NIH Recommends DS, but wanted VSG, help!

[Smye 694]

Hi All,

Several months ago my gastroenterologist of 5 years whom I trust suggested bariatric surgery. I've spent the time since abusing my access to scholarly journals through work and had initially settled on the sleeve. I've got an initial consult with the local sleeve expert surgeon 1 week from today. It's all he does and all he's ever done, I was so excited! I wanted the sleeve!

However, while continuing my obsessive research last night, I decided to look specifically at "super-obese" patients with a BMI between 50 and 60 (my BMI is 54.1) and what I found was devastating - according to the NIH, among the super-obese, the average EWL for VSG is 40-50% whereas the DS has averages of 70-90% in the first year and early studies suggest a much higher success rate at 10-years post-op.

Anyone here go through a similar experience? How have you handled it and what results have you had?

I am a teacher and can't qualify for a loan large enough to cover DS without a few years of saving just to qualify, but don't want to waste time and money on VSG if I'm only going to have to save for several years and take out a second loan later for revision to DS with only 40% EWL in the meantime.

I know DS is often done in two stages with VSG as stage 1, has anyone here done this? How does the cost and experience of doing it in two parts compare with doing the full DS in one fell swoop.

Thanks for putting up with this rambling post. I'll be posting in the VSG forum as well, please forgive the cross-post.

Edited January 1, 2015 by Smye

[Forsythia 882]

My BMI was in the 50s. I had a sleeve. So far I've lost over 100 lbs. Still have about 65 more to go. I'm almost 8 months out. I can't comment on a duodenal switch's results , but for me do far the sleeve have been fab. My diabetes is in remission, no more snoring. And I've exceeded my surgeon's weight loss expectations.

Not sure if there is anyone around on the boards to give you any data on the effacacy of either surgery for more than a few years post op though.

[VSGAnn2014 12,992]

I would be surprised to see the NIH actually *recommending* any single WLS over another.

Would you mind citing cite the study (studies? recommendation?) that you saw?

Thanks.

[Smye 694]

Thank you Forsythia,

Ann, you're right, I overspoke. The NIH itself does not per se, recommend DS over VSG, however I was looking at the following studies:

RYGB> VSG for super obese

VSG EWL rates for super obese

DS>RYGB for super obese - found on NIH (in tandem with the first link by the transitive property, it seemed safe to assume if DS>RYGB and RYGB>VSG, then DS>VSG)

And lastly, because I wasn't satisfied with the transitive proprty alone - staged DS > single-step-DS > VSG for super obese

I'm curious as to whether the staged DS (VSG->DS) is cheaper than the cost of VSG+DS.

[Inner Surfer Girl 12,015]

My understanding is that for many patients the sleeve worked so well that the second stage was not needed. That is why the sleeve is becoming more popular. It's worth talking with your surgeon about.

[VSGAnn2014 12,992]

Thanks very much for those study citations, @Smye.

In the first study http://www.ncbi.nlm.nih.gov/m/pubmed/24352748/ the big difference was that bypass patients lost more weight during the first year than VSG patients did. However, in all the long-term studies I've seen (I'll look for some citations) VSG patients' weight losses by the end of the second year post-op were the same as bypass patients' two-year losses. In other words, VSG weight losses catch up with bypass patients' weight losses during the second year. I was surprised to read, however, that super-morbid VSG patients had higher early post-op complication rates (22%) than did super-morbid bypass patients (9%); not sure what that's about.

The second study you cited at http://www.uchospitals.edu/news/2006/20060922-weight-loss.html was published in 2006. The study compared Roux-en-Y (gastric bypass) surgeries of super-morbidly obese patients to those of similar patients' duodenal switch surgeries. This study did one-year and three-year followups (which means the surgeries studied occurred no later than 2003-2006, and probably earlier). But the study reported that DS was much more effective after one year (83.9% vs. 70.4%) and after three years (84.2% vs. 59.3%). Wowzah! Very impressive.

The third study you cited at http://www.ncbi.nlm.nih.gov/m/pubmed/22791102/ reviewed patients' whose VSGs were conducted a helluva long time ago (2002 - 2004). All those patients had originally planned to do the VSG as a first stage and then go on to a bypass, but for various reasons they did not. And they all had big bougies (50F), which I suppose didn't matter, since all the patients thought they'd be going on to a bypass; nonetheless, very few surgeons these days use such large bougies (most use 36F these days). Their long-term results were followed between 38-95 months post-op. BMI decreased on average from 66 to 46. Personally, I think this study population and their surgical conditions differ considerably from typical VSG patients' surgical conditions these days.

The fourth study cited at http://www.ncbi.nlm.nih.gov/pubmed/22498357 studied French patients at a university hospital there. The study compared patients who went through "staged" surgeries (patients first had a VSG and later had a DS surgery) vs. patients who had the entire DS procedure in a single surgery. A third group emerged--patients who after having a VSG never completed the DS procedure. The follow-up was pretty short-term (averaging only 13 months post-op) and showed average excess weight loss for 50.8% for VSG-only patients; 72.7% for the staged, 2-step DS patients; and 73.3% for the single-DS surgery patients. I think this study proves only that VSG patients, on average, didn't lose as fast as the DS patients. But (as we all probably agree) the long-term results are what we really care most about.

FYI, there's a relatively new Duodenal Switch forum here at BP. I've not spend much time there, but I've seen some DS patients bragging about "how much better" the DS is than the VSG. I've also seen some VSG to DS switches among those folks.

And I've seen some really big folks (on this and other online forums) lose 100% of their excess weight after VSG surgery.

Final comment: All these studies cite averages of study samples. They don't describe the best results obtained by some patients.

Again, thanks for citing these studies so I could review the abstracts. Good stuff.

And best to you.

Edited January 3, 2015 by VSGAnn2014

[sjules 27]

Good info. Keep doing your research and make the best decision for You. Also, go to www.dsfacts.com for additional info on the DS.

[BLERDgirl 6,417]

My doctor said that expected weight loss for VSG was 50 -60% of total body weight but that it would be a slower rate. I'm only 3½ months out but so far I am happy with the sleeve. It did the thing I need most. it somehow put into remission the other issues I had that were cause me to fail repeatedly. I had already changed my eating and was working out regularly. It's just that every time I got sick I regained the same 35 -50lbs. Since my surgery I have not had an allergy attack. I rarely went a week without one prior to surgery. I'm not sure how or why, but I'm very happy this happened.