I've been thinking about this as a pre-op, too, and asking myself which WLS I would most and least regret. I initially wanted to get the gastric band, and I agree that there is no magic cure, and that people need to choose the best WLS for their individual cir****tances. However, after researching all of the options, I’ve decided I would have the least risk of regrets with either the VSG or the DS, and I think I would most regret the band. I’m sorry if that offends anyone, but it’s just the conclusion I have come to based on my research of the WLS options. I’m sure there are many people who get the band and are very happy with it, though.

Ultimately, I’ve decided on the VSG, and here are the main reasons why:
1.    I’m going to have to be self-pay, and I can barely afford VSG, so DS would be too expensive right now. The good news is that if VSG doesn’t give me the weight loss I need after a few years, it can be converted to a DS (being that the sleeve is the first step in the DS). Plus, I’d be paying long-term for the fills if I got a band.
2.    My BMI is under 40 (barely, but still). The EWL data are stellar for people in my BMI range who get VSG--better than the EWL for other WLS procedures. The percentage of EWL isn’t as good the higher the BMI goes up, but even then it’s still good (just not the 90% EWL average that is has for my BMI range).
3.    I don’t want to deal with dumping or food getting stuck, nor do I want to have to eliminate various types of food from my diet altogether. I’d like to enjoy small amounts of all types of foods. I also don't want to deal with vitamin/nutrient deficiencies if I don't have to in order to maintain a healthy weight.
4.    Much lower levels of ghrelin while I’m in the weight-loss stage of my journey (when ghrelin levels would otherwise go up)? Yes, please!

I do have some concerns, of course. None of these procedures are without drawbacks. My main concerns/gripes about VSG are that it will be annoying not to be able to drink with my meals (I can get over that, but I envy the DSers on this point) and that I could regain if the sleeve stretches a lot and the ghrelin levels return to being high and I start slipping into mindless eating habits (this is just as much a risk with GB or RNY, though, from what I've read). The regain possibility scares me, because I’d hate to spend all that money only to regain! But, my chances of long-term weight loss are much better with VSG than they are with continuing the self-defeating cycle of dieting. So, that’s a risk I’ll have to take. And, again, if VSG ultimately doesn’t keep the weight off, I have the option to go to a DS.

I have comments and questions on a couple of the points Sandy made in her well written and informative post (I realize she wrote that several months ago, but I’d still like to reply in case anyone reading this might have some feedback).

Sandy wrote: “Since the band and the RNY have nearly identical loss at 4-5 years (with the band slightly better)
(see this current study's graph:
 http://www.obesityhelp.com/forums/LapBand/3665405… I personally chose the WLS with the smallest risk of death, major complications, and with the best chance for longterm success.”

My thoughts: Hmm…yeah, I’ve heard that statistic, too. But what’s the source for these data? It doesn’t say in the link you provided. Anyhow, I quoted that statistic to my surgeon, and he pointed out a major caveat: the study/review that came up with this statistic was actually funded by the company that makes the band being studied. Slight conflict of interest, no? He said they manipulated some of the data in order to get this statistic that “proves” the lap band is as effective as other WLS procedures. But other studies (not funded by anyone with a major financial interest in a certain outcome) have shown otherwise, as has his personal experience with performing 1000s of WLS procedures (mainly RNY and gastric banding) over the past seven years. So, I’m pretty skeptical of buying into that statistic. It’s great if it’s true, but I’m not so sure of its objectivity. Are there several studies (not funded by any of the band manufacturers) that show this statistic? If so, then maybe it is more legit than I’m thinking it is.

Additionally, maybe initially lap band is the safest procedure, but as for “the best chance of long-term success”? Nowhere have I heard or read that lap band can make that claim. My surgeon made it clear that he would do banding if that’s what his patient wants, but he definitely wouldn’t recommend it over VSG for a restrictive-only WLS because his experience is that people don’t have great long-term success with it. I can see no reason why he would have a financial interest in saying this, because he’d make way more money in the long run with lap band patients, due to the numerous, ongoing times they have to go in for fills.

Sandy wrote: “I personally would never consider … the sleeve because it removes most of the stomach and we simply don't know yet what the longterm side-effects of removing those essential hormones is.”

Good point. I, too, was concerned about this when I first started looking into the sleeve. It really worried me that they’ve only been doing VSG for a few years, so who knows what kind of negative effect it would have on body chemistry to remove a large part of the stomach? That was a hard one for me to get past. However, I started researching it some more, and it turns out that partial gastrectomy (i.e., removing part of/most of the stomach, but not all of it) is a procedure that has been around for a long time, mostly for the treatment of stomach cancer or severe ulcers. So this isn’t actually a brand-spanking new concept to surgery in general, even though it is newer to bariatric surgery. And from what I can tell, there haven’t been any hormonal problems associated with the partial gastrectomies for cancer or ulcer treatment. So why should there be with VSG? Am I totally misunderstanding this correlation here? If so, please let me know, because I do want to make the most informed decision possible.

Also, from all of the primary medical research I’ve read on the VSG, the conclusions say that it’s successful in the short and immediate-term for weight loss, but that more time needs to go by before the long-term weight loss effectiveness can be officially determined, although it looks very promising. In none of those studies (and I’ve read a lot) has there been mention of a problem with missing essential hormones after partial gastrectomy.

Potential leaks are a complication of VSG, though, and it would admittedly suck to have that complication. That concerns me about getting the VSG, but that complication risk is very low, so I’m willing to risk it in the much higher likelihood that my comorbidities related to obesity will resolve post-op (and for all the reasons previously mentioned in this post).