Advice Needed & Welcomed

[AutumnLily 77]

I want to thank all of you who replied. You have all given me more information to consider. Still haven't made a decision. I just wish there was more data on the sleeve as there is with the gastric bypass.

On top of that, and I know this is going to sound crazy, but I was looking forward to the dumping syndrome. No I don't like pain, I just want my body to help me say no to all the crap I keep eating. I don't mean to eat all the carbs and sugars, but it's like an addiction. Does this make sense to anyone other than me?

Kelsey

Did you know that the VSG technically has been around for a long time. It is the first proceedure to the duodenal switch (DS). The VSG was performed on morbidly obese patients to reduce their weight to be able to perform the malabsorptive portion of the surgery DS. What they found was that most of the patients lost weight very well with just the sleeve and did not need the DS. Some did need to carry on with the DS. I have found that I used to be a big sugar lover but now post op I find it a bit too much for me. Plus I do not have any hunger so I can avoid the carbs and sugars with ease (this is for me may not be like this for everyone).

Your best bet is to ask your doctor why he believes the VSG is better than RNY due to your hernia's. It might shed some light on helping you make your decision.

If you are not happy with your progress with the sleeve you can get the second half of the surgery that will have the malabsorption DS. Talk to your doctor about all the possibilities.

[MRSKOUBiK 27]

Did you know that the VSG technically has been around for a long time. It is the first proceedure to the duodenal switch (DS). The VSG was performed on morbidly obese patients to reduce their weight to be able to perform the malabsorptive portion of the surgery DS. What they found was that most of the patients lost weight very well with just the sleeve and did not need the DS. Some did need to carry on with the DS. I have found that I used to be a big sugar lover but now post op I find it a bit too much for me. Plus I do not have any hunger so I can avoid the carbs and sugars with ease (this is for me may not be like this for everyone).

Your best bet is to ask your doctor why he believes the VSG is better than RNY due to your hernia's. It might shed some light on helping you make your decision.

If you are not happy with your progress with the sleeve you can get the second half of the surgery that will have the malabsorption DS. Talk to your doctor about all the possibilities.

Exactly what I was going to say.

Look around. This site is what sold me on the Sleeve vs other options.

[1-4-Many 2]

Kelsey - I was the exact opposite story Even until 2 weeks before my surgery date I got one last call asking if I would go for the RNY instead. The thing was, my brother lived in Australia for a while and knew about the sleeve. As others said, it's not really "new" at all, it's only new in the sense of being covered by insurance and sort of proliferating to the US medical market. I wanted the sleeve. I waited my time out specifically because I wanted sleeved.

So here's the only suggestion I have. Ask how much value it is for you to still have your stomach inside your body, cut away and non-functioning. The actual act of having it reattached and functioning again is --according to my surgeon -- more dangerous and there are few surgeons with experience. So if it becomes, especially after years, essentially ornamental, what does it accomplish.

And dumping, according to my folks, frequently clears after 18 months, assuming you ever got that benefit to begin with. So you end up having to fight that little fight anyway. And many who have had RNY gain back. It's not magic either.

I want you to get what's the best for you. It may be RNY or sleeve. You're doing exactly the right thing. Ask. Research. Decide. But yea for you!!! You're taking action. It's a little sideways right now, but you'll be great.

[SouthernSleever 228]

I know ppl who have had the bypass and wish they had VSG but not the other way around. YOu are not guarenteed to have dumping with bypass or not to have it with vsg. YOu can look at the faliure rate of bypass and that would be enough for me to choose vsg.

[kelsey 0]

hi this is pappapuff, where do you live and who is your doctor?

I'm in Central NJ. I had a consult with Dr. Nicholas Berta in Florham Park.

[snowfie9 6]

So many people have chimed in and I don't have much to add except I never considered bypass surgery. That was way beyond my comfort zone. VSG just seemed like the best available alternative from the get go (I did research lap band for a while but there were too many "band to sleeve" stories for me to think it was a good idea).

But I had a funny exchange with a lady from work who's doesn't like my choice in surgery. "But Dawn", she said "the stomach is a vital organ!". And I just laughed and said "Actually you can live without your stomach entirely".

She replied "Yes, but it's important to the digestive system" and I said "I agree, that's why I'm not doing a bypass". She was funny. Every point she came up with I was like "yes I know, that's the whole point". She's not unsupportive, she's just concerned. But I actually like having these discussions with people because it reinforces, in my mind, that I've thought of all the possibilites and weighed all the options and considered all the factors. because for a decision this important, you really do need to know what you're talking about.

[kelsey 0]

Thank you to everyone who posted. You all helped in making me realize I need to go for a second opinion before deciding anything.

Thanks again!

Kelsey

[Blessed&Broken 0]

I'm not adding much, but when I met with the surgeon, he told me he truly believes that in 20 years, VSG will be the "standard" because there's no re-routing, no malabsorption, and no foreign objects being placed in the body. While I was already pretty sure VSG was going to be my choice, that sealed the deal.

[NtvTxn 1,262]

Let me play devil's advocate and ask you this. Why would you want to rearrange perfectly good intestines? Just askin'!! I never considered RNY because of two things. One, the re-routing thing and two, because of the high rate of weight regain, so I cannot really put myself in your place. I did consider being banded until I started researching and saw how many problems there were and the lack of reaching goal and again, regain. For some reason, removing 85% of my stomach didn't bother me. I was left with a perfectly functioning tummy, just less. It's the best decision I've made. I love my sleeve. I've had an easy time - forced Portion Control is just what I needed. Good luck. Oh, I had a hernia that was discovered and repaired during surgery.

Went to surgeon last week for consultation for Gastric Bypass. I have been wanting this for about 8 years. Had to wait due to insurance companies. Anyway, it was highly recommended that I get the Sleeve instead. Ok................What? Never saw this coming. I have some serious hernia's to contend with that the doctor feels will, in the end be easier for me to deal with if I have the sleeve. He said we could go in with the premise of doing the gastric bypass, but truly feels based on what he see's with the hernia's that he will have to do the sleeve.

The idea of having the sleeve scares me so much. Why would I want to remove part of a healthy organ. I liked the idea of the bypass as nothing would actually be removed.

I am so confused as to what to do. I am now halted in the whole process because of this.

I guess my question to all of you would be, has anyone else had this happen to them. You know, going in wanting the bypass and getting the sleeve instead? And if so, how was it the you where able to process the information to get to the point of being ok to have the sleeve done.

I would appreciate any feedback that you can provide. Thanks.

[NtvTxn 1,262]

Kelsey, you must make lifestyle changes. There is not a WLS that will "fix" you. Even if you do have 'dumping syndrom' - and not all RNY patients do, it doesn't last, at least it has not with my friends. I am the ONLY sleeve patient among my friends. There are two bands and 13 RNY among us from my home town, that I personally know. With my RNY friends, ONE reached goal and has kept it off....with the others, some never reached goal and all of them (the remaining 12) have started re-gaining. Some a little, some enough to where they are considering a second surgery. As far as dumping, I wouldn't swear to it; all of them are at least four years out, but I think they can all eat sweets to some extent. I'm not sure when it started and I'm not sure if all of them had DS right off the bat. I didn't ask a lot of questions; at that time I was already living out of state and wasn't too interested in WLS and certainly not in by-pass.

I want to thank all of you who replied. You have all given me more information to consider. Still haven't made a decision. I just wish there was more data on the sleeve as there is with the gastric bypass.

On top of that, and I know this is going to sound crazy, but I was looking forward to the dumping syndrome. No I don't like pain, I just want my body to help me say no to all the crap I keep eating. I don't mean to eat all the carbs and sugars, but it's like an addiction. Does this make sense to anyone other than me?

Kelsey

[BajaMedGroup 6]

Here is an article I came across a while ago:

Laparoscopic Sleeve Gastrectomy is a Safe and Effective Bariatric Procedure for the Lower BMI (35.0-43.0 kg/m(2)) Population.

Gluck B, Movitz B, Jansma S, Gluck J, Laskowski K.

Source

Mercy Health Partners, 1325 E. Sherman Boulevard, Muskegon, MI, 49444, USA, bgluck@aol.com.

Abstract

BACKGROUND:

The laparoscopic vertical sleeve gastrectomy (LSG) is derived from the biliopancreatic diversion with duodenal switch operation (Marceau et al., Obes Surg 3:29-35, 1993; Hess and Hess, Obes Surg 8:267-82, 1998; Chu et al., Surg Endosc 16:S069, 2002). Later, LSG was advocated as the first step of a two-stage procedure for super-obese patients (Regan et al., Obes Surg 13:861-4, 2003; Cottam et al., Surg Endosc 20:859-63, 2006). However, recent support is mounting that continues to establish LSG as the definitive procedure for surgical treatment of morbid obesity. We will report our experience with the LSG as a primary bariatric procedure and evaluate if this operation is suitable as a stand-alone procedure.

METHODS:

The study is a nonrandomized retrospective analysis of 204 patients from a single surgeon operated between July 2006 and April 2010. The study comprises of 155 women and 49 men with a mean age of 45 years (range, 19-70 years), a mean preoperative weight of 126.6 kg, and body mass index (BMI) of 45.7 kg/m(2).

RESULTS:

The mean percent excess weight loss (%EWL) was 49.9% (n = 159), 64.2% (n = 138), 67.9% (n = 77), 62.4% (n = 34), and 62.2% (n = 9) at 3, 6, 12, 24, and 36 months, respectively. For patients with BMI ≤43.0, the mean postoperative %EWL was 58.9% (n = 72), 74.1% (n = 67), 75.8% (n = 39), 72.1% (n = 17), and 78.7% (n = 5) at 3, 6, 12, 24, and 36 months, respectively. Operative complications include leak (0.0%), abscess (0.5%), hemorrhage (1.0%), sleeve stricture (1.0%), and severe gastroesphogeal reflux disease with need to convert to laparoscopic Roux-en-Y gastric bypass (0.5%).

CONCLUSIONS:

LSG yields excellent outcomes with low complication rates for morbidly obese patients. We advocate LSG as a safe and effective stand-alone procedure, especially with the lower BMI population (BMI 35.0-43.0 kg/m(2)).

[BajaMedGroup 6]

And another one:

Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review.

Gill RS, Birch DW, Shi X, Sharma AM, Karmali S.

Source

Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. shahzeerkarmali@hotmail.com

Abstract

BACKGROUND:

Existing evidence has suggested that bariatric surgery produces sustainable weight loss and remission or cure of type 2 diabetes mellitus (DM). Laparoscopic sleeve gastrectomy (LSG) has garnered considerable interest as a low morbidity bariatric surgical procedure that leads to effective weight loss and control of co-morbid disease. The objective of the present study was to systematically review the effect of LSG on type 2 DM.

METHODS:

An electronic data search of MEDLINE, PubMed, Embase, Scopus, Dare, Clinical Evidence, TRIP, Health Technology Database, Conference abstracts, clinical trials, and the Cochrane Library database was completed. The search terms used included LSG, vertical gastrectomy, bariatric surgery, metabolic surgery, and diabetes (DM), type 2 DM, or co-morbidities. All human studies, not limited to those in the English language, that had been reported from 2000 to April 2010 were included.

RESULTS:

After an initial screen of 3621 titles, 289 abstracts were reviewed, and 28 studies met the inclusion criteria and the full report was assessed. One study was excluded after a careful assessment because the investigators had combined LSG with ileal interposition. A total of 27 studies and 673 patients were analyzed. The baseline mean body mass index for the 673 patients was 47.4 kg/m(2) (range 31.0-53.5). The mean percentage of excess weight loss was 47.3% (range 6.3-74.6%), with a mean follow-up of 13.1 months (range 3-36). DM had resolved in 66.2% of the patients, improved in 26.9%, and remained stable in 13.1%. The mean decrease in blood glucose and hemoglobin A1c after sleeve gastrectomy was -88.2 mg/dL and -1.7%, respectively.

CONCLUSION:

Most patients with type 2 DM experienced resolution or improvement in DM markers after LSG. LSG might play an important role as a metabolic therapy for patients with type 2 DM.

Copyright © 2010 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.