81 mg Aspirin and VSG

[RebaC 0]

I am getting sleeved on June 22. I am 51, strong family history of heart disease (my mom has had triple bypass, two uncles have had quadruple bypass, aunt had double bypass, two uncles have died of heart attacks, my grandmother had a few heart attacks), currently take daily 81 mg of aspirin per my cardiologist for prevention. I know you are not supposed to take NSAIDS once you have VSG. What does one do for prevention? I will be seeing my surgeon for my 2 week pre op on Thursday the 9th, I will ask him. Anyone else with this problem? I have had blood tests for C-reactive Protein which is an indicator of future heart attack and my level was fairly high. This is one the my reasons for this surgery, to get rid of excess weight and changing eating habits and exercise to prevent heart disease. My cardiologist happily cleared me for this surgery. I did a 10 month weight management program through my cardiologist, and I lost 8-10 lbs.

I did not think about this until this morning when I decided not to take the aspirin since I want to reduce bleeding risk from surgery.

Any answers will be helpful for when I talk to my surgeon and cardiologist.

[sfdavid 1]

Congratulations for being on the right path. I had the sleeve January 6th of this year and my doctor let me start back on 81mg aspirin after six weeks of healing. I still take it everyday. Good luck to you!

[Tiffykins 673]

There are no medication restrictions with VSG. NSAIDS needs are a huge factor in many people winning appeals to insurance coverage once they had been denied. I've been taking Aleve, Ibuprofen and all other NSAIDS since being around 6 weeks out without any problems. I just take it with a little something on my stomach be it a few crackers or some yogurt.

Due to my clotting disorder, they've prescribed me 81mg of aspirin every day for the rest of my life.

The no NSAID rule applies to pouches of RNY patients because the tablet/caplet can sit in the pouch and ulcerate. We have a normal functioning stomach just smaller in size so the same rules apply when it comes to taking meds post-VSG.

[losingitin2012 3]

There are no medication restrictions with VSG. NSAIDS needs are a huge factor in many people winning appeals to insurance coverage once they had been denied. I've been taking Aleve, Ibuprofen and all other NSAIDS since being around 6 weeks out without any problems. I just take it with a little something on my stomach be it a few crackers or some yogurt.

Due to my clotting disorder, they've prescribed me 81mg of aspirin every day for the rest of my life.

The no NSAID rule applies to pouches of RNY patients because the tablet/caplet can sit in the pouch and ulcerate. We have a normal functioning stomach just smaller in size so the same rules apply when it comes to taking meds post-VSG.

[losingitin2012 3]

I wonder why my surgeon's office nurse told me no NSAIDs EVER again? Their materials say the same....sure do need my naproxen back for hip pain....

[MeMeMEEE 206]

I've been told no 81 mg asprin or NSAIDS - after a year they will make exception for short stints of NSAIDS if needed. I think it could be that it is so new that they just aren't sure? We are mostly lumped in to RNY in my program at this point.

[feedyoureye 3,087]

The sleeve was recommended to me because my cardiologist prescribed an aspirin a day. I had to quite taking it with approval from my cardiologist for one month before and after surgery. I eat something with it because it can still ulcerate the staple line...but has sell problems than an RNY might have. I think Docs would rather you not take them, but some confuse the sleeve with RNY rules. take care.

[kellyw74 258]

You can take ANY medication with the sleeve. There aren't restrictions of ANY type. That is the bypass that you can not take them.

My dr. asked that I not take Ibuprofen for 3 months post-op just to give my stomach time to heal, but I can take them now.

Kelly

[Tiffykins 673]

I wonder why my surgeon's office nurse told me no NSAIDs EVER again? Their materials say the same....sure do need my naproxen back for hip pain....

This is just my experience: Most surgeons keep the same "rules" for all bariatric procedures be it VSG, RNY, or the band. It is still recommended to not use it excessively, nor take the NSAIDS on an empty stomach. I've been taking NSAIDS of all sorts since being around 6-7 weeks out without any issue. I always make sure I have something in my stomach be it some yogurt, or crackers with cheese. Something in there just as it's recommended when we have big stomachs. With the recent downgrade of max daily dose of Tylenol (Acetaminophen) from 8 pills to 6 pills per day due to liver issues, my main concern with Tylenol usage is that I can protect my stomach, I can't protect my liver.

From the pioneers of VSG as a stand alone procedure who have been performing it the longest:

Advantages and Disadvantages of Vertical Sleeve Gastrectomy

Vertical Sleeve Gastrectomy Advantages

• Reduces stomach capacity but tends to allow the stomach to function normally so most food items can be consumed, albeit in small amounts.
• Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin).
• Dumping syndrome is avoided or minimized because the pylorus is preserved.
• Minimizes the chance of an ulcer occurring.
• By avoiding the intestinal bypass, almost eliminates the chance of intestinal obstruction (blockage), marginal ulcers, anemia, osteoporosis, Protein deficiency and Vitamin deficiency.
• Very effective as a first stage procedure for high BMI patients (BMI > 55 kg/m²).
• Limited results appear promising as a single stage procedure for low BMI patients (BMI 30-50 kg/m²).
• Appealing option for people who are concerned about the complications of intestinal bypass procedures or who have existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedures.
• Appealing option for people who are concerned about the foreign body aspect of Banding procedures.
• Can be done laparoscopically in patients weighing over 500 pounds, thereby providing all the advantages of minimally invasive surgery: fewer wound and lung problems, less pain, and faster recovery.

Vertical Sleeve Gastrectomy Disadvantages

• Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass.
• Higher BMI patients will most likely need to have a second stage procedure later to help lose the rest of the weight. Remember, two stages may ultimately be safer and more effective than one operation for high BMI patients. This is an active point of discussion for bariatric surgeons.
• Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss.
• This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur.
• Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure.
• Considered investigational by some surgeons and insurance companies.

Next: >> Frequently Asked Questions About Vertical Sleeve Gastrectomy

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

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.”

[RickM 1,747]

The no NSAID rule applies to pouches of RNY patients because the tablet/caplet can sit in the pouch and ulcerate. We have a normal functioning stomach just smaller in size so the same rules apply when it comes to taking meds post-VSG.

The other factor on the RNY/NSAID issue is the suture line between the pouch and the intestine - since the part of the intestine that is joined to the pouch is not used to being exposed to stomach acid like the duodenum (which gets bypassed along with the stomach) that joint is very susceptible to being irritated. It also tends to never fully heal as a result and continually weeps a bit of blood, compounding the Iron absorption issues of the RNY