~ Not Sure What To Do

[Samantha~Leibold 0]

Hello Everyone.... I am new to things like this and am not too sure of what I am doing. I have struggled with weight loss all of my life. I don't know what it feels like to be thin. I am at a point in my life where I want to enjoy life to the fullest. I am trying to figure out what would be best for me. I have researched the lap band surgery and thought it might be the thing for me but now as I research more I have doubts. I have friends that have had the gastric bypass surgery with great results but I have also seen how they are slowly putting the weight back on. Which leads me here to research about this sleeve surgery. It looks to be alot like the gastric bypass. Anyone out there willing to help me figure this all out?

Details about me....

I am 5'3" tall and I currently weigh 301 pounds. I have no energy to do anything. I love playing softball but this weight is really dragging me down. I am 36 years old and feel like I could live life better. I have two daughters that I want to be able to do more things with.

I don't know what else to say.....

[heartonmysleevey 133]

Same boat here! I'm in limbo between the lap band and the sleeve. My biggest fear is the future with both.

With the lap band I'm afraid of slips, erosions etc. With the sleeve I'm afraid of a stretching pouch.

I would love to hear from someone that was sleeved for a few years now.

I'm on my second month of my 6 month supervised diet. Hoping that soon I can come to a decision.

Good luck to you.

[Nancy Rivers 24]

Hi folks and welcome to the forums. You will find a lot of information in the different areas on here. There are several who have had the sleeve for a while - Tiffykins immediately pops into my mind, although there are many others.

Feel free to ask questions - nothing is off limits.

[mamamckinzie 92]

I am going thru the steps for WLS. When I started I checked out the lapband first. I liked the idea of it not being permanent. I went an had a consult and was seriously considering that direction. After reading so many reports of problems and slow weight loss I decided to go to another seminar that covered all the differenct surgeries. After I got over the shock of the removal of stomach part I decided that of all the procedures I liked the sleeve best. Then I kept looking at the differenct WLS boards and found that most people were very successful with the sleeve. I did not like the idea of slippage, possible emergency surgery due to slippage or erosion. Yesterday I say the psych and today I see the nut. Good luck on whatever surgery you decide on. We will be here for you no matter what your decision.

[feedyoureye 3,087]

Many posts here from people who have had the sleeve over one year, and many who have revised from the band after band failure too... search and research!

[Tiffykins 673]

I've had both the sleeve and the band. I can tell you my horror stories with the band, but will spare you the gory details and just recommend you check out the Band to Sleeve Revision on this forum from the main page. You'll see just how many of us have to revise to the sleeve after having the band. I have a lot of information on VSG, the band and RNY in my blog, I'll post it here, but it's a long post so grab a cup of coffee and enjoy. Attached you to the information will be research links and articles pertaining to the VSG.

The band has the lowest and slowest weight loss stats with the most long term complications and highest re-operation rates. I do not regret my band decision, VSG was not available when I had my band, and it taught me a lot about myself, my food issues. I love my sleeve, it's the very best decision I ever made for myself and my family.

Here is a study from the band manufacturers:

Patients can experience complications after surgery. Most complications are not serious but some may require hospitalization and/or re-operation. In the United States clinical study, with 3-year follow-up reported, 88% of the 299 patients had one or more adverse events, ranging from mild, moderate, to severe. Nausea and vomiting (51%), gastroesophageal reflux (regurgitation) (34%), band slippage/pouch dilatation (24%) and stoma obstruction (stomach-band outlet blockage) (14%) were the most common post-operative complications. In the study, 25% of the patients had their band systems removed, two-thirds of which were following adverse events. Esophageal dilatation or dysmotility (poor esophageal function) occurred in 11% of patients, the long-term effects of which are currently unknown. Constipation, diarrhea and dysphagia (difficulty swallowing) occurred in 9% of the patients. In 9% of the patients, a second surgery was needed to fix a problem with the band or initial surgery. In 9% of the patients, there was an additional procedure to fix a leaking or twisted access port. The access port design has been improved. Four out of 299 patients (1.3%) had their bands erode into their stomachs. These bands needed to be removed in a second operation. Surgical techniques have evolved to reduce slippage. Surgeons with more laparoscopic experience and more experience with these procedures report fewer complications.

Adverse events that were considered to be non-serious, and which occurred in less than 1% of the patients, included: esophagitis (inflammation of the esophagus), gastritis (inflammation of the stomach), hiatal hernia (some stomach above the diaphragm), pancreatitis (inflammation of the pancreas), abdominal pain, hernia, incisional hernia, infection, redundant skin, dehydration, diarrhea (frequent semi-solid bowel movements), abnormal stools, constipation, flatulence (gas), dyspepsia (upset stomach), eructation (belching), cardiospasm (an obstruction of passage of food through the bottom of the esophagus), hematemsis (vomiting of blood), asthenia (fatigue), fever, chest pain, incision pain, contact dermatitis (rash), abnormal healing, edema (swelling), paresthesia (abnormal sensation of burning, prickly, or tingling), dysmenorrhea (difficult periods), hypochromic anemia (low oxygen carrying part of blood), band system leak, cholecystitis (gall stones), esophageal ulcer (sore), port displacement, port site pain, spleen injury, and wound infection. Be sure to ask your surgeon about these possible complications and any of these medical terms that you dont understand.

Back to Top What are the specific risks and possible complications?

Talk to your doctor about all of the following risks and complications:

• Ulceration
• Gastritis (irritated stomach tissue)
• Gastroesophageal reflux (regurgitation)
• Heartburn
• Gas bloat
• Dysphagia (difficulty swallowing)
• Dehydration
• Constipation
• Weight regain
• Death

Laparoscopic surgery has its own set of possible problems. They include:

• Spleen or liver damage (sometimes requiring spleen removal)
• Damage to major blood vessels
• Lung problems
• Thrombosis (blood clots)
• Rupture of the wound
• Perforation of the stomach or esophagus during surgery

Laparoscopic surgery is not always possible. The surgeon may need to switch to an "open" method due to some of the reasons mentioned here. This happened in about 5% of the cases in the U.S. Clinical Study.

There are also problems that can occur that are directly related to the LAP-BAND� System:

• The band can spontaneously deflate because of leakage. That leakage can come from the band, the reservoir, or the tubing that connects them.
• The band can slip
• There can be stomach slippage
• The stomach pouch can enlarge
• The stoma (stomach outlet) can be blocked
• The band can erode into the stomach

Obstruction of the stomach can be caused by:

• Food
• Swelling
• Improper placement of the band
• The band being over-inflated
• Band or stomach slippage
• Stomach pouch twisting
• Stomach pouch enlargement

There have been some reports that the esophagus has stretched or dilated in some patients. This could be caused by:

• Improper placement of the band
• The band being tightened too much
• Stoma obstruction
• Binge eating
• Excessive vomiting

Patients with a weaker esophagus may be more likely to have this problem. A weaker esophagus is one that is not good at pushing food through to your stomach. Tell your surgeon if you have difficulty swallowing. Then your surgeon can evaluate this.

Weight loss with the LAP-BAND� System is typically slower and more gradual than with some other weight loss surgeries. Tightening the band too fast or too much to try to speed up weight loss should be avoided. The stomach pouch and/or esophagus can become enlarged as a result. You need to learn how to use your band as a tool that can help you reduce the amount you eat.

Infection is possible. Also, the band can erode into the stomach. This can happen right after surgery or years later, although this rarely happens.

Complications can cause reduced weight loss. They can also cause weight gain. Other complications can result that require more surgery to remove, reposition, or replace the band.

Some patients have more nausea and vomiting than others. You should see your physician at once if vomiting persists.

Rapid weight loss may lead to symptoms of:

• Malnutrition
• Anemia
• Related complications

It is possible you may not lose much weight or any weight at all. You could also have complications related to obesity.

If any complications occur, you may need to stay in the hospital longer. You may also need to return to the hospital later. A number of less serious complications can also occur. These may have little effect on how long it takes you to recover from surgery.

If you have existing problems, such as diabetes, a large hiatal hernia (part of the stomach in the chest cavity), Barretts esophagus (severe, chronic inflammation of the lower esophagus), or emotional or psychological problems, you may have more complications. Your surgeon will consider how bad your symptoms are, and if you are a good candidate for the LAP-BAND� System surgery. You also have more risk of complications if you've had a surgery before in the same area. If the procedure is not done laparoscopically by an experienced surgeon, you may have more risk of complications.

Anti-inflammatory drugs that may irritate the stomach, such as aspirin and NSAIDs, should be used with caution.

Some people need folate and Vitamin B12 supplements to maintain normal homocycteine levels. Elevated homocycteine levels can increase risks to your heart and the risk of spinal birth defects.

You can develop gallstones after a rapid weight loss. This can make it necessary to remove your gallbladder.

There have been no reports of autoimmune disease with the use of the LAP-BAND� System. Autoimmune diseases and connective tissue disorders, though, have been reported after long-term implantation of other silicone devices. These problems can include systemic lupus erythematosus and scleroderma. At this time, there is no conclusive clinical evidence that supports a relationship between connective-tissue disorders and silicone implants. Long-term studies to further evaluate this possibility are still being done. You should know, though, that if autoimmune symptoms develop after the band is in place, you may need treatment. The band may also need to be removed. Talk with your surgeon about this possibility. Also, if you have symptoms of autoimmune disease now, the LAP-BAND� System may not be right for you.

Back to Top Removing the LAP-BAND� System

If the LAP-BAND� System has been placed laparoscopically, it may be possible to remove it the same way. This is an advantage of the LAP-BAND� System. However, an "open" procedure may be necessary to remove a band. In the U.S. Clinical Study, 60% of the bands that were removed were done laparoscopically. Surgeons report that after the band is removed, the stomach returns to essentially a normal state.

At this time, there are no known reasons to suggest that the band should be replaced or removed at some point unless a complication occurs or you do not lose weight. It is difficult, though, to say whether the band will stay in place for the rest of your life. It may need to be removed or replaced at some point. Removing the device requires a surgical procedure. That procedure will have all the related risks and possible complications that come with surgery. The risk of some complications, such as erosions and infection, increase with any added procedure.

LapSf Study that I swiped from MacMadame's profile

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

Lap Band Failure

Are you looking for information on lap band surgery failure rates and long term success rates?

Lap Band surgery has only been in existence a relatively short time, approximately 10 years. Initial results with lap band were very positive with respect to weight loss and morbidity. Not many long term studies have been done. Here are the results on one eight year study. The study defines failure as losing less than 25% of excess weight. Average age of the patients was 38 years and included 50 men and 270 women.

Complication Percent affected General Complications 33.1%

Erosion 9.5% Slippage 6.3% Port Problems 7.6% Thirty three percent, fully one third of all patients developed complications such as erosion, slippage, catheter or port problems. Twenty two percent of the patients required reoperation to fix failures of the lap band.

Now for the disheartening results, only about 60% of those banded that don't have major complications maintain an acceptable excess weight loss in the long run. That means of those without complications only 4 in 10 are going to be successful. Did your doctor tell you that? Did you ask him?

In five years 40% of lap bands fail and only 43% have lost 50% of excess weight after seven years. The study concludes that LGB (Laporoscopic Gastric Band) should no longer be the surgery of choice until they figure out a way to either screen out those that have complications or eliminate the complications. The study indicates other longer lasting procedures should be used.

If you would like to read more about the study, here it is.

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

And then my personal reasons for VSG over RNY for my revision:

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

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.

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. Also, medication restrictions scare me to the core. Imagine being diagnosed with a disease or condition that requires steroid therapy, and not being able to take it without destroying your pouch, or being diagnosed with something and the medication used to treat can not be readily absorbed because of the bypassed intestine. I just wasn't willing to take that risk.

I lost all my weight with the exception of 7lbs with the sleeve. It's been a fabulous journey, and I'm easily maintaining with zero issues.

P.S.

I wrote this before pregnancy. Myself and the baby are thriving, and suffering zero issues due to VSG.

[Samantha~Leibold 0]

Thank you so much everyone for your replies. I really need the support and encouragement to keep me positive about it all. I will keep researching things to see what I can do to help me on my way.

[Tippy2us 11]

I started with the band 4 years ago and it was a good start but I hated every minute of it. The port hurt, I threw up a lot, had heart burn, etc. I never had a slip, but was generally very unhappy so during my last appt. with my surgeon he talked to me about the revision to the sleeve. I'm 9 days past surgery and absolutely giddy!!!

I'm happy for the experience of the band because it got my eating in check. I know for a fact that I will not stretch the sleeve because I already eat less than I did before getting the band.

But, with that said, if I were recommending a procedure to a friend of mine I would say get the sleeve for sure! Just be mentally ready to eat a lot less food. One thing I've found is I really have no appetite anymore which is a huge help!

You came to the right place for help...Read what these wonderful people have taken the time to post. This site has helped me so much and BEST of luck to you in your decision!!

[Roseib 13]

Re sleeve stretching, just to emphasize that the muscle part of the stomach is left. They remove the stretchy part. I've heard several doctors say either it won't stretch or it won't stretch much as a result. Stretching would not be a worry of mine.

[heartonmysleevey 133]

Thanks! So very helpful.

I'm also I'm lapbandtalk.com as well. So good to know that pouch won't stretch.

So much maintainence with the band isn't very appealing either.

Thanks again

[Guest Rosalind]

I understand. I initially had my consultation for the Lapband surgery. After reading up on it, I realized that they don't last forever. The thought of having addtional surgeries and possible not conquering my weight problem is frightening....Thus the reason I have changed my mind and decided on the sleeve. I don't like the idea of malabsorbtion. I pride myself on being 44 years old and looking 34 years old or less. I have seen people look aged with gastric bypass. I have also see people have a hard time keeping weight off. What I thought was unfortunate has been my fortune . My insurance company require 6 months of a doctor supervised diet. The mixed bag is that I am perfectly health......great bp, great blood sugar, great cholesterol. I have lost 32 lbs since starting with my doctor 4 months ago by eating all food groups and exercising. The bad part, I have had to wait for a long period of time which causes much reflection. My husband is encouraged. Most of the time, I am discouraged. Starting at 310, I thought the weight would fall off! Unfortunately, it did not.

If you are considering Lap band surgery, look into the revisions and why people are getting revisions. I didn't want that band to erode inside of me. Also, I didn't want to go through months of adjustments trying to get a sweet spot to lose the maximum weight

[feedyoureye 3,087]

Re sleeve stretching, just to emphasize that the muscle part of the stomach is left. They remove the stretchy part. I've heard several doctors say either it won't stretch or it won't stretch much as a result. Stretching would not be a worry of mine.

The new stomach does stretch. It will not get to be as big as it once was. It might get to be 3-4 times bigger than when you first get it done... you start out able to eat maybe a quarter cup, and end up able to eat a cup (after 6 months or more). For some folks it seems to stay smaller, others larger...Some kinds of foods just slide on through, and you can eat even more of them. If you stick to dense Proteins first, you eat less. New studies show some people stretch out the esophagus end, from overeating, and have a return of some weight and increased reflux at the same time(after the third year, 30%). It is speculated that continuing nutritionist visits years out will help keep the weight off. I asked my Doc, who is the head of the Bariatric dept of a University teaching hospital, about removing the 'stretchy" part of the stomach...and he said "It is all stretchy" He also disclosed to me that he thought that the sleeve had a higher chance of regain than the RNY further out. He said this will not happen to all people, but you need to watch what you eat forever. I really want to believe that I have lost this weight "FOREVER", but I see the studies, and know MANY people with the sleeve, will have weight regain... perhaps not all of it, but as much as half of the total EWL. That is one reason to really use the honeymoon period to lose as much as you can, work on those exercise habits and take responsibility for eating habits... and not rely or blame the sleeve for your total success or failure... There is also an increase in depression at 3-6 years out too... will you be happy living with 50% of your excess weight lost? And not 100%? The newest statistics say most people will be happy with their results, even if they gain some of the weight back. Just reporting on what I have read... I don't want to go into a wishful fairytale land here, I want to go in prepared to be as successful as I can with the sleeve in the real world.

So far I love it!

[chef neil 25]

hi-

Everyone is different, and each of us made that decision for a reason...

My wife is a RnY, I am a sleeve... we are achieving great results- by following the program.

No matter what program you choose- the effectiveness will depend on how you embrace that program...

why do people gain that weight back? they simply don't follow the program...

The surgery is for life... big decision... I took that in the same light as I took the oath of marriage...

for life! Vitamins for life... restrictions for life, be it a type of food or the amount...

in turn I am getting/staying healthy and hopefully live longer.

I am 50 years old... At 36, you have some things going for you... Youth... a lot less mental and physical issues... I am so glad you came here to think about things...May you find YOUR path and have the life you want...

Neil

[CowgirlJane 14,259]

This is a huge decision, so you are smart to be thinking it over carefully.

I was banded 10 years ago when the choice was really the band or the gastric bypass. I have never felt comfortable with the gastric bypass - not then and not now. I realize that is largely an emotional reaction, but I think we all need to feel comfortable with the basic idea of the particular surgery.

I chose the band, largely because it is reversible. What I didn't realize is that it will MOST LIKELY need to be removed at some point. Mine does, it has slipped.

I have documentation from Bioenteric LapBand that states it should not be considered a permanent implanted device. What I also didn't realize at the time is that while it is removable, many (most?) people have fairly significant scarring, swelling and adhesions. In other words, it does damage while it is in there. Be careful when you consider this "reversible" aspect as a benefit - it isn't as beneficial as I had thought.

I personally didn't mind the fills, my problems with the band were a little different. I lost weight my first year, but honestly it took alot of dieting and exercise to get from 272 down to about 202 over a year. I did better losing weight on weight watchers. I was very happy to get down to the low 200s, but it was clear to me that my odds of becoming normal weight were close to nada. Things went really bad when I had such excessive reflux/heart burn that I needed to have it unfilled - I regained everything and plus some.

As was pointed out very eloquently by others, the issues around having a "pouch" are very real and need to be clearly understood.

So, I hear that the new bands are better. The old ones were smaller, so even unfilled they caused some of the problems. The sleeve is not entirely risk/issue free either. Personally, the reflux is a big concern because I never had it before banding and it became a major quality of life issue. I hate it. When I had fill in my band I had to sleep with the head of my bed elevated, I couldn't eat within many hours of bedtime etc and I still had problems.