At 370 lbs... is VSG or DS better?

I saw this article also. I believe DS would have been a better choice longterm, though she is certainly doing well so far. And I agree about her surgeon's self-serving comment about the VSG being the best operation available. But hey, at least is wasn't all about the magic, gold standard RNY. That's a nice change.
      I hope her success will continue. At present, she's still in that honeymoon phase with strong restriction. That won't last forever. If she succeeds in maintaining the low calorie, small portions, low fat, low carb diet, she'll do well. I believe there will be some people who do well longterm with VSG, but what percentage that will prove to be remains unknown. Other purely restrictive operations have not panned out. Time will tell.

Larra
   

As a sleeve patient, I'd agree that at her weight the DS would probably have been a better choice, but it was likely not an option offered to her.

We do have patients on the sleeve board lose down from those kinds of weight, so it's not unheard of. It also sounds like she got a nice tight sleeve since she's still only eating a couple ounces of food (that's what I can eat at 6 months). There are a lot of odd sleeves being made that allow much bigger capacity and since they leave more gastic fundus, a lot of room for stretch.

Since the sleeve is a restrictive surgery, extra fundus = room for stretch = regain.

Even so, the odds are stacked against SMO sleeve patients. The most successful sleeve patients start from BMI below 50. Any time I see a SMO poster asking about the sleeve, I always recommend they seriously consider a DS.

I'm quite happy with my VSG - I'm 80% of the way to goal and still losing an average of 2 to 2.5 lbs a week. The VSG does lose slower than DS on average due to no malabsorption, but I don't think 90 lbs in 6.5 months (I lost 23 on pre-op diet) is precisely slow. I expect to make goal easily in the first year with 144 lbs to lose.

There are trade-offs between the VSG and the DS. I am an advocate of the DS for many patients, but for those who are a good candidate (starting BMI around 50 or below, not too damaged metabolism and volume eaters rather than grazers *no serious eating disorders need apply*) I think the sleeve is a great procedure.

There's no surgery, in my mind, that's the best for everyone (on the other hand, there's certainly one that ought to be outlawed because it's the worst for everyone).

Edit to add: You know those folks you get on here who just don't seem capable of the follow-up care they need to have with a DS and you guys yell at them and they just don't get it? I sometimes wonder if they, even if not a good candidate as described above, might not be better off losing less weight with the sleeve as most sleevers can get away with that kind of head-in-the-sand thing. I just don't know how you identify those folks ahead of time.

I saw that, and was shocked that they did a restriction-only procedure.  The good news is that in some time, if necessary, a full DS revision could be done.  That doc doesn't do and probably doesn't know much about the DS anyway.

If I was under 400 as a start weight, I would have done well with a VSG. But starting at 640 it has been really hard. My lowest was 472 and then I bounce back up to 480, then I lose a few and jump up a few.. It is doing my head in.  My surgical team won't listen to me. I've "maintained" for over 6 months (I'm 14 months out)  I lost about 160lbs....which is great, but I am stuck and NEED the DS, but when I inquire with my team they just pat me on the back and say what a great job I have done.  But yeah, if I was 370, I'd do the VSG, but then again I have no real disire or need to be thin, I just want to be active.