Options until the time it ended. I would lose and then gain and then lose and then gain - you know the drill. I mean REALLY, if I could have done it on my own would I have needed the surgery? My surgeon was fine with it. What Kaiser did you go to???