Long:What You Need to Know When Considering WLS of any Type

First off I want to put it out there that I am not an expert, medical professional and speak only to my experience and what I have learned over the last 3 years of investigating and finally deciding to have WLS.  This is not aimed at deterring anyone from their choice of surgery, but is intended to offer up a perspective on the pre-op mindset most people seem to have before a decision is made regarding which surgery to have.

Prior to even researching a particular type of surgery, I lurked on this site for close to a year and a half.  I read posts about all types of WLS and the WLS complications and WLS failure boards.  At the same time, my brother was in the process of getting his lap band approved and our god-daughter had RNY surgery...so I had a bit of information coming to me via their experiences.  My daughter's SIL has had her band for about 6 years...so had her as a resource as well...although she, until recently had only one fill, but had lost about 50% of her EW.

My opinion of WLS was this: There are 4 choices and they all work equally well...some have more complications than others and some are a more difficult recovery than others.  My choice was going to be based upon the lower post-op complication rate and how difficult the recovery might be...

I thought I was informed and understood how each surgery worked and what the risks were...I was wrong.

I didn't truly understand how a AGB worked until just before my surgery.  I realized shortly before my surgery that this was going to be a lot of work and require me to diet in one fashion or another for the rest of my banded life.  This didn't concern or deter me, since I saw my band as a way to support my diet program and to help me to maintain. 

It hasn't been easy at times and it is difficult to see others who have had the other types of surgeries, lose all their excess weight within 6, 9 or 12 months and post their photos...but I wasn't focused on losing all my excess weight in a short period of time...a 60 year old body cannot handle that much nutritional deprivation and with my skeletal issues, I was not going to be able to tolerate bone loss and connective tissue losses that can occur with malabsorptive surgeries. 

My doctors and I agreed that there were two options for me AGB or VSG and at the time I applied for pre-authorization, the VSG was not covered by my insurance (I have a BC/BS MedAdvantage plan) and my surgeon was not offering that surgery.  Since Virginia Mason was the only medical facility accepting Medicare patients AND a Bariatric Center of Excellence (required by Medicare, not that I think it is a special distinction) it was my ONLY option for surgery, covered by my insurance.  This is how I came to choose my surgery...more or less by default.  I had the option of having RNY, but honestly, it was never a true option for me.

If I were to make this choice today, I would choose VSG simply because of the follow up care the band requires and the potential risk of my band failing later on...that isn't to say that I regret my choice, because I don't.  I am a very pragmatic person and understand that when I make a decision, it is based upon the situation at the time.  Could I have waited 6 months and then had the VSG???  At the time, I made my choice, I was not aware that it was going to be an option...one thing about WLS, it is evolving, quickly.  What any one of us decides today is not necessarily what we would decide a year from now or even a month from now...so I don't get hung up on the coulda, shoulda, wouldas...

Now hear this...

Surgery will be painful, more for some than others.  You will suffer from gas, incisional pain, gastric disturbances and the after-affects of general anesthesia (which is significant).  You will never return to your pre-op anatomy 100% regardless of deciding later to be reversed, revised or any other modifications that you may choose to endure.

If you have upset menstrual cycles, leg pain, left shoulder pain or a pain in the ass....it won't necessarily be because of your particular surgery.  Any surgery in which the abdomen is opened can cause you problems down the road that may or may not be able to be resolved with or without medical intervention.

Chances are you will lose a significant amount of hair.  This is not due to malnutrition, but to the general anesthesia which screws up our hair growing schedule and causes up to 75% of our hair follicles to go temporarily dormant.  No supplement in the world can prevent hair loss post-op, and the amount varies from 0% lost to 75% lost over a period of 3 months to a year.

No matter what surgery you choose, there will be requirements that are inconvenient and sometimes minor complications that can be frustrating.  If you suffer from inconvenient or minor complications, count yourself lucky and appreciate the small price you are paying for a vastly improved long term outcome for your general health.  Some are not so fortunate as to have minor inconveniences and minor complications and suffer serious long-term and sometimes life-threatening complications that cannot be easily resolved, if at all.  Whether that person has your type of surgery or not, they deserve your consideration and sympathy...and support.

There are no guarantees with any of the surgeries that all your EW will be lost and that it will stay off...I read every day on all the boards about individuals who haven't lost much at all...or have lost it all and gained it all back and more...in that respect it is a crap shoot.  When I have had other surgeries, I have been told various % of failure, death, disabilty due to my surgery.  I have never gone into surgery expecting my surgery to return me 100% to physical health...

Scar tissue happens with any surgery.  How much scar tissue you form is largely dependent upon your genetics.  Adhesions happen with any surgery (less with lap procedures than open) because any time air is introduced and our tissues become drier, they tend to stick to each other forming adhesions.  It used to be very common to form them following any surgery and re-operations to remove them were common.  When I had my hysterectomy in 2002, my doctor told me my abdomen was full of scar tissue and adhesions and caused the surgery to take longer...this was from my bilateral ectopic pregancy in 1979 when the surgery was emergent due to both pregnancies rupturing my fallopian tubes and almost killing me.  I didn't expect the same outcome as I would have had the surgery been done with a bit of notice and not at midnight.

I guess the point of this is to let you all know that what ever you choose, you must go in with both eyes wide open as much as possible.  Don't get so focused on a surgery date that you lose sight of all the days after your surgery.  Don't be the "bride" who is so focused on the WEDDING that she forgets about the MARRIAGE.  Take a little more time to truly hear what people are saying and weigh it carefully.  This is a big decision...

Thank you for reading...I know it is a long post.

Steph

Very good post Steph.

I chose the lap band for some of the same reasons you did.  I was and am afraid of malabsorption and I suck at vitamins.. If I had to take any more than I do now, I would be gagging non stop.

VSG wasn't in the radar at the time and wasn't covered by my insurance.  I do remember only wanting to hear the good and thinking that problems happened to other people.  Frankly, at that time in 2005 2006 the horror stories that we hear now were not beginning to surface.

It didn't turn out well for me, but it wasn't as bad as it could have been.  I was fortunate to have an ins. that would cover the revision to the VSG although they didn't cover it as a first choice surgery.

The reason some of us are so adamant about warning newbies that are seeking advice is that we want to help them make an informed choice.  I especially think back to myself with rose colored glasses firmly strapped to my head.  The band was nothing like I thought it would be from the glowing stories of others.

I am glad to see that even successful bansters are now warning of some of the pitfalls and complications regarding the band.

Thank you Phyllis...if we only had a "crystal ball" to tell us what will happen later on.

Excellent advice Steph. I hope people take the time to read this and ponder it. I too had only 2 choices that my insurance would cover and I decided that at 52 I did not want to deal with the malabsorption and other things that went with the RNY. Just my personal choice I have friends that have had it and was very happy with their outcome I just didnt think it would be right for me. My youngest daughter is now thinking of having WLS and she is leaning more toward the sleeve. Whatever she decides I will back her on it. Probably if my insurance would have allowed it I would have gone with it too. I must say I am very happy with my band so far will I be in the future I dont knowBut for now it was the choice for me. Have a good day

Thanks Anna, I would direct my daughter towards VSG if she needed WLS also. 

Well said thank you for the insight Steph it's greatly appreciated and taken to heart.

Shelley Belley

Very well put!

 Steph, that was a great post. Not one word too long.

Thank you...I appreciate your feedback.

This should be stickied somewhere on the forums.