sleeve vs bypass

lol I didnt think that was harsh at all, I very much appreciate the input. If more people didnt try to sugarcoat everything in order not to hurt peoples sensitivities, less of us would be in our predicaments.

Gerd patients do typically go Rny. Some of us though went vsg. I had horrible gerd prior to vsg, but during the surgery a hiatel hernia was fixed and it was completely resolved. Until that is 4 years later when I had a return of a very large hiatel hernia that required another surgery for repair. If it happens again my only option is to revise to Rny to release the pressure.

The sleeve is a new application for a very old surgery. Gastrectomy surgeries have been perform for around 140 years for ulcers and stomach issues. There is exhaustive research and information about it.

It has been around far longer than RNY.

omgoodness, i am a 28/30 and cant wait to be buying 8/10 again!!!!!! congrats! i threw away all my winter clothes already because I refuse to be that size one more winter, plus I figure if I die during surgery that's one less thing for my kids to have to sort through and clean up ha morbid I know, but I'm scared to death but I'd rather go down fighting!

Gastrectomies have been around for a very long time. But a vertical sleeve gastrectomy is a very recent innovation. You cannot compare a VSG done for weight loss purposes to a gastrectomy because of ulcers or cancer. And, very few of those were done, and patient survival was very poor.

Doctors have been removing and rerouting intestines for just as long as they've been doing gastrectomies. But that didn't make those surgeries RNY either.

You are comparing apples and pumpkins. VSG is a new surgery with a much more limited track record. I say that not to dimini**** but simply because it's true.

You can if you are capable of critical thinking.

The long term effects of removing all or most of the stomach are well known with decades of studies and research.

You are very defensive (and passive aggressive). What makes you so unsure about you surgery choice?

Gastrectomies performed for cancer, wounds in battle, etc have absolutely no relation to a verticle sleeve gastrectomy. A bowel resection bears no relation to a DS or RNY. You can pretend to extrapolate numbers to fit your preconceived notions, but you would come to a false conclusion.

All VSGs are gastrectomies. All gastrectomies are not VSGs. Use your critical thinking skills to parse that out.

You are fundamentally correct - the RNY is a variant of the Billroth II procedure that has been done for some 130-140 years, initially for gastric cancer, The novel part of the RNY was optimizing the pouch size for weight loss rather than maximizing its size as disease permitted, and leaving the remnant stomach behind as it was not diseased. The downsides to the configuration have been well known for a long time - potential for dumping, reactive hypglycemia, bile reflux and ulcer sensitivity around the anastomosis - and is why the bariatric world continues to look for something better. So far, the DS and VSG have made the grade as viable alternatives in the eyes of the ASMBS and US insurance industry & Medicare system, with the SIPS/SADI on the periphery working on making their case.

I'm not sure of the origins of the sleeve gastrectomy, but the earliest major WLS use was in the DS, when Drs. Hess & Co. adapted the European Scopinaro biliopancreatic diversion procedure by replacing a relatively large stomach pouch and shortish common channel to the current day "traditional' DS configuration. Certainly, some disease mechanisms could be treated with a vertical resection like a sleeve rather than the horizontal resection normally see in a Billroth II, though that is the typical approach to most gastric cancers that don't require a total gastrectomy.

Exactly. And what is unique about the VSG was developing both the volume and shape to suit weight loss needs, rather than simply removal of damaged or diseased tissue, with an eye to leaving behind the most healthy tissue possible.

And as the DS was actually first, further refining the sleeve shape from an intended DS, to an intended stand alone sleeve.

The main difference between a DS sleeve and a stand alone VSG sleeve is the size, as the DS sleeve is typically about double the size of the VSG sleeve (though some surgeons are using VSG sized sleeves with their DSs). The basic intent is the same, as in removing the stretchiest part of the stomach and leaving a relatively stiff sleeve behind. It is the smaller size where some problems crop up, as apparently it takes more skill to make them smaller and still get the shape right, so we have seen a relatively greater number of questionable sleeves made (strictures, hour glass shapes, bulges top or bottom, etc.) as the surgeons work up the learning curve. And this is where some of the GERD problem comes from, and unfortunately many of those docs, though they may be adequately practiced now, don't know how to fix those problems and opt instead to simply revise it to a bypass as that is within their comfort zone.

As some of the GERD problem is fundamental in that the stomach volume is reduced much more than the acid producing potential (which in a bypass is simply left behind in the remnant stomach,) and in some the body never quite adjusts, there is a situation in some cases where the bypass revision is appropriate as the problem is inherent in the patient's makeup and not in a defective sleeve. It is this volumetric difference that is why we tend to see fewer GERD problems with the DS, though they use the same basic sleeve.

It's this dichotomy that presents the question of how many of the bypass revisions that are done actually need to be done, vs. those which are done for the convenience of the surgeon. This is why I suggest that anyone having these problems should get a second (or third) opinion from an experienced DS surgeon to verify that such a revision is the appropriate course of action.