Sleeve vs. Gastric Bypass

[bowlinJJ 0]

So, I get the call from my office that they are going to put in the paperwork to insurance (tricare), and proceeds to tell me that Tricare doesn't cover the vsg. They will only cover the bypass or lapband. So, any suggestions, which route to go? I'm leaning towards the bypass. I need help? I weigh 309.6 lbs, I'm 5'3", bmi = over 53. What's the differences between the vsg and bypass? Ugh! I have a consultation with the surgeon to discuss everything on Monday. I'd like to have a little bit of knowledge and for questions to ask.

JJ

[Tiffykins 673]

Is there a military hospital that you can go to and get the sleeve if that is the surgery you really want. I refused RNY/bypass when I had to revise from the band and I listed the reasons below. I've also included the basic information about both surgeries. There are many reasons why I chose VSG instead of RNY, and my VSG was covered at a military hospital 100%.

I would recommend checking out the obesityhelp.com website, look under surgical forums, check out the Revision forum so you can see how many people are looking to revise from RNY because of weight regain or complications, and then check out the failed weight loss surgery forum just so you can get an idea of people that are further out.

Here are my reasons for getting VSG instead of RNY:

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!

P.S. I wrote this before pregnancy. And, just as an update, I'm 24 weeks pregnant and thriving. The baby is weighing 2-3oz heavier and is measuring right on target for length. I have zero issues consuming enough calories/protein/carbs to support my body and another developing human. My labs have remained stellar throughout the pregnancy, and life is pretty good. I am 2 years out at this point, and couldn't be happier with my decision to have VSG over RNY for my revision. It's been an amazing journey.

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.

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.

Bypass information

Gastric Bypass - The Digestive Process

To better understand how the gastric bypass weight-loss surgery works, it is helpful to know how the normal digestive process works. As food moves along the digestive tract, special digestive juices and enzymes arrive at the right place at the right time to digest food and absorb calories and nutrients. After we chew and swallow our food, it moves down the esophagus to the stomach, where a strong acid and powerful enzymes continue the digestive process. The stomach can hold about three pints of food at one time. Food is slowly released into the small intestine where absorption of the nutrients, Vitamins and minerals takes place. The rate at which foods and fluids are released into the small intestines is controlled by a sphincter on the outlet of the stomach. Empty time can be over several hours.

Procedures

Bariatric operations currently performed include gastric restriction (vertical banded gastroplasty; laparoscopic adjustable gastric banding), malabsorption (biliopancreatic diversion; biliopancreatic diversion with duodenal switch), or both (Roux-en-Y gastric bypass). Two of the most commonly performed bariatric surgeries are the laparoscopic adjustable gastric banding procedure and the Roux-en-Y gastric bypass.

Roux-en-Y Gastric Bypass Surgery

The most common bariatric surgery procedure performed in the United States, Roux-en-Y gastric bypass (RYGB) combines a restrictive and malabsorptive procedures. A small (15-30 cc) gastric pouch is created to restrict food intake and a Roux-en-Y gastrojejunostomy provides the mild malabsorptive component. Bariatric surgeons can perform the Roux-en-Y gastric bypass procedure using minimally invasive surgical techniques.

The advantages of Roux-en-Y gastric bypass include superior weight loss when compared to vertical banded gastroplasty, with excellent long-term weight reduction and resolution or elimination of co-morbidities (80 percent resolution of Type II diabetes after surgery). Early and late complication rates are reasonably low, and operative mortality ranges from 0.2 percent to 1 percent.

Disadvantages of Roux-en-Y gastric bypass include the potential for anastomotic leaks and strictures, severe dumping syndrome symptoms and procedure-specific complications, including distension of the excluded stomach and internal hernias. Roux-en-Y gastric bypass is technically more challenging to perform than the restrictive procedures, particularly when using the laparoscopic approach. In experienced hands, the conversion rate of laparoscopic Roux-en-Y gastric bypass to open is 5 percent.

Laparoscopic Adjustable Gastric Banding

A restrictive procedure, laparoscopic adjustable gastric banding (LAGB) involves placing a silicone band with an inflatable inner collar around the upper stomach. The band is connected to a port that is placed in the subcutaneous tissue of the abdominal wall. The inner diameter of the band can be adjusted according to weight loss by injecting saline through the port.

Laparoscopic adjustable gastric banding surgery is performed laparoscopically, offering less surgical trauma in the wound and to the viscera, improved postoperative pulmonary function and decreased incidence of wound-related complications such as hematomas, seromas, infections, hernias and dehiscence. LAGB is technically the simplest bariatric surgery to perform and requires less operating time than other procedures. No anastomoses are created, and the morbidity and mortality are low. The procedure is reversible and, if patients fail to lose adequate weight after laparoscopic adjustable gastric banding, it can be converted to a Roux-en-Y gastric bypass.

The disadvantages of laparoscopic adjustable gastric banding include the need for frequent postoperative visits for band adjustments and band slippage or gastric prolapse through the band (5 percent to 10 percent), which requires re-operation. Band erosion into the stomach, gastroesophageal reflux, esophageal dilation and dysmotility also can occur.

Laparoscopic technique helps reduce pain, shorten recovery

Traditional or "open" gastric bypass surgery requires a 6-to 8-inch incision and approximately four weeks of recuperation. Some surgeons can offer gastric bypass surgery patients the laparoscopic approach.

This procedure involves making five to six small openings (approximately ? to 1 inch in size) in the abdomen. These openings allow the bariatric surgeon to pass a light, camera and surgical instruments into the abdomen. The abdomen is inflated with gas (carbon dioxide) to allow the surgeon to get a better view of the stomach and internal structures. Surgical instruments about the width of a pencil are placed into the abdomen to complete the surgery.

In a Roux-en-Y gastric bypass surgery,most of the stomach is "bypassed" and a small portion (about the size of an egg) remains functional. In some cases, the bariatric surgeon may find it necessary to convert from laparoscopic to open surgery. The surgeon bases this decision on various factors, including the patient?s safety and the opportunity to achieve the best possible outcome.

The minimally invasive approach achieves results identical to those associated with open surgery, but with less post-operative pain and swifter recovery. Patients who undergo laparoscopic bypass surgery can return to work after two to four weeks. Laparoscopic surgery also reduces the risk of developing hernias, which are more common after traditional abdominal surgery.

Next: Risks and Rewards of Bariatric Surgery > >

This information has been provided courtesy of the Cleveland Clinic Bariatric and Metabolic Institute. Please visit the Cleveland Clinic Bariatric and Metabolic Institute.

[former_vbg 198]

Tiff summed up everything perfectly! I highly recommend taking some time and really read through what she posted. The failure rates for the RNY's is VERY high. The lap band isn't much better, but for different reasons. All of this is in Tiff's post.

Do yourself a favor and contact the insurance company yourself, ask where the policy bulletins are posted so you can read it yourself. Don't settle for what other people tell you. Again, to reiterate Tiff, fight for what YOU want- it's your body.

[bowlinJJ 0]

She did sum it up perfectly! I did contact my insurance company and the bypass and lapband are their two options. I just don't understand it. I've seen others have the same insurance as I do, and have the sleeve. Ugh. I just don't know what to do, but more research. Thanks for your input. Much appreciated to both you and Tiff.

JJ

Tiff summed up everything perfectly! I highly recommend taking some time and really read through what she posted. The failure rates for the RNY's is VERY high. The lap band isn't much better, but for different reasons. All of this is in Tiff's post.

Do yourself a favor and contact the insurance company yourself, ask where the policy bulletins are posted so you can read it yourself. Don't settle for what other people tell you. Again, to reiterate Tiff, fight for what YOU want- it's your body.

[Tiffykins 673]

She did sum it up perfectly! I did contact my insurance company and the bypass and lapband are their two options. I just don't understand it. I've seen others have the same insurance as I do, and have the sleeve. Ugh. I just don't know what to do, but more research. Thanks for your input. Much appreciated to both you and Tiff.

JJ

VSG is covered at military hospitals.

To help you better, I can ask some questions, and you can send me a message with the answers if you don't want to answer publicly.

Which type of Tricare do you have Tricare Prime, Tricare Prime Remote, Tricare for Life (for retirees/dependents of retirees), Tricare Standard?

Where are you located, and what military bases, posts, forts, whatever military installations are around you?

I fought to have VSG for my revision from the band. I had to jump hoops, and fight for it, but it's totally worth it.

[bowlinJJ 0]

I have Tricare Prime, and we are located in Central Texas. Ft. Hood is the closest Military base next to us, and because my husband is retired military, I'm not able to be seen there due to the amount of people they already have on their installation. I can understand that. What I think I need, is the procedure code for the VSG. Thanks for your help.

JJ

VSG is covered at military hospitals.

To help you better, I can ask some questions, and you can send me a message with the answers if you don't want to answer publicly.

Which type of Tricare do you have Tricare Prime, Tricare Prime Remote, Tricare for Life (for retirees/dependents of retirees), Tricare Standard?

Where are you located, and what military bases, posts, forts, whatever military installations are around you?

I fought to have VSG for my revision from the band. I had to jump hoops, and fight for it, but it's totally worth it.

[suez1105 2]

Tifykins, you are a wealth of information and experience for us pre-sleevers and newbies. thanks for sticking on here and helping us. I know a lot of people post on here until they loose the weight and then are gone. It's understandable, but we really do appreciate all those who stay and even come back to check in with us and offer any insight. Thanks so much!!

[CowgirlJane 14,259]

Tiffkins, thank you for that very informative post.

What really struck me is the "pouch" comment. That clicked since having a pouch sucks. Having a normal, but smaller stomach seems a much better solution.

Do you happen to know what they use as the cut off when the say "high BMI" patients having different outcomes. I have read this elsewhere but have been unclear on what the cut off is to be considered "high BMI" for purposes of these studies.

[Tiffykins 673]

I have Tricare Prime, and we are located in Central Texas. Ft. Hood is the closest Military base next to us, and because my husband is retired military, I'm not able to be seen there due to the amount of people they already have on their installation. I can understand that. What I think I need, is the procedure code for the VSG. Thanks for your help.

JJ

If you're near Ft. Hood, you should find out if they'll take you for the sleeve, or at Lackland at Wilford Hall. I know of three retiree wives that have all had VSG performed at Ft. Hood (2) and 1 at Wilford Hall.

[bowlinJJ 0]

I appreciate your help much. I'm trying to work things out so that I can have the sleeve. We shall see.

JJ

If you're near Ft. Hood, you should find out if they'll take you for the sleeve, or at Lackland at Wilford Hall. I know of three retiree wives that have all had VSG performed at Ft. Hood (2) and 1 at Wilford Hall.

[Tiffykins 673]

Tiffkins, thank you for that very informative post.

What really struck me is the "pouch" comment. That clicked since having a pouch sucks. Having a normal, but smaller stomach seems a much better solution.

Do you happen to know what they use as the cut off when the say "high BMI" patients having different outcomes. I have read this elsewhere but have been unclear on what the cut off is to be considered "high BMI" for purposes of these studies.

The sleeve began as a stand alone because it's the first stage of the duodenal switch procedure. Surgeons would perform the sleeve, and then follow up with either RNY or DS for the malabsorptive component. However, results were so fabulous with VSG alone, patients stopped coming back or didn't need the 2nd staged procedure.

High BMI is typically over 60. BUT, with that being said, there are several (8-10) high BMI patients on OH that have gotten to a healthy BMI with the sleeve only. It took them 12-18 months, but they didn't need the 2nd stage.

My BMI starting with the sleeve was 49 so I was technically considered a heavyweight, and had great success with the sleeve.

That information I posted is older than the newer studies that were released late last year. And, they have honed their technique and bougie sizes have become more standardized with a 32-40fr used for longest success. Anything over a 42-48fr was so showing a higher incidence of regain at 2-4 years out, and that's why surgeons went smaller on the bougie to ensure full dissection of the fundus.

[CowgirlJane 14,259]

Well, you are definately a great example for me to see just how successful I could be too because my current BMI is 49. I think you are younger (I am 47) and I know individual results may vary , but it is still so encouraging to see how obviously successful you have been! I am trying to start reducing NOW so that when the band comes out and I am waiting the sleeve I can hopefully lose a little... and at least NOT gain. At 5'5", my normal weight should be something like 135-145 range, but I would be estatic, positively estatic if I could maintain a weight of around 160... I mean, that would just send me over the moon with joy.

I was wondering if I fell in the catagory of the "high BMI". It is amazing that people reach the weight they are gonna hit in that 12-18 months even when there is so much more to lose.

My surgeon uses the 38, which I think falls in the range of normal for the best results so i am happy with that.

Thanks again! I have spent some quality time at Pub Med reading through studies, but it is so wonderful to have such an nice summary punctuated with your own personal experience!!!

The sleeve began as a stand alone because it's the first stage of the duodenal switch procedure. Surgeons would perform the sleeve, and then follow up with either RNY or DS for the malabsorptive component. However, results were so fabulous with VSG alone, patients stopped coming back or didn't need the 2nd staged procedure.

High BMI is typically over 60. BUT, with that being said, there are several (8-10) high BMI patients on OH that have gotten to a healthy BMI with the sleeve only. It took them 12-18 months, but they didn't need the 2nd stage.

My BMI starting with the sleeve was 49 so I was technically considered a heavyweight, and had great success with the sleeve.

That information I posted is older than the newer studies that were released late last year. And, they have honed their technique and bougie sizes have become more standardized with a 32-40fr used for longest success. Anything over a 42-48fr was so showing a higher incidence of regain at 2-4 years out, and that's why surgeons went smaller on the bougie to ensure full dissection of the fundus.

[Tiffykins 673]

Well, you are definately a great example for me to see just how successful I could be too because my current BMI is 49. I think you are younger (I am 47) and I know individual results may vary , but it is still so encouraging to see how obviously successful you have been! I am trying to start reducing NOW so that when the band comes out and I am waiting the sleeve I can hopefully lose a little... and at least NOT gain. At 5'5", my normal weight should be something like 135-145 range, but I would be estatic, positively estatic if I could maintain a weight of around 160... I mean, that would just send me over the moon with joy.

I was wondering if I fell in the catagory of the "high BMI". It is amazing that people reach the weight they are gonna hit in that 12-18 months even when there is so much more to lose.

My surgeon uses the 38, which I think falls in the range of normal for the best results so i am happy with that.

Thanks again! I have spent some quality time at Pub Med reading through studies, but it is so wonderful to have such an nice summary punctuated with your own personal experience!!!

40something is NOTHING chickee ! ! ! You'll do fabulous. . . I had a goal weight of 150lbs, and went below to my maintenance weight of 125-130lbs so anything is possible with the sleeve. I'm hoping once Tatum arrives that I'll be able to drop and maintain back around 130lbs. My husband prefers me with a little more curves, and cushion. After all, he married me at 270, so he definitely likes more fluff that what I was carrying at 120-125lbs.

[Frustr8 7,886]

Hmmn?

[elcee 3,341]

Interesting topic as I have a band that is no longer helping and am looking at revision.

I know very few people with an RNY but I have heaps that have sleeves:-

I have a friend that lost very little with her sleeve and now weighs more than before she started.

Her husband had a sleeve and lost heaps but he now seems to have regained quite a bit too

I have another friend that has a sleeve and whilst she is still very slim she has started to regain - probably due to the fact that she loves chocolate and family sized packets of crisps.

I have a friend that was considering having a band over her sleeve - not sure what she did.

Then there are a number in my band support group that have revised to sleeves but still seem to be pretty overweight.

So in summary a lot of the reasons that people here said were contrary to getting an RNY seem to be equally applicable to the sleeve.

The only thing that is certain is that long term weight control is very complex and an ongoing battle.