VSG vs Lap Band

Can anyone tell me the difference (as far as the rate of losing weight) between the VSG and the lap band?  I am just curious if the weight loss rate is faster, slower or the same. What about recovery time?  how does it compare? My insurance doesn't cover the VSG at this point but I have 6 months before I can surgery anyway so I am hoping that They will cover it by then if it's a better option than the lap band.  I know I don't want the by pass and I am not looking forward to having to get the fills and unfills with the lap band.  I will if I have to but so far the VSG sounds a little easier. 

 

A Prospective Randomized Study Between

Laparoscopic Gastric Banding and Laparoscopic

Isolated Sleeve Gastrectomy:

Results after 1 and 3 Years

Jacques Himpens, MD; Giovanni Dapri, MD; Guy Bernard Cadière,MD, PhD

Department of Gastrointestinal and Obesity Surgery, European School of Laparoscopic Surgery,

Saint-Pierre University Hospital, Brussels, Belgium

Background: Laparoscopic adjustable gastric banding (GB) is the most popular restrictive procedure for obesity in Europe. Isolated sleeve gastrectomy (SG), is less common, but more invasive and with a higher learning curve. The aim of this prospective randomized study was to compare the results of GB and SG after 1 and 3 years of surgery.

Methods: 80 patient candidates for laparoscopic restrictive surgery were operated consecutively and randomly, between January and December 31, 2002, by GB (7M, 33F) or by SG (9M, 31F) (NS). Median age was 36 (20-61) for GB versus 40 (22-65) for SG (NS).

Median BMI was 37 (30-47) for GB versus 39 (30-53) for SG (NS). After 1 and 3 years: weight loss, feeling of hunger, sweet eating, gastroesophageal reflux disease (GERD), complications and re-operations were recorded in both groups.

Results: Median weight loss after 1 year was 14 kg (-5 to +38) for GB and 26 kg (0 to 46) for SG (P<0.0001); and after 3 years was 17 kg (0 to 40) for GB and 29.5 kg (1 to 48) for SG (P<0.0001). Median decrease in BMI after 1 year was 15.5 kg/m2 (5 to 39) after GB and 25 kg/m2 (0 to 45) after SG (P<0.0001); and after 3 years was 18 kg/m2 (0 to 39) after GB and 27.5 kg/m2 (0 to 48) after SG (P=0.0004). Median %EWL at 1 year was 41.4% (-11.8 to +130.5) after GB and 57.7% (0 to 125.5) after SG (P=0.0004); and at 3 years was 48% (0 to 124.8) after GB and 66% (-3.1 to +152.4) after SG (P=0.0025). Loss of feeling of hunger after 1 year was registered in 42.5% of patients with GB and in 75% of patients with SG (P=0.003); and after 3 years in 2.9% of patients with GB and 46.7% of patients with SG (P<0.0001). Loss of craving for sweets after 1 year was achieved in 35% of patients with GB and 50% of patients with SG (NS); and after 3 years in 2.9% of patients with GB and 23% of patients with SG (NS). GERD appeared de novo after 1 year in 8.8% of patients with GB and 21.8% of patients with SG (NS); and after 3 years in 20.5% of patients with GB and 3.1% of patients with SG (NS). Postoperative complications requiring re-operation were necessary for 2 patients after SG. Late complications requiring re-operation after GB included 3 pouch dilations treated by band removal in 2 and 1 laparoscopic conversion to Roux-en-Y gastric bypass (RYGBP), 1 gastric erosion treated by conversion to RYGBP, and 3 disconnections of the system treated by reconnection. Inefficacy affected 2 patients after GB, treated by conversion into RYGBP and 2 patients after SG treated by conversion to duodenal switch.

Conclusion: Weight loss and loss of feeling of hunger after 1 year and 3 years are better after SG than GB. GERD is more frequent at 1 year after SG and at 3 years after GB. The number of re-operations is important in both groups, but the severity of complications appears higher in SG.

The Lap-Band leaves your entire stomach in place so as long as you chew really good (or drink lots of liquids) you will be able to get lots of food through the band and fill up the otherside of the stomach.  With the VSG you only have a 3-4 oz stomach. Once you eat 3-4 oz. you are full and you have to wait until your stomach digests that into your intestines before you can eat again.  The result is that most Lap-Banders have the ability to eat more than a VSG person and therefore have slower weight-loss. Also, when you first get the band it is not filled. It's not until about a month later that you get a fill and it could take several months until you get the right amount of fill to give you the right restriction. Meanwhile, VSG folks are losing most of their weight within the first 6-9 months.  Frankly, the whole fill thing is a pain in the butt. WIth the VSG you have it done and then you are back to a normal schedule and you forget about it. I heard someone on this board refer to her band as a "tempermental toddler" ...you never know when it's going to act up.

Trina, We are seeing close to 60% excess weight loss at 6 months with sleeve.  It takes our band patients about 2 years to lose that much.  So the band is definitely slower.  However it's also a lower risk operation.  I wouldn't hold your breath on insurance coverage for sleeve in 6 months.

Thanks for the response.  I would definitely love to have the VSG instead of the band, but I can't afford to self pay.  My daughter had bypass in Nove 2006 but she has had some problems and I am too big of a chicken do to that.  I won't hold my breath on the insurance but I can keep my fingers crossed. 

Hey Dr. Curry! I'm Dr. C's (Cirangle) One week old patient. I just wanted to let you know that I think it's great that you check out the board once in awhile.   I LOVE MY SLEEVE!   

There's another consideration that has bothered me about the band, and maybe you can straighten me out on this.  I am 48, and hope to live another 40 years!  Would I be able to trust the band to hold up that long, or would I be going back in for surgery again and again to have parts fixed and replaced?  I am pretty set on the sleeve anyway - I like the fact that once it's done, it's done, no fills, no fuss.  But this concern is one that I don't see discussed much, and it really did weigh on my mind.  Thanks, Dr. Curry!

Thats exactly why I would rather have VSG in stead of the band... I don't want to have to worry about going back in for surgery to have it removed someday if something goes wrong with it. 

Dr. C......I just read this post and it gives me hope. I lost my band due to esopheageal spasms and am terrified to get another, although the ins will pay for that or an RNY (I am already vit defecient) Does this sound like something that could be done and not be considered ins fraud? I asked to self pay the sleeve part when they removed my band that they said that would befraud.

 "I am sleeved, WITH a Lap Band.  The reason is two fold.  My insurance pays for Lap Band, but not the sleeve.   I had the lap band surgery and self paid the sleeve portion of the surgery.  $1715.00"

Mechelle Johnson

Who said it was fraud and why?  Was it the timing of the surgeries?  Or the fact that you were having a removal at the same time. I would imagine if you want to self pay a sleeve, it wouldn't be fraud if it wasn't being done at the same time as the band removal.   My sleeve was done at the same time as the band, and I DID get the band.   If it is fraud, I was unaware, and I doubt my doctor would have risked his relationship with the insurance companies and his reputation by doing fraudulent procedures.