I must have missed his first post...

Vertical Sleeve Gastrectomy can be converted to either a RNY or a DS.  The use of the Sleeve in larger patients as the first stage of a gastric bypass is outlined in this article from Medscape:

Two-Stage Gastric Surgery Safer for High-Risk Patients

Alicia Ault

April 5, 2004 — For high-risk obese patients seeking gastric bypass, it may be safer and more effective to first conduct a laparoscopic sleeve gastrectomy (LSG), and then perform a Roux-en-Y procedure later, researchers reported at the Society of American Gastrointestinal Endoscopic Surgeons annual meeting in Denver, Colorado, on Saturday.

Philip Schauer, MD, from the University of Pittsburgh Medical Center in Pennsylvania, presented results on the first 75 patients, who underwent a sleeve gastrectomy between June 2001 and July 2003. In the LSG procedure, a portion of the stomach is removed, and the remainder is reduced to about the size and shape of a banana.

LSG will cause many patients to lose weight, which could make them better candidates for the higher morbidity, higher mortality Roux-en-Y gastric bypass, Dr. Schauer told Medscape in an interview. The data appear to show that the sleeve procedure only causes short-term weight loss, so in most cases, the Roux-en-Y procedure will likely be required, he said.

Patients were aged 23 to 72 years and had a body mass index of 45 to 91 kg/m ². Eighty-eight percent had obstructive sleep apnea, 60% had degenerative joint disease, 60% had hypertension, and 18% had coronary artery disease. Sixty-four percent were considered high risk for surgery, or ASA III, according to American Society of Anesthesia risk, and 34% were very high risk, or ASA IV.

Forty-two percent of the patients had one or more life-threatening comorbidities, including chronic obstructive pulmonary disease, pulmonary hypertension, or a recent history of congestive heart failure.

Of the first 75 patients *****ceived LSG, no deaths occurred, and there was a mean 19-point decrease in BMI as well as a mean weight loss of 37%. All of the ASA IV patients converted to ASA III, all the ASA III patients significantly improved, and life-threatening comorbidities were decreased to moderately severe.

Patients lost 100 to 150 pounds in the first nine to 18 months after LSG. When weight loss began to plateau, "That's a suggestion that additional weight loss will not be significant, and that's when we intervene," said Dr. Schauer.

So far, 23 patients have had Roux-en-Y gastric bypass. Overall, there have been no deaths; 8% have had major complications, and 13% have had minor complications, but that compares favorably to full laparoscopic bypass for high-risk patients, Dr. Schauer said.

The two-stage procedure is not for all patients, only for those at high risk for any bariatric surgery, who have a BMI of 60 or greater, are older than 60 years, and have a severe life-threatening comorbidity, said Dr. Schauer, noting that these patients are about 5% to 10% of his practice.

Going forward, all of the LSG patients in the study will be encouraged to undergo Roux-en-Y gastric bypass, so that results from the full two stages can be compared with weight loss in the patients who had the two procedures done simultaneously.

Dr. Schauer noted that insurers have been reluctant to cover the two-stage procedure without more firm data on its ability to reduce complications. Dr. Schauer said he believes that the risk reduction and lower mortality rate will offset the additional cost for a second procedure, especially in patients on whom many surgeons will not operate at all.

SAGES 2004 Annual Meeting: Abstract S114. Presented April 3, 2004.

Reviewed by Gary D. Vogin, MD

Wow this is the first time I've ever heard of the verticle sleeve being converted to RNY.  Everything I've previously read and seen on OH talks about the VSG being done prior to DS on SMO that doctors felt is was safer to do in two steps.  Or, as we now see the VSG is a stand alone procedure without malabsorption.

Deleted the 2nd paragrapy about needing a password: 

Ok, I didn't try to create a log in because I figured it was only for medical personal, I was wrong I thought what the heck let me try, lol, and I could so I'm not reading, lol. 


Thanks for the info, Kathy!