sleeve vs bypass

[kcspeak 0]

Can anyone tell me why they chose the sleeve verses bypass? I know so much about lap band and bypass, but am just researching the sleeve! I am approved for surgery June 1st and am trying to see if interested in the sleeve! I assume there would not be the chance of dumping syndrome after? Are there side effects similar to the lap band? What is the sleeve made of? Any info on sleeve/how /why you chose the sleeve would be SO appreciated!

[MeMeMEEE 206]

I am choosing sleeve because it leaves your stomach functioning and there isn't the malabsorption issues.I don't like the reroute in RNY as I have lots of friends who are very Vitamin deficient because of it. Overall it is a safer surgery also, per my surgeon.

[Virginia S 13]

First, the sleeve is not made of anything - it's a just name for what's left of your stomach post-surgery based on the shape. Basically they remove the round part of your stomach and leave a long thin tube that runs from your espophagus to your intestine. They don't bypass anything. There are a couple of advantages:

The part they remove is the stretchiest part, which makes it harder to stretch. It is also the part that produces the hunger hormone. If you take an antacid to get rid of the rumbly/grumbly feeling, you shouldn't feel hungry. Bypass leaves some of the gastric fundus so it stretches easier, and has normal hunger feelings. All that said you CAN stretch your new sleeve, it's just a lot harder to do.

Because there's no bypass, there's no dumping and no malabsorption of food/vitamins. Your food goes through the same channels as it does now, there's just less capacity to eat.

The sleeve/stomach (we don't call it a pouch) is tight and gives good restriction when you eat. Today I served myself 1/4 cup of egg salad and didn't eat it all. That will grow over time - long time sleevers can eat 4-6 oz of dense Protein - but that can take months.

There's nothing artificial left behind like the band, and nothing to slip or malfunction. No adjustments. Just heal, follow the food rules (high Protein, low carb) and get on with life.

You can eat anywhere, though eating certain things will defeat your weight loss. So - want a chocolate egg because it's Easter? You can do that, but don't do it every day. Every restaurant has something you can eat even on the diet phase - lean meat, chili, meat salads, etc. plus veggies.

I started looking at the sleeve because I take a steroid every day and steroids can cause problems (marginal ulcers, etc.) for bypass patients. That made me realize - even if someone doesn't have a health condition when they have surgery, what happens if they do get sick? So - sleeve for me.

Hope this helps!

[Tiffykins 673]

Even people without altered stomachs can dump. Have you cut something out of your diet like fried foods, or high fat foods, and when you add it back, you get sick to your stomach? That's kind of the same thing. I have never dumped with my sleeve, but others have reported similar symptoms when eating high fat, especially high milk fat products such as ice cream and buttercream cake icing. There is nothing similar between the band and sleeve. The sleeve is simply them stapling off and removing the stretchy part of your stomach. There is no foreign object, or rerouting of intestines. It is very similar to the surgery that has been performed for decades upon decades for stomach cancer and ulcer patients. It's a partial gastrectomy for all simple purposes.

This is my standard reply when this question pops up every couple of days. I won't try to sway anyone one way or another, but I'll give you my reasons for choosing VSG over RNY for my revision from the band. You can also check out the revision, failure, and food issue forums on here to get an idea of some long term RNY patients. For me, it was never an option. The cons outweighed the pros.

The VSG was my 2nd, and final WLS. I could have easily had RNY, but I fought to have VSG as my revision from the band. Some factors I considered in deciding on VSG. The pouch that RNY offers is similar to the pouch with the band. Least to say, a pouch sucks, I love having a normal tummy, just less capacity and still fully functioning.

1) No blind stomach left behind that can be difficult to scope yet can still get ulcers and cancer.

2) 2 years max on calorie/carb/sugar malabsorption, but a lifetime of vitamin/nutrient malabsorption. This process is called adaptation, and it happens with intestinal bypass surgeries.

3) I had a pouch with the band, and it sucked. I'm pretty fond of my pyloric valve and the sleeve let me keep it. I love having a normal functioning stomach, just smaller in capacity.

4) Regain stats and #of RNY patients seeking revision truly scared the poop out of me

5) I have too many friends in real life that struggle with Vitamin deficiencies post-RNY, and most of them either never got to goal, or have gained back a significant amount of their weight.

6) The long term complications with RNY were too numerous for my comfort level. Pouch or stoma dilation, strictures, vitamin/nutrient deficiencies, ulcers,

7) I researched gastrectomies that had been performed for stomach cancer and ulcer patients, and found comfort in the long term results and minimal complications of patients that had lost most or all of their stomachs had dealt with over several years.

8) I was a volume eater, and knew a restrictive only procedure would work for me. That was my thought process when I got the band, and I thought I could beat the odds on complications. Sadly, the band only lasted 8 months before I had to revise.

9) I did not want to have food or medication restrictions. I chose WLS to have a "normal" life, and I think it's normal to eat a couple of Cookies. With RNY, I wasn't willing to go through the possibility of dumping if I wanted to have a couple of Cookies, or a slice of cake on occasion. The big scare for me is medication restrictions for life. NSAIDS and steroids are a NO GO for life with a RNY pouch. I realize that I may never be diagnosed with a condition or disease that requires steroid use, but it is possible. I want the best long term results with the least amount of complications. Malabsorption is not anything to play with in my mind, and I was not willing to take that risk.

I lost all my weight in my ticker with the exception of 7lbs with the sleeve, and I did it in 10.5 months. The 115lbs fell off the first 6.5 months, and then the rest I lost as I was getting into maintenance over another 4 months.. It's been a fabulous journey, and I'm easily maintaining with zero issues for nearly a year at this point. I want to add that every WLS regardless of your choice will require discipline. Only a percentage of RNY patients dump on sugar/fat, pouches and stomas stretch, then you have the medication restrictions. I'm not trying to convince you, but these were my concerns when I knew I had to revise from the band. I started at 263 the day of my revision and today I weigh 127lbs. I bounce on the scale 125-130lbs any given week, and I couldn't be more ecstatic!

Best wishes in your research!

The Vertical Sleeve Gastrectomy procedure (also called Sleeve Gastrectomy, Vertical Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction, Logitudinal Gastrectomy and even Vertical Gastroplasty) is performed by approximately 20 surgeons worldwide. This forum is titled “VSG forum” to include the two most common terms for the procedure (vertical and sleeve). The earliest forms of this procedure were conceived of by Dr. Jamieson in Australia (Long Vertical Gastroplasty, Obesity Surgery 1993)- and by Dr. Johnston in England in 1996 (Magenstrasse and Mill operation- Obesity Surgery 2003). Dr Gagner in New York, refined the operation to include gastrectomy(removal of stomach) and offered it to high risk patients in 2001. Several surgeons worldwide have adopted the procedure and have offered it to low BMI and low risk patients as an alternative to laparoscopic banding of the stomach.

It generates weight loss by restricting the amount of food (and therefore calories) that can be eaten by removing 85% or more of the stomach without bypassing the intestines or causing any gastrointestinal malabsorption. It is a purely restrictive operation. It is currently indicated as an alternative to the Lap-Band® procedure for low weight individuals and as a safe option for higher weight individuals.

Anatomy

This procedure generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from 1-5 ounces (30-150cc), depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded. The Roux-en-Y gastric bypass stomach can be reconnected (reversed) if necessary. Note that there is no intestinal bypass with this procedure, only stomach reduction. The lack of an intestinal bypass avoids potentially costly, long term complications such as marginal ulcers, Vitamin deficiencies and intestinal obstructions.

Comparison to prior Gastroplasties (stomach stapling of the 70-80s)

The Vertical Gastrectomy is a significant improvement over prior gastroplasty procedures for a number of reasons:

1) Rather than creating a pouch with silastic rings or polypropylene mesh, the VG actually resects or removes the majority of the stomach. The portion of the stomach which is removed is responsible for secreting Ghrelin, which is a hormone that is responsible for appetite and hunger. By removing this portion of the stomach rather than leaving it in-place, the level of Ghrelin is reduced to near zero, actually causing loss of or a reduction in appetite (Obesity Surgery, 15, 1024-1029, 2005). Currently, it is not known if Ghrelin levels increase again after one to two years. Patients do report that some hunger and cravings do slowly return. An excellent study by Dr. Himpens in Belgium(Obesity Surgery 2006) demonstrated that the cravings in a VSG patient 3 years after surgery are much less than in LapBand patients and this probably accounts for the superior weight loss.

2) The removed section of the stomach is actually the portion that “stretches” the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food. Remember, resistance is greatest the smaller the diameter and the longer the channel. Not only is appetite reduced, but very small amounts of food generate early and lasting satiety(fullness).

3) Finally, by not having silastic rings or mesh wrapped around the stomach, the problems which are associated with these items are eliminated (infection, obstruction, erosion, and the need for synthetic materials). An additional discussion based on choice of procedures is below.

Alternative to a Roux-en-Y Gastric Bypass

The Vertical Gastrectomy is a reasonable alternative to a Roux en Y Gastric Bypass for a number of reasons

1. Because there is no intestinal bypass, the risk of malabsorptive complications such as vitamin deficiency and Protein deficiency is minimal.
2. There is no risk of marginal ulcer which occurs in over 2% of Roux en Y Gastric Bypass patients.
3. The pylorus is preserved so dumping syndrome does not occur or is minimal.
4. There is no intestinal obstruction since there is no intestinal bypass.
5. It is relatively easy to modify to an alternative procedure should weight loss be inadequate or weight regain occur.
6. The limited two year and 6 year weight loss data available to date is superior to current Banding and comparable to Gastric Bypass weight loss data(see Lee, Jossart, Cirangle Surgical Endoscopy 2007).

First stage of a Duodenal Switch

In 2001, Dr. Gagner performed the VSG laparoscopically in a group of very high BMI patients to try to reduce the overall risk of weight loss surgery. This was considered the ‘first stage’ of the Duodenal Switch procedure. Once a patient’s BMI goes above 60kg/m², it is increasingly difficult to safely perform a Roux-en-Y gastric bypass or a Duodenal Switch using the laparoscopic approach. Morbidly obese patients who undergo the laparoscopic approach do better overall in their recovery, while minimizing pain and wound complications, when compared to patients who undergo large, open incisions for surgery (Annals of Surgery, 234 (3): pp 279-291, 2001). In addition, the Roux-en-Y gastric bypass tends to yield inadequate weight loss for patients with a BMI greater than 55kg/m² (Annals of Surgery, 231(4): pp 524-528. The Duodenal Switch is very effective for high BMI patients but unfortunately it can also be quite risky and may be safer if done open in these patients. The solution was to ‘stage’ the procedure for the high BMI patients.

The VSG is a reasonable solution to this problem. It can usually be done laparoscopically even in patients weighing over 500 pounds. The stomach restriction that occurs allows these patients to lose more than 100 pounds. This dramatic weight loss allows significant improvement in health and resolution of associated medical problems such as diabetes and sleep apnea, and therefore effectively “downstages” a patient to a lower risk group. Once the patients BMI is lower (35-40) they can return to the operating room for the “second stage” of the procedure, which can either be the Duodenal Switch, Roux–en-Y gastric bypass or even a Lap-Band®. Current, but limited, data for this ‘two stage’ approach indicate adequate weight loss and fewer complications.

Vertical Gastrectomy as an only stage procedure for Low BMI patients(alternative to Lap-Band®and Gastric Bypass)

The Vertical Gastrectomy has proven to be quite safe and quite effective for individuals with a BMI in lower ranges. The following points are based on review of existing reports:

Dr. Johnston in England, 10% of his patients did fail to achieve a BMI below 35 at 5 years and these tended to be the heavier individuals. The same ones we would expect to go through a second stage as noted above. The lower BMI patients had good weight loss (Obesity Surgery 2003).

In San Francisco, Dr Lee, Jossart and Cirangle initiated this procedure for high risk and high BMI patients in 2002. The results have been very impressive. In more than 700 patients, there were no deaths, no conversions to open and a leak rate of less than 1%. The two year weight loss results are similar to the Roux en Y Gastric Bypass and the Duodenal Switch (81-86% Excess Weight Loss). Results comparing the first 216 patients are published in Surgical Endoscopy.. Earlier results were also presented at the American College of Surgeons National Meeting at a Plenary Session in October 2004 and can be found here: www.facs.org/education/gs2004/gs33lee.pdf.

Dr Himpens and colleagues in Brussels have published 3 year results comparing 40 Lap-Band® patients to 40 Laparoscopic VSG patients. The VSG patients had a superior excess weight loss of 57% compared to 41% for the Lap-Band® group (Obesity Surgery, 16, 1450-1456, 2006).

Low BMI individuals who should consider this procedure include:

1. Those who are concerned about the potential long term side effects of an intestinal bypass such as intestinal obstruction, ulcers, anemia, osteoporosis, Protein deficiency and vitamin deficiency.
2. Those who are considering a Lap-Band® but are concerned about a foreign body or worried about frequent adjustments or finding a band adjustment physician.
3. Those who have other medical problems that prevent them from having weight loss surgery such as anemia, Crohn’s disease, extensive prior surgery, severe asthma requiring frequent steroid use, and other complex medical conditions.
4. People who need to take anti-inflammatory medications may also want to consider the Vertical Gastrectomy. Unlike the gastric bypass where these medications are associated with a very high incidence of ulcer, the VSG does not seem to have the same issues. Also, Lap-Band ® patients are at higher risks for complications from NSAID use.

All surgical weight loss procedures have certain risks, complications and benefits. The ultimate result from weight loss surgery is dependent on the patients risk, how much education they receive from their surgeon, commitment to diet, establishing an exercise routine and the surgeons experience. As Dr. Jamieson summarized in 1993, “Given good motivation, a good operation technique and good education, patients can achieve weight loss comparable to that from more invasive procedures.”

Next: Advantages and Disadvantages of Vertical Sleeve Gastrectomy >>

This information has been provided courtesy of Laparoscopic Associates of San Francisco (LAPSF). Please visit the Laparoscopic Associates of San Francisco.

[JamieLynn77 1]

I chose the sleeve because RNY scared me, i didn't want anything re-routed, or changed drastically. and i knew ppl with the RNY who were horrible sick after surgery and I didn't want that to be me. The lap band was NOT an option cuz i was against putting anything foreign in my body, that has history of breaking and adhering to the stomach. so i convinced myself that i could do it on my own. then i heard about the sleeve. I did my research, and knew a girl who did it, and was a year out. And i liked what i read. It was simple and to the point. I liked the fact that it got rid of a majority of the stomach, the part they believe produces the gherlin, which signals hunger, sometimes unneccesarily. and that is was a tool, and that the rest was up to me. I liked that aspect. and i am uber happy with my choice. i have had practically zero problems thus far. and its all in learning how to eat properly, which i have found to be very exciting. Trying new, healthier foods, and knowing i am absorbing all the key nutrients that i am supposed to be. i have no regrets about my sleeve at all!

[sk8lady 5]

Great posts before mine, but I thought I'd chime in anyway. My reasons were the same as most.....the idea that nothing was "changed" inside of me won me over. No re-routing and nothing plastic left inside with a tube to a port. Just a smaller stomach that would restrict the amount of food I can consume. I have had NO problems with any type of food. I have had a couple of instances where I ate a small amount of chicken too quickly and on one occasion, it did come back up which was a relief because it was very uncomfortable. But no restrictions on WHAT I can eat....just the amount. I am six weeks out and other than being able to "pig out" which is what got me here in the first place, life is back to normal. Had friends over last night and for six people, they ordered 2 large pizzas and one small. I had ONE piece and that was plenty for me. I couldn't believe that all of the pizza went but it felt good knowing that it wasn't because of me!

The recovery time was much quicker than with the bypass I believe. I took just over a week off from work and though I got a little tired and worked slightly shorter days, no one even knew the real reason I was out. I chose to keep it very private and only a few very special friends know what I did. I just don't need any negative feedback from people that think they KNOW what it is like to get to that point to even consider WLS.

The sleeve wasn't even an option when I first started my program, but it came available just as I was getting to the point of choosing my type of surgery. I had done a lot of research and I was wishing that the sleeve was an option. When they told me that my insurance company had started to approve it, I thanked God for answered prayers. It was what I had wished for all along.

Little discomfort for a few days after surgery, but I was operated on Thursday morning and could have gone home Friday afternoon though I chose to stay until Saturday for one more day of peace and quiet before coming home to a dog and a cat and my loving husband. Good choice on my part. So a two night hospital stay and I was back in my own bed.....sleeping comfortably after only a few more days with a pillow propped under my stomach so I could lay on my side a little bit. (I am not a back sleeper at all!)

No regrets from me at all......I think it was meant to be for me!!

[emilygrace 5]

Same reasons as everyone else - just as much weight loss as bypass, more than band, but less complications. Was an easy choice for me. I didn't take it lightly, because it is still fairly major surgery with perioperative risk, but I knew if I made it through surgery and the postop period, I would have a low chance of complications.

I will say though that if I felt I needed malabsorption (which some people definitely do, and only you and your surgeon can decide which is the best option for you) I would go for the duodenal switch over the RNY.