Sleeve Science...A Summary of Some Current Research.

[CoffeeGrinDR 148]

Mostly I wanted to see what the medical literature has to say about VSG and dying. Turns out, it's pretty darn safe - but don't take my word for it, I'm not a medical doctor. Just sharing some research.

KEY FINDING: LAP-BAND FAILS 44% OF THE TIME.

This study finds that the LAGB failed as a primary bariatric procedure for 44% of patients due to either inadequate weight loss or adequate weight loss with unmanageable symptoms. This suggests that the LAGB [lapband] should be abandoned as a primary bariatric procedure for the majority of morbidly obese patients due to its high failure rate.

Kindel, T., Martin, E., Hungness, E., & Nagle, A. (2013). High failure rate of the laparoscopic-adjustable gastric band as a primary bariatric procedure. Surgery for Obesity and Related Diseases.

KEY FINDING: SLEEVE REDUCES GHRELIN AND IS MORE SUCCESSFUL THAN GASTRIC BANDING.

As a consequence of resection of the gastric fundus, the predominant area of human ghrelin production, ghrelin is significantly reduced after LSG but not after LAGB. This reduction remains stable at a follow-up 6 months postoperatively, which may contribute to the superior weight loss when compared with LAGB.

Langer, F. B., Hoda, M. R., Bohdjalian, A., Felberbauer, F. X., Zacherl, J., Wenzl, E., ... & Prager, G. (2005). Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obesity surgery, 15(7), 1024-1029.

KEY FINDING: LSG IS SAFE AND EFFECTIVE (as far as we know in the short-term).

Results: Of the 62 patients who underwent LSG performed by two surgeons, the data of 30 patients (7 males and 23 females) were further analyzed. Mean preoperative BMI was 41.4 (33-59) kg/m2. Mean operative time was 80 min (range 65-130). Mean hospital stay was 3.2 days (range 2 to 25). Mean weight loss at 3 and 6 months following the procedure was 22.7 kg and 30.5 kg respectively, and mean % excess weight loss (EWL) was 40.7 and 52.8, respectively. Three patients were considered to have mild complications, and one patient had a major complication that necessitated surgical intervention. There was no mortality. Conclusions: In the short-term, LSG is a safe and effective treatment option.

Roa, P. E., Kaidar-Person, O., Pinto, D., & Rosenthal, R. J. (2006). Laparoscopic sleeve gastrectomy as treatment for morbid obesity: technique and short-term outcome. Obesity surgery, 16(10), 1323-1326.

KEY FINDING: Even 5 years out sleeve gastrectomy is effective to fight obesity.

Five years after performance of SG, weight loss was satisfactory, few complications were observed, the reduction of co-morbidities was significant, but there was an increase in the frequency of GERD.

Fuks, D., Verhaeghe, P., Brehant, O., Sabbagh, C., Dumont, F., Riboulot, M., ... & Regimbeau, J. M. (2009). Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery, 145(1), 106-113. (Conducted in France)

KEY FINDING: Gastric sleeve works on its own, the weight stays off, and the ghrelin doesn’t come back in the first 5 years.

At 5-year follow-up, a mean EWL of 55.0 ± 6.8% was achieved, indicating that SG leads to stable weight loss. Beside significant weight regain, severe reflux might necessitate conversion to gastric bypass or duodenal switch. After an immediate reduction postoperatively, plasma ghrelin levels remained low for the first 5 years postoperatively.

Bohdjalian, A., Langer, F. B., Shakeri-Leidenmühler, S., Gfrerer, L., Ludvik, B., Zacherl, J., & Prager, G. (2010). Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obesity surgery, 20(5), 535-540.

KEY FINDING: Meta-analyses indicate that while there are a small number of complications (mainly fistulas for BMI<60) people don’t die from sleeve surgery. (Canada, Korea, France, Israel, USA)

Behrens, C., Tang, B. Q., & Amson, B. J. (2011). Early results of a Canadian laparoscopic sleeve gastrectomy experience. Canadian Journal of Surgery, 54(2), 138.

Han, S. M. (2005). Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean patients. Obesity Surgery, 15(10), 1469-1475.

Nocca, D., Krawczykowsky, D., Bomans, B., Noël, P., Picot, M. C., Blanc, P. M., ... & Fabre, J. M. (2008). A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obesity surgery, 18(5), 560-565.

Rubin, M., Yehoshua, R. T., Stein, M., Lederfein, D., Fichman, S., Bernstine, H., & Eidelman, L. A. (2008). Laparoscopic sleeve gastrectomy with minimal morbidity early results in 120 morbidly obese patients. Obesity surgery, 18(12), 1567-1570.

Hutter, M. M., Schirmer, B. D., Jones, D. B., Ko, C. Y., Cohen, M. E., Merkow, R. P., & Nguyen, N. T. (2011). 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. Annals of surgery, 254(3), 410.

[Arts137 1,811]

Thanks for the summary AND the references!!!

[CoffeeGrinDR 148]

No probs, Arts. Research is kind of my thing, citations are just habit.

[Steamywindows 39]

Thank you! I would be interested to know if your search included any of the psychology -behaviour arenas?

[Arts137 1,811]

((((( coffeegrinDR )))))

[CoffeeGrinDR 148]

Steamy, it did. Psycho-social research tends to be much more difficult to draw clear correlations from due to the sensitive nature of things. What I found were some interesting (and at times confounding) outcomes. I'm happy to do another summary.

Basically, overall quality of life for WLS patients goes WAY up but there DOES tend to be higher instances of depression amongst WLS patients than the control population...

Here's where this gets "noisy" in statistical terms...we know that the reasons for our obesity/problems with weight are attributable to a confluence of factors, and none of them will be exactly the same for two people. The advice from what I've seen in the medical journals mirrors that of what many wise vets here say: the work is not just about the body, but the mind, and the heart.

I often think there needs to be a lot more done in terms of social and mental (and perhaps spiritual if that's your cuppa) support for healing than anyone in Western/modern medicine would ever want to admit. Some psychologists are finally wading into this difficult area. I read a book by Sara Stein, MD, that discusses her own personal struggle with weight (as a psychologist) and it is reassuring. That book is called "Obese From The Heart" and it is helpful but it is a beginning to a much LONGER conversation. There are a few other books out there -- workbooks on emotional eating, self-soothing without food - but I haven't gotten into them yet. I believe in books that help you see into yourself but for some reason these sorts of works don't tend to resonate strongly with me (and yet I KNOW I am an emotional eater).

My plan is to see my therapist weekly and journal my experience and keep talking to you all. The one structured thing I plan to do is to document how I am feeling - how i would have responded before - and what my NEW response is. Classic cognitive behavioural therapy work...make the implicit habits explicit until you change them I guess.

I'll be back with a psych-lit summary later.

[Steamywindows 39]

That is really congruent with what I have read. Not that it is extensive...I know Geneen Roth has written a number of books. (Feeding the hungry heart etc )However I have not read them yet: I am uncertain of the evidence which she bases her work on. As complex as the issue is, I am very interested. Thank you so much for posting!

[CoffeeGrinDR 148]

True, I think Geneen Roth's work is good because it speaks to these issues but (forgive me, this is my humble opinion) she does a lot of pitying of the victim. And that just doesn't work for me. I want a structured recovery plan.

She is mostly repetitive in her books and I appreciate it takes a lot for most of us to open up to soft parts of our insides that have led us to this point but where is the next step?

I think that's why I find the forum here so helpful, these are people actively living the next step and living to tell about it from a place of strength.

Much love to everyone in their journey.

[Steamywindows 39]

I an wary of the pity issue....so will give that some thought. I think pity might be as useful as bitterness. Do you know the saying "bitterness is the acid you throw on yourself"?

[sleevedup 46]

You are awesome CoffeeGrinDR!!! Wow, very nice indeed!

[docbree 199]

Steamy, it did. Psycho-social research tends to be much more difficult to draw clear correlations from due to the sensitive nature of things. What I found were some interesting (and at times confounding) outcomes. I'm happy to do another summary. Basically, overall quality of life for WLS patients goes WAY up but there DOES tend to be higher instances of depression amongst WLS patients than the control population... Here's where this gets "noisy" in statistical terms...we know that the reasons for our obesity/problems with weight are attributable to a confluence of factors, and none of them will be exactly the same for two people. The advice from what I've seen in the medical journals mirrors that of what many wise vets here say: the work is not just about the body, but the mind, and the heart. I often think there needs to be a lot more done in terms of social and mental (and perhaps spiritual if that's your cuppa) support for healing than anyone in Western/modern medicine would ever want to admit. Some psychologists are finally wading into this difficult area. I read a book by Sara Stein, MD, that discusses her own personal struggle with weight (as a psychologist) and it is reassuring. That book is called "Obese From The Heart" and it is helpful but it is a beginning to a much LONGER conversation. There are a few other books out there -- workbooks on emotional eating, self-soothing without food - but I haven't gotten into them yet. I believe in books that help you see into yourself but for some reason these sorts of works don't tend to resonate strongly with me (and yet I KNOW I am an emotional eater). My plan is to see my therapist weekly and journal my experience and keep talking to you all. The one structured thing I plan to do is to document how I am feeling - how i would have responded before - and what my NEW response is. Classic cognitive behavioural therapy work...make the implicit habits explicit until you change them I guess. I'll be back with a psych-lit summary later.

Wish I could "like" this post twice. You are so articulate - are you an author? Cognitive therapy is a life saver.

Edited August 18, 2014 by docbree

[FairySleeve 297]

Thank you very much!

[Rovobay 920]

thanks for the info. happy that I chose the sleeve.

[Fireweed56 8]

I'm using bio-feedback and mediation as part of my journey tools with the help of my therapist. My surgery is still several weeks out there but wanted to begin working on my head hunger. Emotional eating is a natural response for those of us who have been stuffing our thoughts and emotions for years. I've begun peeling back layers and testing my vulnerability with close family and friends. More importantly I'm beginning a new relationship with myself and trying to find my true thoughts and feelings.

[annisa 31]

There is a great book my therapist recommended for me, ARE YOU HUNGRY? There also is a workbook for pts who have had the sleeve done. I bought both the book and workbook, I realize this in only a tool in my life changing chapter of my life. I am willing to learn and do all to be successful.