Lap-Band vs. Sleeve - How did you decide?

Hi Sandy.

I see in your signature that you're a "band educator".  As a fellow educator, I do hope that you take your ethical standard seriously regarding competence and using outdated material (not only research, but testing materials as well...should that apply).  In any case, your statement that gherlin is "closely linked to depression" is not only faulty, but to put it simply...it's just bad science.  Correlation NEVER equals causation.  In such a case, the medical and psychological histories of all participants in a study would need to be documented and analysed to conclude that any type of correlation is present. Moreover to make statements such as "I know so-and-so and other so-and-sos and after their sleeves, they were all depressed".  To say the least, personal experience does not equate to science either. 
For the sake of argument, I will not assume a hidden agenda nor will I assume a direct attempt to mislead the OP.  However, for your future reference, here is an article from 2008 regarding this subject (with ALL bases covered..i.e. "good science"):

Ghrelin and Eating Disturbances in Psychiatric Disorders.
Authors:
A. Schanze¹
U. Reulbach¹
M. Scheuchenzuber¹
M. Gröschl²
J. Kornhuber¹
T. Kraus¹

Source:

Neuropsychobiology; 2008, Vol. 57 Issue 3, p126-130

 Appetite and eating behavior are frequently altered in psychiatric patients. The newly discovered gut-derived neuropeptide ghrelin simulates hunger and weight gain. Therefore, it might be involved in appetite regulation during psychiatric disorders. Methods: In 83 depressed, 42 schizophrenic patients and 46 healthy controls plasma ghrelin levels were measured, and the psychometric scores on the Three-Factor Eating Questionnaire (TFEQ) were assessed. Results: Neither ghrelin levels nor TFEQ scores differed between both patient groups and healthy subjects. However, TFEQ subscale 2 (disinhibition) was predicted by BMI-corrected ghrelin levels, while age, sex, smoking, and medication did not show any influence. Discussion: Ghrelin correlates with factors of eating behavior, specifically with subscale 2 on the TFEQ. Ghrelin might be involved in appetite-regulating pathways during psychiatric disorders. However, its influence is not likely to be displayed as a difference between diagnostic groups. Rather, ghrelin is associated with eating behavior in psychiatric patients meaning susceptibility to eating problems. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

In other words, there was no difference in ghrelin levels between the "healthy controls" and the "clinically depressed".  Therefore, no link is present.  Again, this is 2008 research.
I'm also sure that as an educator, you realize that scientific, peer reviewed literature is the only way to base such statements. And, as an educator, I'm sure you realize that the internet is no place to find such literature.

Again, please be sure to base all statements as supported by research.  Ethically, it's essential.

Hi, Sylvia - thanks for your input!

I respectfully disagree that the internet is "no place to find literature." ALL scientific reports and research is archived and available.

I just concluded the international Sleeve Conference, and will give a report this evening or tomorrow (30 slides to upload)  and include many of the slides shown after i get them into an onine place. People may then make their own conclusions. to me, the depression link is quite clear.

One thing I did learn was that the portion of the stomach left with the sleeve now is less than the old DS sleeve, so malabsorption is clear, and old DS results do not apply very well.

The best to you-
sandy r

Sandy - you state that malabsorption is clear with the gastric sleeve.  Malabsorption happens because of rerouting of the intestines - NOT reduction in stomach size.  The absorption takes places in the intestine (those first 18 inches).  So malabsorption is NOT an issue in people with the sleeve.  Now - malnutrition is possible with all 3 surgeries if you don't eat properly and get all your protein and vitamin supplements in.  Each surgery has its own risks - it sounds to me as if you yourself are against anything other than the lap band - remember it too has risks.  As an educator, you should be sharing information regarding all 3 surgeries, and not trying to convince anyone of one particular surgery.  It is up to each person to look at the benefits and risks of each surgery, and make up their own mind.  They should not be influenced by one person's opinion.  We all know or have heard of people who have had horrible complications from all the surgeries.  But we have also heard of or know of people that have done tremendously with all three.  Not all surgeries are suitable for all patients.  But let the surgeon and the patient make that final decision.

Sorry, but malabsorption is VERY VERY  MUCH an issue.
The current recommendations as of march 2008  are to supplement VSG patients EXACTLY as if it was a bypass.

A great many of the hormones removed when the stomach is removed are essential for nutrient absorption. it's not at all true that absorption takes place only in the intestine. they are finding clear deficiencies in A, D, selenium, zinc, calcium, iron, and more,
I was surprised too, but please wait for the information I will post as soon as I get all the slides uploaded. Please see these striking results re EWL, safety, malabsoption and more before repeating very outdated informaton.

I am never trying to "convince" anyone. I simply share my perspective, as do others, and will  present very objective facts and clear slides from the International conference on the VSG. I state repeatedly that people must research well and decide for themselves.

sandy r

Your perspective is seriously flawed Sandy - and anyone going over to the sleeve forum will see that for themselves.   They will have to look hard to  find anyone who is unhappy with their sleeves, and for myself, as a failed (eroded) band to sleeve revision - there is no comparison between the two surgeries..  

I am healthier than I have ever been - I can eat everything including meat, fresh fruit and vegetables and my labs at 9 weeks out are excellent. as are those of some who are more than 2 years out.   My depression following my band failure has gone since my revision.   In New Zealand I can't find any depressed sleevesters, because they just don't have problems.   I helped set up a band support network here in NZ 2005 and here is an overview of the original members of our group.

Out of a group of 12 of us *****main friends and who were banded from April 2005, I had the least success because the locking mechanism had failed, I had a port replacement and eventually lost my band to erosion where 90% of my band ended up inside my stomach.   Two girls (Was just one initially until four weeks ago) suddenly lost restriction  after months of having no fills, thought surgery would be to repair a faulty port or floating tube- turned out the band had failed and was replaced, one has developed a hernia above her band and was spiking temps since her surgery, she was aspirating stomach acid iinto her lung while she slept, developed aspirational pneumonia and is now unfilled and waiting for removal of her band.   Of the rest, two have struggled to continue losing and are still grazers and fluctuate between being able to eat too much or being too tight and suffering reflux BUT the junk food still goes down.   One of those  is now considering a revision.   The remainder are very happy with their bands, 5 are very happy with their weight loss and are at their goal, and the others are maintaining but would like to lose more.   All except 2 trek back and forwards for fill adjustments as required.   Most can overeat and constantly search for food if the fill level is not right.   None of the girls now have long term confidence that they won't have a problem with their bands in the future.    Now.......unlike my band friends, I can eat practically anything, food does not get stuck, and I am losing slowly and steadily!   So there you have my personal  study based on all of our experiences!  

Paul Cirangle has done a 5 year study on the sleeve and it has been available for some time.   I suggest you check it out especially since your other study relates to less than 3 years. 

Honesly - I now  have serious doubts about trusting any information coming from you about the sleeve, and I cringe when I think that people who are asking for an unbiased opinion about what surgery to choose, are being misinformed by someone who has a lapband.

Marion

So how exactly is 50-60% ewl over 5 years the best chances at permanent weight loss, when the RNY is 75% and the DS is 85% ewl over 5 years?

And on the depression thing -- I'm 3 yrs post op from my DS (same sleeve since you don't educate on that), and I'm the hap, hap, happiest person this side of the funny farm. 

Sandy...
Reading your posts, and "bitting my tongue through most of it", (It is my personal Observation)
"I Believe You Are Crazy As A ****house Mouse."
And I think you do more damage than good.
I have been sleeved for almost a year now.. And No depression at all... Everyone i know who has been sleeved.. ( and I know quite a few ! ) Guess what... NO DEPRESSION !! ) The band on the other hand.. I know for a FACT.. MANY.. have had problems, and constant up keep with fills, Adjustments, and yes.. Dire medical Issues, and do you know what the revised to ??? 
THE SLEEVE !!!
Please stay in the ****house with the other crazies, where you can do No harm !!

DR FIELDING...did my band to sleeve conversion, so don't talk about what you DONT KNOW!

i HAD 2 FAILED BANDS WITH FIELDING, they are not one size fits all. Works for some, but I need permanent, no reflux, no fills, no erosion, no slippage, no throwing up.

BANDS, as ANY WLS, can be EATEN AROUND.

STOP GIVING THESE PEOPLE FALSE INFO!

AND IT TOOK YOU FIVE YRS TO GET TO GOAL???? SPEAKS FOR ITSELF!

The sleeve has actually been around for at least 20 years as part of the DS - that's longer than the lap band. It's being made a bit smaller when done as a stand alone, but other than that it's exactly the same. And there has been no report of high incidence of depression with the DS.
     People with the sleeve, whether alone or as part of the DS, do benefit from having much lower levels of ghrelin. No detriment due to loss of some other unknown, possibly nonexistent, stomach produced hormone has been found so far - and remember, it's been 20 years.
    Will the sleeve stretch out some? Sure. But never to where your stomach used to be.
    While some people have had great results with the lap band, many others have not done so well. The results in terms of longterm weight loss, on average, are not as good as RNY or DS. Longterm results for the sleeve are not yet known. So, while I can understand the urge for the least invasive approach, least invasive doesn't always get you the best results.
    I chose the DS because it has the best longterm results in percentage excess weight loss, maintaining that weight loss (so very important) and resolution of comorbidities. I knew going in that I would need to take vitamins and supplements for life, emphasize protein in my diet, and get regular lab work. None of these things has been burdensome. I have lost 100% of my excess weight and I'm very happy with how I eat (normal smaller meals) and the overall quality of my life. There are excellent 10 and 15 year follow-up studies available (you can pm me if you want to see them) demonstrating a low incidence of nutritional problems, and those that do occur are almost always related to noncompliance.
    Each of us has to figure out what we can live with. For me, I was unwilling to have any operation with a poor average percentage excess weight loss or a substantial risk of weight regain. I was willing to have my intestines "rearranged" to avoid those risks. Research all the options before making this huge decision. I am more than satisfied with my choice and hope you will be as well.

Larra

All of your posts have been a great help to me and I look forward to learning more.  I am really interested to hear what Sandy learned at the sleeve conference.

It's clear that there are admirers and detractors of every WLS and advantages and disadvantages as well.  In the end, as many have expressed, the decision is a personal one.  The best thing I can do is to educate myself about the options.

Amy