Studies and Reports

[Stacey Nicole 40]

I have been reading a lot and making sure that this procedure is the right one for me. I also want to write down as many questions as I can come up with for my surgeon consultation next week. I am worried that there is very little documented after 3 to 5 years after surgery since this is so new.

However, this is just part of what they do when they perform a duodenal switch and that procedure has been successful since the 70's. Right?

Will I wake up one day and say "What have I done?!!!" Will I need that portion of my stomach at any point in my life? Is this going to cause issues later on?

I understand that most moribly obese people die from something related to that so I might as well take a jump into a healthy life.....I am just worried.

What convinced you that this was the right thing for you? What questions did you ask your surgeon that you think I might want to? Am I CRAZY??

Any advice would be greatly appreciated:)

[LadyIvy 159]

You are not crazy. This procedure is new enough that you have to weigh your costs and benefits. You have to accept the fact that you are going to willingly become a bit of a scientific guinea pig. I made sure that I took the time to research both the good and the bad possibilities that come with this surgery. There are so many unknowns right now it is pretty scary. One of my major concerns regards what will happen if I ever get stomach or esophageal cancer. They usually use stomach tissue for repairs and I won't have any to spare. There is also the hormone called gherlin that you are removing massive quantities of along with the stomach tissue. However, right now I have BP problems and cholesterol issues. My father died of complications with both diabetes and his heart and my grandmother died of congestive heart failure. When I factor these personal considerations into the possibilities it becomes clear that being overweight is so much more dangerous for me. What is good about this surgery is that while I have found some people experiencing "buyers remorse", when everything is said and done, I have yet to find one person that says that they would not do it again. This is why it is such a personal decision. Keep researching while you are waiting for a date. You will know if it is right for you. I have a million questions for my surgeon when the time comes. You are not crazy and should ask every question you feel needs answered (and maybe more than that for good measure). Good luck in your decision making. You will meet lots of nice people on here who have all thought about this in depth. I hope you get all the answers you need to find your peace

[CowgirlJane 14,259]

I have two big concerns. The first is reflux/GERD. Now, I know not everyone gets it, and most people who do get it can control it with drugs. A nightmare scenerio for me would be to have a lifelong problem of uncontrolled/partially controlled reflux. What a nightmare scenerio - and a sizeable minority of sleeve patients have some degree of reflux. Anyway, there is some disturbing indication that people 3-6 years out start seeing an increase in that problem. My second big concern is leaks. I am a revision from the band, and have a higher risk of leaks. What is scary is that leaks are always bad, but some people's journey to recovery is especially hellish and long (like a year!!!). I have tried to pick an experienced surgeon and doing what I can to minimize the risk, but I had the band for a long time so have mounds of scar tisue. It is very hard to get an actual risk percentage for a revision patient, but it is more then 1%, the published rate for "virgin" sleevers, probably less then 10% rate based on what I hear. I have never seen a published study on the rate for revision patients though.

In the end though, when i look at my overall situation... I realize that i am pushing 50, pre-diabetes, i have sleep apnea, i have arthritis is both knees and my feet are killing me.... if I keep this weight on I have a very very high chance of dying way too young and suffering alot from my comorbidities in the meantime. Heck, I am already suffering from joint and back (and feet!) pain.

when you do the total risk assessment, for my situation, it seems like it is worth it to gamble on the sleeve and hope like heck I am in the majority that don't have major issues. I am looking forward to resuming being active in all the things I LOVE to do. It will be alot easier after i have lost 100-140 pounds.

[iegal 460]

Sorry - no matter how much research you do you still will have an emotional moment of - "What have I done", just like that new hairstyle, home or car purchase or other. Logically - write a list of why you are doing this so you can remind yourself in that moment. I can lie to tell you the road is always easy with a sleeve. No, there are struggles.

So when will you know this is right. When you decide you have hit the final point of no return. I can remember walking around with a strong resolve to NEVER be higher weight than what I was again. The surgeon did not convince me with all my questions, I convinced me. I needed the sleeve to save me from me. food was not the enemy, I was the enemy. Still a foodie just no longer a non stop eater.

Why was this right for me? I have two close friends how have Gastric/RNY and nope, would not want to have those "experiences". Also, I am scared to death of needles so the fills of a band quarterly rules that surgery out. Plus, my surgeon said VSG was a better choice than Banding but he would put in a band if that is what I decided was for me.

What is best for you? Fills, reroutes or restriction? No one has all the answers, at some point you must step out in faith to trust yourself. Hugs! I love my sleeve and have no regrets.

[Tiffykins 673]

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

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

Sorry for the craptastic formatting, but I'm too lazy to take out all the little funky "Font" thingies.

Pre Op /The Op

If self pay - What does your fee involve?

Is there some follow up care thrown in there, like labs at 3,6,9 and 12 months?

Pre op diet � what to eat/drink and how long for?

Do I get a nutritionist/psychologist?

What size bougie is used? (This is the medical instrument which determines the size of your remaining stomach)

Do you oversew the staple line?

How many incisions do you make?

Do you go in thru previous scars?

How many nights in the hospital � is there facility for someone else to stay in my room as well?

Do they need to be with me 24/ during my hospital stay?

How many leak tests do you do?

How many sleeves have you performed?

Complication/leak stats? How many if any deaths?

Who do I contact if I think I have a problem (most places give out an emergency number)?

Is the hospital equipped an ICU and blood bank in case of complications?

If complications do happen to occur, are these complications/additional surgery/days in hospital covered by the original quoted price of the surgery?

Would you remove my gall bladder at the same time if needed?

Can you give me some patient testimonials or do you have any before/after pictures of your patients that I could read/look at?

Is it standard operation procedure, ie: no nail polish, no body jewellery?

Do I need to stop taking any particular medication pre op? (Take a list of what you take and dosage)

Post Op

How often are the post op check ups?

Where are they? � is price included?

What supplements/anti acid drug would I need to take and for how long?

Do I need labs done post op? � Are these checked with you or my local doctor?

DO I get a dvd of the operation?

Post op diet?

How much weight would I be expected loose?

What if I loose too much, how to maintain?

Do you use heparin? � Will I have to inject it myself?

How soon after the op can I��drive, swim, work out, lift weights, lift my kids?

[Tiffykins 673]

And, partial to full gastrectomies have been performed for stomach cancer and ulcer patients, those patients have other issues with having a diseased organ, however, most are able to live very normal, fully functioning lives without most or all of their stomach.

Personally, I don't miss my stomach. I have good Portion Control, I eat normal foods, lost all my weight, and knew for many reasons that VSG was my answer.

I recommend perusing over to Obesityhelp and checking out the Revision board and look at how many complications and revisions are being done for RNY patients.

I don't think you are crazy, you're in the research stage, and you're doing great. Think twice, cut once.

You deserve the best life possible especially when choosing surgery.

I never had buyer's remorse or thinking "oh sh*t what have I done?" I knew what I had done, and I knew the rewards would pay off.

[RickM 1,747]

You are correct that the VSG is part of what has been done in the DS for quite some time (though the stomach for the DS is usually made a little larger than is done for the stand-alone VSG,) which can be an advantage if your selected surgeon has good DS experience, as there are quite a few around who have been doing DS's for 10-20 years as opposed to some who are just now adding the VSG to their RNY practices.

The longer term effects of the stand alone sleeve are not as well known as the more established procedures, but most of the problems that are seen with the DS are with the intestinal part of the procedure or incompatibility of the common channel length to the individual's metabolism (too much or too little malabsorption - not the easiest thing to determine ahead of time), or intestinal adhesions causing problems later on. I know quite a few DSers (have been going to their support meetings for about eight years with my wife who had one) and even those who have had problems are still glad that they did it - it is better than the problems of severe obesity. That said, many of them are also older and delayed having surgery until there was little choice (their health had deteriorated so much) and all wish they had done it sooner. However, being younger than most, you have a lot more time to live with your decision, so taking the "minimal change"option of the VSG makes a lot of sense. While it does permanently remove part of your stomach, it also leaves more options for the future if something stronger needs to be done; while we don't like to thing of such things as needed, a revision to a DS is fairly straightforward with the sleeve, while revising an RNY to a DS is a complicated procedure for which only a relative few surgeons are really qualified.

Adding to Tiffy's great list of questions and considerations, I would add a couple more. On the post op diet front, some surgeons overlay a very low carb diet on top of their VSG - this is appropriate for some, not so appropriate for others. It's something to ask about and consider relative to your own experiences and needs (I'm sure glad I didn't have to put up with it, and am healthier as a result.)

Also, there is a wide variety of pre- and post-op diet schedules - some docs have patients do a couple to several weeks of pre-op dieting, sometimes extensively liquid, sometimes requiring a certain amount of pre-op weight loss, while other docs have no such requirements. Likewise, post-op, some programs are heavy on liquids for weeks before moving to mushes, soft Proteins and ultimately real food while others start out with mush and soft Protein in the hospital. This are not real big deal in the overall scheme of things - this is a long term health benefit we're after here - but makes a difference in the overall experience and are worth asking about and preparing for.

Good luck, and it's great you're getting on top of this problem early!

[Stacey Nicole 40]

Thanks do much for all of the information everyone - I appreciate it!!