Undecided - please read on

[mandarin1383837820 7]

Hello to all! I am new to this forum as I am trying to get every bit of information I can before deciding on WLS. First I thought the band is for me, but after months of reading about it I knew it is not gonna happen. So sleeve seemed as the next "level", and of course I want to know about the complications. So I was reading on the RNY forum, to see why they chose RNY over the sleeve, and one of the member made this comment:

" My surgeon's biggest issues with the sleeve is that it is a newer procedure and there is data out there with people having leaks two years down the road- he doesn't like that and neither did I." (here is the link: http://www.rnytalk.com/topic/8641-what-made-you-chose-rny-rather-than-sleeve/ )

And I was like WHAAAAAAAAAAT???? Does anybody know anything about this???

Also I have found this great article about complication percentage ect http://asmbs.org/2012/06/sleeve-gastrectomy-as-a-bariatric-procedure-update/

Oh my, such hard decision...

Any input please?

[Brighteyes 237]

Hello to all! I am new to this forum as I am trying to get every bit of information I can before deciding on WLS. First I thought the band is for me' date=' but after months of reading about it I knew it is not gonna happen. So sleeve seemed as the next "level", and of course I want to know about the complications. So I was reading on the RNY forum, to see why they chose RNY over the sleeve, and one of the member made this comment: " My surgeon's biggest issues with the sleeve is that it is a newer procedure and there is data out there with people having leaks two years down the road- he doesn't like that and neither did I." (here is the link: http://www.rnytalk.com/topic/8641-what-made-you-chose-rny-rather-than-sleeve/ ) And I was like WHAAAAAAAAAAT???? Does anybody know anything about this??? Also I have found this great article about complication percentage ect http://asmbs.org/2012/06/sleeve-gastrectomy-as-a-bariatric-procedure-update/ Oh my, such hard decision... Any input please?[/quote']

I specifically asked my surgeon how long was I at risk for a leak. If I remember correctly he said 6 weeks. Don't quote me, but I remember being surprised at how quickly I would heal. He explained it further saying that your stomach heals similar to your skin. If you cut your arm once it heals then you're not at risk for that to reopen. Same concept. I am sure my surgeon could explain it better. I took what my surgeon said at face value. If you are really questioning it I am sure there has to be some studies done that you can read in different health journals. Best of luck to you and your decision.

[sonya139 95]

I did a lot of research and you are not in danger of a leak after about 6 weeks. That's why you're on liquid, full liquid and puree diets. Once you're on solids you are no longer in danger of leaks. You're more prone the first few weeks.

[notmeanymore 629]

Im sure when you go on the RNY site they are pro RNY just like here at VSG we tend to be pro VSG (with the exception of those with complications of course). To the leak comment, I was told by my surgeon that after 2 months leaks are pretty much unheard of. But you do your own research and get the facts (not gossip or opinion but facts) on both to help you with your personal decision. Whichever you decide, I wish you the best outcome

I did my research as well and chose VSG because of the lower risk of complication as well as not having to worry about malnutrition. I need the restriction as a tool. Plus I wasnt comfortable having my intenstines re-routed. Its what works for me.

[kathp 81]

Good luck as you make your decision. I was more afraid of the band (foreign object, twisting/slipping) and RNY (rerouting insides, dumping, etc) than I was of the sleeve. Yes, it's permanent, but my surgeon is always saying we don't need such a large stomach because we're not cave people who hibernate!

The sleeve has been out there for more than 2 years. It's just been covered by insurances for a shorter amount of time. And it used to be step 1 of two for heavier people on the path to RNY, before they determined it could stand alone. (that's my understanding, from my research). So, I am not worried about developing a leak in the future because a) my surgeon used stitches instead of staples (which would have scarred over anyway) and I didn't eat seeds, even on fruit, in the first 6 weeks, so there's nothing trapped in there going to be festering or anything (I'm imagining a splinter working it's way out, and know that I followed the rules and am good).

Everything has risks, but it seems to me this 2 years out leak thing is a crock.

[Nurse_B 270]

I too was leaning towards the band. I went to a consultation in town and discussed with a surgeon the options and the risks. After a lengthy chat and some research on my own, I believe the sleeve is best for me. I have about 150 pounds to lose, I don't want to have to be in my physicians office all the time getting a fill or getting it taken out. I want to have the surgery and heal, and be good to go physically. I have also researched numerous places and have asked several surgeons about the time frame for a leak or major complications. All seem to agree the first 60-90 days is when the biggest complications arise. There are many people on here who have had complications, yet still are thankful for the sleeve. I am just awaiting a date, but I look forward to finally living the life I have dreamed about. Good luck to you!

[SeriouslyChange 319]

I was on the fence about the 2 as well. I'm 24 without children. What made me choose the sleeve was that when I have children, I want to be able to bake gingerbread Cookies for Christmas, decorate them, and eat. I want to cook and teach my daughter how to cook and be able to taste her first cake or brownies.

I don't indulge in sweets now. But I don't want to have to worry about dumping and not be able to enjoy my life in moderation. I am also a bit lax about Vitamins and RNY is strict about Vitamins.< /p>

I love my sleeve and am happy with my decision

[CowgirlJane 14,259]

i think that thread has many great points but i have never heard of leaks years out in any study.

i am happy and healkthy with the sleeve

[mandarin1383837820 7]

I am thanking everybody for their input. I agree with all of you, and really truly I think the sleeve would be the best for me - I am horrible on taking supplements and the thought of losing my hair also scares me.

However, I was further investigating as that comment on the RNY forum just bugged me, and indeed there are late sleeve gastrectomy leaks. It is rare, but it happened before. I am posting the link, and I am not doing this to scare anybody away but for everybody to read on and know even though most likely it will not happen, but it can unfortunately....

I'm just gonna have a long talk with my doctor and see what he thinks...I am bummed now...:/

Late Sleeve Gastrectomy leaks and its severe consequences

Two patients developed late EGJ leaks. One of them 10 months after a re-sleeve gastrectomy and the second one presented with a symptomatic collection 2 years after the LSG and multiple surgeries were required. Results: The first patient required a total gastrectomy after several trials of conservative management. The second patient required 7 laparotomies and died to his primary intestinal vascular pathology.

http://www.bmilatina.com/index.php/bmi/article/view/8

[PdxMan 4,292]

Well, I'm guessing there is some mis-information regarding the "leak after 2 years". Either she didn't understand what her Dr said, or the Dr had been mis-informed or was quoting a case which had other issues.

As has been mentioned, approximately 6 weeks post is the window where leaks can occur. This is the time when the stomach forms scar tissue over the staples which then completely seals the stomach. If your staple line hasn't healed over in 2 years, well, then ... you've got something else going on and would also have issues healing after bypass, so ...

As far as the diabetes cure rate of 60%, I have not heard of that either. A recent study with 25 GBP and 12 VSG patients indicates the outcomes are similar:

http://jcem.endojournals.org/content/early/2013/09/19/jc.2013-2538.abstract

which has held true for me.

I know my cousin, who got the GBP 3 years ago is struggling with weight re-gain. His sister has had all kinds of issues with bowel obstructions and malnutrition issues. As far as what Drs are telling you ... well ... a salesperson with red cars is going to tell you red cars get better gas milage ... know what I mean?

(they are going to sell you what they know ... just as I am )

[mandarin1383837820 7]

Indeed you are right. The patient had something else going on that's why the staple line did not hold. It's still scary :/

"On the second patient the leak happens very late, 2 years after the LSG. We have no notice of any such delay presentation and lead us to suspect that it may related to intestinal and mesenteric ischemic disease with narrowing since leaks reappeared in all the subsequent LT surgeries most likely unrelated to any technical defects but related to the patient vascular pathology that finally bled and after several transfusions lead to MOF and his death."

Well, I'm guessing there is some mis-information regarding the "leak after 2 years". Either she didn't understand what her Dr said, or the Dr had been mis-informed or was quoting a case which had other issues.

As has been mentioned, approximately 6 weeks post is the window where leaks can occur. This is the time when the stomach forms scar tissue over the staples which then completely seals the stomach. If your staple line hasn't healed over in 2 years, well, then ... you've got something else going on and would also have issues healing after bypass, so ...

As far as the diabetes cure rate of 60%, I have not heard of that either. A recent study with 25 GBP and 12 VSG patients indicates the outcomes are similar:

http://jcem.endojour...3-2538.abstract

which has held true for me.

I know my cousin, who got the GBP 3 years ago is struggling with weight re-gain. His sister has had all kinds of issues with bowel obstructions and malnutrition issues. As far as what Drs are telling you ... well ... a salesperson with red cars is going to tell you red cars get better gas milage ... know what I mean?

(they are going to sell you what they know ... just as I am )

Edited October 16, 2013 by mandarin

[PdxMan 4,292]

There are going to be risks in every surgical scenario. Each of us has to know our histories as far as how are bodies handle it. Myself ... I have had all kinds of surgeries and I respond well to healing. Never an issue with anesthesia, so I wasn't too worried. As you will find on many threads here regarding the risks, one of the risks I had to weigh was the risk of NOT having the surgery. I KNEW what was at the end of that tape when I played it all the way through.

There are folks for whom the GBP is a better option. For my opinion on this, PM me. I would post it here, but I'm afraid I do not have the literary tact to describe it in such a way where I would not come across as judgemental. I don't know exactly why, but when I write about a specific group of people, though I try not to, my posts are interpreted as being judgemental.

[7 Bites_Jen 479]

Leakage is almost impossible that far out - the scar line has completely healed by then, and has even fused together. I'm not sure the surgeon in question knows what he is talking about, LOL.

I chose the sleeve over any other surgery because of the lack of risk involved. If you look at the complications that come with every other surgery, the sleeve has the fewest risks. Also, it's not as new as some people think. It's actually the first stage in the duodenal switch. Leaks do occur, but not often and when they do they are caught fairly quickly. With other surgeries, you can have complications sometimes up to 10 years after!

[Madam Reverie 2,958]

I posted this a while back. Hope it helps.

"I posted this on another forum and felt it might be useful for other people to have a read of, if like me, you like your scientific facts.

Maybe the below will provide a bit of clarity as to the 'nuts and bolts' of some of the bariatric procedures and their long-term (within the limitations of the data) efficacy.

This first academic journal quoted was published in May 2013. So, it doesn't get more 'up to date' with regards to evaluating the comparative effectiveness in the three biggest weight loss procedures. I have only reproduced the abstract and have quoted the source below as the abstract covers the salient information we'd be interested in.

The second section is all about the metrics, with a snapshot of all the procedures being evaluated in a tabulated form (the table was removed from the cutting and pasting process, so read left to right) and the risks associated with the operations. The primary and secondary sources are also cited.

Better to make decisions based on rigorous scientific research, than hearsay and charasmatic sales pitches, I feel... Hope it helps.

Article 1:

Abstract: Objective: To evaluate the comparative effectiveness of sleeve gastrectomy (SG), laparoscopic gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB) procedures.

Background: Citing limitations of published studies, payers have been reluctant to provide routine coverage for SG for the treatment of morbid obesity.

Methods: Using data from an externally audited, statewide clinical registry, we matched 2949 SG patients with equal numbers of RYGB and LAGB patients on 23 baseline characteristics. Outcomes assessed included complications occurring within 30 days, and weight loss, quality of life, and comorbidity remission at 1, 2, and 3 years after bariatric surgery.

Results: Matching resulted in cohorts of SG, RYGB, and LAGB patients that were well balanced on baseline characteristics. Overall complication rates among patients undergoing SG (6.3%) were significantly lower than for RYGB (10.0%, P < 0.0001) but higher than for LAGB (2.4%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736) but higher than for LAGB (1.0%, P < 0.0001). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001), but was 77% higher for SG than for LAGB (34%, P < 0.0001). SG was similarly closer to RYGB than LAGB with regard to remission of obesity-related comorbidities.

Conclusions: With better weight loss than LAGB and lower complication rates than RYGB, SG is a reasonable choice for the treatment of morbid obesity and should be covered by both public and private payers.

SOURCE: Carlin A, Zeni T, Birkmeyer N, et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity. Annals Of Surgery [serial online]. May 2013;257(5):791-797. Available from: MEDLINE with Full Text, Ipswich, MA.

Article 2:

September 2012: Morbidity and mortality associated with LRYGB, LSG, and LAGB from the ACS-BSCN dataset

LRYGB LSG LAGB 30-d mortality (%) 0.14 0.11 0.05 1-y mortality (%) 0.34 0.21 0.08 30-d morbidity (%) 5.91 5.61 1.44 30-d readmission (%) 6.47 5.40 1.71 30-d reoperation/intervention(%) 5.02 2.97 0.92

SOURCE: Data from Hutter MM, Schirmer BD, Jones DB, et al. First report from the American College of Surgeons Bariatric Surgery Center Network: laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg 2011;254(3):410–20 [discussion: 420–2], in: Timothy D. J, Matthew M. H. Morbidity and Effectiveness of Laparoscopic Sleeve Gastrectomy, Adjustable Gastric Band, and Gastric Bypass for Morbid Obesity. Advances In Surgery [serial online]. n.d.;46(Advances in Surgery):255-268. Available from: ScienceDirect, Ipswich, MA"