Lap-Band vs. Sleeve - How did you decide?
As a former bandster and now sleever, I feel comfortable with my research and decision to revise from band to sleeve. THe sleeve is so much easier than the band. No fills or band adjustments. No complications that I am aware of. I feel really healthy, definitely not depressed and working my way back to a healthy BMI. If your insurance doesnt pay for WLS, I would definitely consider the sleeve your better option. ONce the complications start with banding, it becomes an expensive venture. If you move to a different state, no doctor wants you as a patient. I was banded in the US in TX, moved t GA and couldnt get post op care here in my 5th year as a banded person. Very sad, but its a reality. THe docs dont want anything to do with other docs patients.
Babs
334/182/150
Wow, am I sorry you have been caught in the middle of the firestorm of crazy talk! I will not now, nor will I ever try to dissuade anyone from their choice of wls. I will however share my family experience.
My husband had his VSG in May 2006. He lost 120 pounds in 8 months, bringing him to around 200 pounds (he is 6'2"). He has stayed right around there for almost 2 1/2 years so far. He gets very intense physicals and labs as part of his fire dept yearly testing and he has never been healthier. His gout, sleep apnea, high BP, high Cholest, pre-diabetes and severe foot pain all resolved right away. He self-paid $17,000 + $3,000 in co-pays for pre-op testings at LapSF in San Francisco, CA.
I had my VSG in June 2007. I lost 94 pounds. I reached my goal weight of 150 pounds in 6 months and 1 week. I currently weigh 133 (I am 5'7") and I wear small tops and size 4 pants. I have had no trouble except for some mildly low iron, which I may have always had. I spent $10,000 + $420. for 2 roundtrip airline tickets to have my VSG with Dr. Alvarez in Perdre Negras Mexico.
We could not be happier with our results! My husband could have had the RNY or LapBand paid for by our insurance but for HIM these were not good choices. He felt that due to his very physically demanding job as a firefighter/emt he could not have the malabsorption of the RNY or the possible 'sticking' from the band (sometimes he has to wolf his food down in a hurry). We do believe that ALL WLS are good and can work if people make the choice that is right for them.
Continue your research and make a decision that really works for you forever...our eating issues are not temporary. Also, please be careful of annoynomous people who claim to know everything about all surgeries. Focus on facts from trustworthy sources and personal experiences from forum users.
married to Fireman John VSG 5/06 @ LapSF - 6'2" and 190 pounds
I am Thankful for all the Servicemen and Women because
FREEDOM IS NOT FREE
For those of you who feel there is no malabsorption, a better EWL at 3-4 years than the band or bypass, no relation to depression, or some of the other info I gave that some so hotly contested, I hope you will carefully read these reports and look at the slides.
For those who feel there is no foreign body to fail with the sleeve, Dr dixn reminded us that ever staple and every suture IS a foreign body, and the failure of staples is a very major risk.
for those here who claim the sleeve leaves a normally-functioning stomach, this is learly not the case, an there are serious ramifications.
For those who continue to disagree, which is surely your right, please talk with Dr. Dixon, Dr. Frezza, or Dr Weiner who did the studies and stand by the research and reports. DrWeiner has the most sleeve patients in the world, and the largest studies, by far.
I am only the messenger and learning from them. I hope you will do that with an open mind, as well.
Again, I urge anyone considering any WLS to research well and get the LATEST reports, research, and studies on ALL procedures, and not relay on hearsay or old, outdated info. Knowledge re wls procedures, especially the newer ones, is growing rapidly.
I try to "sway" no one. One of my best friends recently opted for a sleeve, and I am fully supportive. I do love my band, did well by following the guidelines pretty well, and simply present facts, like this conference. I try to base my opinions on the most current research, like the international conference last march and this updated info from dr dixon at yesterday's conference. Didn't see any of you there., as far as I know. I form my beliefs and others may form theirs.
the best to all of you. We are all in this weight loss journey together and such knee-jerk nastiness simply because I believe differently is very unwarranted and childish.
Sandy r
at goal 4.75 yrs
As promised earlier , here is the report from the International web conference I attended today on the Sleeve Gastrectomy. I will present all material exactly as stated by Dr Dixon, and people may interpret results for themselves. This is based on his presentation earlier this year at the First International Sleeve Gastrectomy in March 2008. conference
I will then give a link to a site with most slides that were presented. Interpret the data for yourselves.
Report on Vertical Gastric Sleeve Web conference,
Presented by Dr. John Dixon, Director of Obesity Surgery Research,
1. The sleeve is the “new kid on the block”, still experimental
2. No data available past 3 years, most only 2 yrs
3. Average weight loss at 1 year = 50%
Average weight loss at 2 yrs – approx 57%
Average weight loss at 3 years – 50% - less than band or bypass
4. Major complication is staple line leaks – a higher risk than with bypass
5. Safety of Sleeve is questionable
6. Late complications include:
Reflux
Stenosis – serious because there is not enough stomach tissue left to repair
Fistulas – serious because not enough stomach tissue left to repair
Malnutrition – very poorly studied, but clearly will be malnourishment
B-12 deficiency common
Wt regain clearly demonstrated
7. Dr Rudolf Weiner in
with his patients: 65% EWL at 1 year
45% EWL at 3 years – poorer than either bypass or band
These results presented at Conference in Argentina 2008, to be published Jan 09
8. Must treat Sleeve patients exactly as bypass patient
Vitamin and mineral supplementation exactly the same
Deficiencies demonstrated in A, D, B12, iron, Selenium, Zinc, Calcium, Protein, more
Link to slides with above information, shown as Dr Dixon was speaking and answering our questions.
share.shutterfly.com/action/welcome?sid=0IbOXLFqzZsnLw
Slides:
1. Report from first International Vertical sleeve conference, March 2008
Conference
2. ASBMS position on sleeve
3. Normal Ghrelin levels defend against depression
4. Conclusions re Sleeve - (put here for those who do not want to go thru every slide)
- results beyond 3 yrs unknown
- irreversible
- high rate of pouch dilation – second stage procedure is likely needed
- common and predictable nutrition problems
- re ghrelin – low levels do not affect longterm loss, but produce risk of anemia, muscle loss,
bone loss
5. Ghrelin related to depression
6. more on ghrelin re satisfaction, happiness, depression
7. Ghrelin – previously unrecognized function re mood regulation
8. Micronutrient deficiencies with sleeve : A, B 12, D, Zinc, Iron, Ferritin, Selenium, Folic acid
9. Post-op nutritional deficiencies are from stomach acid reduction with stomach removal
10. Post-op risks : removal of large part of stomach removes many cells that play important role
in nutrition
11. Risks of B-12, Copper, Thiamine, iron, possibly protein and calcium
12. EWL (excess weight lost) at 12 months – 51%-83%, average about 55% - depending on bougie size
13. Report of Wernike’s encephalopathy one week out
14. altered consciousness, patient converted to bypass
15. as above
16. Conclusions re nutritional deficiencies:
patients start out deficient
after surgery eat much less
additional risk from loss of stomach function and stomach surface
17. Nutritional deficiencies of Bypass (relates to sleeve in a minute)
protein, iron, Calcium, Vit B-12, D, B-1
18. Sleeve – Key Points #1
- most of stomach removed
- irreversible
- stomach is essential for growth and micronutrient absorption
- Sleev Gastrectomy patients suffer anemia and metabolic bone disease
- long staple line has significant risk of leaks
19. Muti vit supplementation inadequate
20. Sleeve – Key Points #2
- gastric remnant expected to dilate, then can get DS, Bypass, or Band
- durable weight loss has not been shown, regin is major risk
- revisional surgery carries major risk
21. Conclusions
- Results beyond 3 yrs unknown
- irreversible
- high rate of pouch dilation
- revision likely needed
- nutrition problems likely and predictable
- low ghrelin levels do not help lomg term los, but give risk of anemia, muscle loss, bone loss
22. Late Complications
- Reflux
- Stenosis – serious because not enough stomach tissue left to repair
- Fistulas – serious because not enough stomach tissue left to repair
- malnourishment
- B 12 deficiencies
- Weight regain
23.EWL – 1 year – 50%, 2 yrs – 58%, 3 yrs 56%, < 3 yrs 52% - less than both band and bypass
24. Risk of leaks with Sleeve is Higher than with Bypass
25. Complication results slides – only very small studies so far, rates expected to be even higher
26. Laughter about this Center doing only one case, and stating procedure is safe – from J Obesity surgery, 2008
27. Only one study in the world re data over 5 yrs – reports wt regain and pouch dilation
Final conclusions:
- SG is an alternative procedure
- Sleeve is the first of a 2-part procedure for most people
- Initial loss better than band
- Some support for Sleeve to be a single surgery
- Long term safety and durability unknown
DISCLAIMER: Any suggestions or comments are not intended as medical advice, but only as general information. Please always contact your own surgeon or his staff for any specific problems or concerns you are having. Although I have many years as a medical professional and band educator, I offer suggestions here only as an experienced Bandster.
I wouldnt personally ever consider getting any portion of my stomach taken off and as long as you obey the rules....the band will be fine...
It seemed to this newbie (as I dont consider my stint here before august an honest attempt here but that is another story) that there are many sleeve people coming into the lap band forum discussing how that is the best decision overall and the band is a waste...How about this
We all do what is best for us......Do your research and know that no one is going to make that decision for you...but please do read all data as all data can be interpretted differently...
No matter the surgery when/if you are successful you talk about it. I too encourage everyone to look realistically at THEIR lives and why they are obese and make the decision that they feel will suit their lifestyle and I pray that decision yields the long term benefits that they desire.
2 people can look at the same portrait and see different things...
Continued success.
Ms Shell
"WLS is only for people who are ready to move past the "diet" mentality" ~Alison Brown
"WLS is not a Do-Over (repeat same mistakes = get a similar outcome.) It is a Do-BETTER (make lifestyle changes you can continue forever.)" ~ Michele Vicara aka Eggface
While I chose not to have my stomach cut out, I chose to have a foreign object in my body....Get it? MY body....
And while there is a SLIGHT chance something can happen even if I do follow the rules, it is still IMHO a smaller risk than walking around without my own God given organs...
Ms Shell
"WLS is only for people who are ready to move past the "diet" mentality" ~Alison Brown
"WLS is not a Do-Over (repeat same mistakes = get a similar outcome.) It is a Do-BETTER (make lifestyle changes you can continue forever.)" ~ Michele Vicara aka Eggface
While I chose not to have my stomach cut out, I chose to have a foreign object in my body....Get it? MY body....
And while there is a SLIGHT chance something can happen even if I do follow the rules, it is still IMHO a smaller risk than walking around without my own God given organs...
I'm not bashing the band. My niece has one and has done great with it. But don't minimize the long-term risks of it. They are there and they are real.
HW - 225 SW - 191 GW - 132 CW - 122
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Actually with the proper Doctor performing the surgery and placing the stiches in the gastric wall exactly the way they are supposed to, the chance of slippage or re-operation is almost eliminated to the point of 3%. Most of those cases in that 3 % were because of patients not following therules of the band.
I would still say IMHO, that the band for me was the better choice due to the fact that I am not losing the organs I was born with to perform the functions they are supposed to perform to keep my body healthy long term
However, that 10-40% is not all slips. It is also erosions, port flips, port leaks, band leaks and other failures of the mechanical devise that a band is.
It's also over a 10 year period. You are no where near that far out so you still don't know if those things will happen to you.
As for losing part of my stomach, I'm happy for it to be gone. My stomach was broken. It was *not* performing as it was supposed to because it makes too much ghrelin. Obese people have at least 3x as much ghrelin as normal people. That is why we are always hungry.
HW - 225 SW - 191 GW - 132 CW - 122
Visit my blog at Fatty Fights Back Become a Fan on Facebook!
Starting BMI 40-ish or less? Join the LightWeights
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