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

Amy, kudos for your search. As a newbie on here, I feel sad that our differences are being aired here. Of a truth, every WLS has advantages and disadvantages. Every person who travels this journey makes his decision based upon how those advantages, etc. fit with their lifestyle. As you can tell, the 4 surgeries I am aware of--RNY, Lap, DS and VSG, the folks representing each group are passionate about their decisions. I pray you find what will work for you and bring health and happiness to you.

Also, when you are researching, there is a "regrets" board, that is a good place to go to see what some of the disadvantages are. Also, you can do a search for "regrets, lap band"; or "regrets, VSG" and find info there.

Good luck on your journey.

Amy,
Good for you for doing your homework.  Take your time and make sure you're confident about what will be the best option for you.  Given that you are SMO (as I was), do pay close attention to how much of your excess weight you can expect to lose, and how much you can expect to keep off. 
A key statistic here is average %EWL (% of excess weight lost) for each procedure.  Yes, there are some people who do really well with each WLS, just as there are some people who do really poorly.  But most of us end up living somewhere in the vast middle ground in between, so I encourage people to make decisions based on what they can realistically expect - and that means look at the averages, and not just the success stories and failures.
I chose the DS because I needed to lose at least 150 lbs., and the DS gave me the best odds of losing most of my excess weight and not regaining.  I know there are people who love their bands and get to goal.  But my concern about the band (especially for us SMO folks) is that it has the lowest average %EWL of all 4 major WLS procedures.  On the LapBand forum, there's a table summarizing the stats from a number of studies:
http://www.obesityhelp.com/forums/lapband/lapband_system_can didates.html
For me, I saw that if I had an average result with the Band, I would end up still 70 to 90 lbs. overweight, and that was definitely not for me.  Am I saying you shouldn't get the Band?  Of course not!  But do give yourself plenty of time to consider your decision - there's a lot more to choosing a WLS than most of us realize at first.  I recommend you take some time just reading posts on each of the forums.  You'll get the best possible picture of what it's like to actually live with each procedure - the problems, the benefits, the day-to-day eating/living/coping - as well as the successes and the failures.  And here's a comparison chart from the website of my surgeon, *****gularly does all 4 procedures:
http://www.lapsf.com/weight-loss-surgeries.html
The awful thing about being self-pay is, well, you have to pay for it.  But the upside is that you get to decide what you want, without an insurance company butting in.  So take advantage of that freedom.  Decide what will be best for you, and then figure out how you can make it happen!  And do stop by the DS forum if you want to learn more about the DS:
http://www.obesityhelp.com/forums/ds/a,messageboard/board_id ,5357/
Best of luck with your journey!

~~Post Date: 10/7/08 12:49 pm
Hi, Amy - I'm attending a conference this afternoon on the sleeve and will share what i learn.

I choose the band because I wanted the best chance at permanent loss, I did not want to cut out most of my stomach, and I know that removing much of the hunger hormone, ghrelin, has serious side effects. since low ghrelin levels are closely tied to severe clinical depression, this concerned me.

Obesity itself is already closely linked to depression, and i don't think we need added risk. some people I know with the sleeve are extremely depressed, not getting help from their psych meds, not handling divorces well, unable to work, and engaging in very unbalanced behavior online.

and  I also feel that we don't know nearly enough about the other hormones produced in the stomach to be just chopping them out for the sake of temporary weight loss with the sleeve. I'd like to see several years of much more complete research before people flock to the sleeve. Remember, people all flocked to the bypass at first too, and we now know some of the very poor stats and outcomes.

The sleeve pouch is also likely to stretch out in time, just as the bypass pouch does, unless one can SELF limit to tiny meal - and this is exactly what I could not do by myself before. I need the band's help! Many of the top bariatric surgeons, including Dr fielding, will not do sleeves for this reason.

there are more than a few people who had a band here, got a sleeve later, and are not doing well at all. ALL the WLS procedures require the very same things from us - much better eating, much better activity,  hard work on the food and eating issues, and many mental changes and lifestle changes - and forever. People fail all procedures if they do not take these things to heart. I felt that, since I had to do the same work to succeed longterm, I wanted the safest and least invasive procedure, one that did not remove most of my stomach, and one that i had more control over.

more later after the conference - I'll add it in this post .

sandy r
band educator
at goal 4.75 yrs~~

What a complete and utter load of crap.   You seriously don't have a clue what you are talking about.

Sandy, you might want to learn a bit about what you "claim" to educate others.  You have no idea what you are talking about.  If you are basing your "opinions" on outdated, proven wrong studies, you simply look silly.

Feel free to continue pretending to educate others about how papaya enzyme kills, WLS causes cancer, and all the other assorted nonsense you post.  But stay clear of sleeves, you have no idea.  You are posting outdated info previously proven incorrect and claiming it is some mystical conference you attended.  Either you are lying through your teeth YET AGAIN, or you are going to crappy informational seminars.  Personally, I think your seminar is a bit too convenient.  I mean com'on... seriously, who would invite you to an informational seminar?

Cheers, cutie!

Amy,
One thing to keep in mind is the upkeep, especially if you are going self pay.  A friend went to Mexico to have the lapband surgery -- and found that to get her fills she had to drive 2.5 hours to a doctor that would do that without performing the surgery.  This meant taking the day off work, when she needed a fill.

The Fill, according to her, cost $400(although I've seen less posted here).  She quickly found out that besides the 2nd mortgage she had taken on her home, the loss of 'vacation' days to get her fills, gas, and cost of the fill itself, was more than she expected.

She had to stop getting her fills, and has stopped losing weight, far before goal. 

That was why I chose to go another route.  I choose the sleeve, insurance said no, approved RNY, accepted their decision..went to sleep getting the RNY and woke up with the sleeve...due to internal issues once my surgery started.

I wish you the best of luck in your decision and whatever you choose...

Amy, congratulations on doing your research. I would like to encourage you, however, to do independent research regarding all WLS options, but particularly about the sleeve, not because I am trying to make a case that it is better than other procedures for all patients, but because Sandy's information specifically regarding the sleeve is false and misleading on too many levels to go into here.

You are most welcome to join us on the VSG board (and I am sure the same would be true re RNY and DS) for objective information, links to studies, personal experiences (mostly good, but there are a few people who have had problems and who are encouraged to talk about them openly in a supportive and helpful environment.

Hi Amy!

ditto what Ros-Mari said, she is 100% right.

when I was deciding which surgery to get I kept hearing the band was adjustable, like that was a good thing.  I just don't understand that. People have to get fills/unfills to adjust it in the search for good restriction. 

VSG gives you good restriction right from the first and you don't have to have anything adjusted. To me, that is much better.

any WLS can fail you if you eat around it. that said, the sleeve leaves you with a stomach - a  normal, fully functioning stomach - that is not a stretchy as the pouch you get with a band.

*disclaimer* I've never had a band so can only speak for a sleeve. but here is something I took into account for my decision. Dr. Pleatman was not my surgeon, btw, I'm just passing on what he said:

What are the advantages of the VSG over the LapBAND?

With the VSG there is no foreign body to break, slip, or erode. There is nothing to be adjusted. Reoperation rate for these complications is therefore eliminated. You don't need to worry about getting follow-up care if you move to another city.

Weight loss is faster and more reliable with the VSG. The feeling of fullness that you get from the VSG is much more satisfying than the feeling of obstruction or discomfort that you get with the LapBAND. Few patients vomit after the VSG, while many patients continue to have vomiting episodes long after they have their LapBANDs placed.

What are the disadvantages as compared to the LapBAND?

The LapBAND is reversible; the VSG is not. Unfortunately this turns out not to be much of an advantage of the LapBAND, as the only reason to remove a LapBAND is for complications.

http://www.laparoscopy.com/pleatman/vsgfaq.htm

Hi, I am revising to the VSG from the band in November with Dr. Aceves in Mexico.  I had the band 4/3/07.  My BMI was only 40.  The band has never been a good "tool" for me.  It is different for everyone.  In my experience, I could not eat protein when I had a good fill.  I would get stuck constantly and throw up daily.  Now...every band person will say, "You ate too fast, didn't chew well enough, and ate too much!"  Wrong...my doctor said the band was just not for me.  Period.  My fills were easy, but had to go often, fill...unfill...fill...unfill.  I started to finally have terrible heartburn and couldn't take it anymore, I had the band removed 8/19/08.  I feel this was the best decision for me.  After reading many, many posts I am seeing tons of people that originally had the band revising to the sleeve.  So that is the route I am taking to a healthier life.  I, like you, wanted the "easiest" surgery, as in not messing with malabsorportion or my intestines changing.  So that is why now I am getting the sleeve.  I am not saying that any surgery is better than any other, I am saying the band was not for me.  PLEASE...read all you can and research and you will figure what is best for you.  You can PM if you need any other info. on my situation.  Jenny

One thing everybody who considers the lapband needs to take into account is that the lapband can and often enough does cause a lot of scar tissue in the stomach, which makes reversions much more dangerous or even impossible. You can`t just remove the band and things are as they were before - the band can do lots of damage to the stomach and the esophagus, too.

In reference to "SANDY"   this is absolutely ridiculous information. For someone to love their band so much that they want to sway everyone to get it is one thing. But to provide horrendous information about other surgeries that people may be considering is unacceptable. people come here for help. nothing but facts should be stated so that people have a fair choice when making their decision. For someone who is a so called "band educator", well then educate on the band and do not discuss other surgeries you obviously know nothing about. If you have a band and you're happy with it, why do you even care about the other ones. what is your motive?? You should be banned from this site, just as you have been banned to practice as a nurse in some states. Simply put, you are full of crap!!!! How do you sleep at night? Makes me wonder if your band is too tight and restricting nutrients to your brain!! Gee whiZ!!

Hi Amy!

I am 16 months post-op with my sleeve and I am a bit biased since it is such an awesome tool.  There are pro's and con's with all WLS, but for me the sleeve had many more pro's and con's for MY situation.  I started out with a BMI of 77 I'm 5'2 and was 425 pounds.  I started out researching the lap-band for all the same reasons that everyone else does.  Least invasive, adjustable, reversible...

But realistically, for someone my size...  I don't think I could have been as successful.  The idea of being so tethered to something, i.e. fills, unfills, refills, threat of erosion, slippage, blockage, productive burping, sliming...  I just couldn't do it.

I thought that a bypass of some sorts would be my only option.  Then I found the sleeve.  It has proved to be an awesome tool. 

I wanted to make a few things clear though.  Reading through all of the responses that you've received, I just felt the need to clarify...

~Any surgery can be defeated.  Each (band, sleeve, DS, RnY) are only tools.  You have to decide to make the life changes that go along with whichever tool you choose in order to be 100% successful.  These surgeries fix your stomach...  not your head and habits.

~Yes, the sleeve can stretch...  Never to the capacity that it was before.  The portion that remains is the lean, most muscular, least stretchy part of the stomach.  BUT if you push the limits and overeat often, then yes...  your stomach will stretch.  My surgeon gave me a 3 oz stomach.  I try not to over eat, but at 16 months I can eat 4oz of solid food at a time....  So stretching by an additional 1 oz isn't that big of a deal to me.  Just makes me feel like I can eat more normally...  which I feel that I do.

~Yes, malabsorption is a risk with the sleeve.  In your stomach is the Intrinsic factor (google it).  This is important to the absorption of certain vitamins such as the B vitamins.  It is easy for a sleevester to become deficient in B vitamins if you don't supplement.  But this is easily corrected with additional B vitamins either in shot form or sub-lingual vitamins.  (you may also want to look up the correlation between Vitamin B deficiencies and depression...  There is a link between the 2, which could be what Sandy is referring to...  Depression meds wouldn't work for those people because it's possibly a vitamin deficiency...)

Please keep researching...  Knowledge is power. 

If you have any additional questions, please don't hesitate to ask!!!
~Lauren~