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I haven't made a decision yet other than to narrow it down to either VSG or DS. I plan to continue research, research, research so that I find what I feel is right for me. I do know that to do DS I'll probably have to go out of town. I'm certainly willing to do that for the right procedure done by the right person. Thanks!
on 12/4/10 10:29 pm - Woodbridge, VA
And then there are some surgeons who are honestly fed the same misinformation or outdated information based on the old BPD procedure that many patients hear from non-DS surgeons - that the DS is only for super morbidly obese folks (very high starting BMI), that DSers end up with a disgusting body odor, that DSers have excessive bowel movements on a daily basis (this topic comes up on the DS board somewhat frequetly - most common anser I see is 2 poos in the morning and that's it - there has even been a study that concluded that there is no statistically significant difference in the amount of bowel movements between RNYers and DSers), that DSers will have diarrhea for the rest of their lives (I don't know many people who can take calcium and iron sulements like many of us do and not be constipated!), that DSers will have uncontrollable peel-the-paint-off-the-walls gas every day (again, a topic that often comes up, and the most common answer is that gas is very easily controlled by watching what you eat)...the list goes on. Some of these are possible side effects, but they happen to VERY few DSers, and they are not afforded to DSers alone (for example, I recently saw a thread on the VSG board asking if they sold Gas-X strips at Costco).
Not that you asked for my personal opinoin, but here it is anyway: The VSG and the DS are the most logical WLS procedures available today. I hope that someday, they outrank the band and the RNY as the most commonly performed procedures (though I doubt it since the band is so easy to install and is backed by millions on marketing $$, and the RNY is so much easier to learn and perform than the DS). So hopefully either way you go, you'll be happy with your decision. Just keep doing your research, and you'll find what makes the most sense for you.
I don't think my research is through yet! This can be so confusing!
on 12/4/10 5:57 am - Woodbridge, VA
I had only been diagnosed with type 2 a year before my surgery. I specifically chose the DS in an attempt to obliterate my diabetes. Due to drama unnecessary to bring up here I ended up with a VSG plus only a little bit of malabsorption; my common channel is about 4 TIMES as long as that of a "normal" DS.
So, I can tell you with certainty that the VSG alone would not have been enough for me because this surgery I ended up with still wasn't quite enough. Now, don't get me wrong - my diabetes is WAY easier to control, and if I went to a new doc tomorrow, they would not diagnose me as diabetic based on my current A1C and fasting values. However, I still know I am diabetic because if I have something full of fast-acting carbs (like a milkshake or a pile of mashed potatoes), my post-prandial levels will still spike well into the 200s, sometimes over 250. Normal people don't see those numbers. Also, if I don'****ch my food intake and get lazy about limiting my carb intake, my fasting values will creep back up. When I'm diligent about eating low in carbs, they're happily in the mid 70s to mid 90s. But just a few weeks ago, I checked and had a fasting of about 115 (which helped kick my butt back into gear about limiting my carbs).
I am off of all meds. Pre-op, I was up to 2500mg metformin and 500mcg sitagliptin (Januvia), and I don't take any diabetes meds now. I was cut down to 1000mg metformin when I left the hospital from surgery, cut to only 500mg a few months later, and cut completely free of meds by 6 months (my PCP was more conservative than others and didn't want to cut me from everything cold turkey right away). My A1C at my 1 year post-op labs was 4.8. But, like I said, I know it's still in there...
I found a study recently that provided these figures for type 2 resolution at 1 year post-op with the VSG:
Starting BMI averaging 54.4: 69%
Starting BMI averaging 45.5: 88%
So, a lower starting BMI will provide better chances of resolution with the VSG. With the DS, I have many, many studies that show type 2 resolution exceeding 90% regardless of BMI.
Also, one thing that has not yet been proven with the VSG is the long-term resolution rates. Not having diabetes at year 1 is great, but what about year 5? Year 10? Year 20? I don't know how old you are, but I had my surgery at 26 and wanted the best chances of KEEPING the diabetes away. Studies are now showing diabetes returning a few years after RNY for some unfortunate folks, whereas with the DS, this doesn't happen. The VSG as a stand-alone WLS procedure has barely 5 years of research behind it, whereas the DS has more than 20.
I keep a running thread of studies and articles here on this board and in my profile if you'd like to read up.
I'm curious what you mean by that the DS comes with "the most potential problems." Between the VSG and the DS, that is true, but I have to say the RNY scared the crap out of me, and I was RELIEVED when I found out about the DS! I never considered the VSG for myself since kicking diabetes was my primary objective, and the reconfiguration of intestines plays a pretty major role in that. With the DS, the biggest complaint I see consistently is that eating lots of carbs can cause gas. This is true even for me - sugar doesn't bother me at all, but starchy carbs (pasta, potatoes, breads, rice, etc.), and I know I'm in for some gas bloating and pain later on. I see more DSers battling constipation than diarrhea. And I hope no one has tried to tell you that DSers end up with a foul body odor (I have heard this one before and have yet to meet a DSer in person who has this problem, and I've probably met more than 50 DSers in person so far).
I post on both the DS ad VSG boards since I ended up with this sort of in-between surgery. I can tell you that I've seen more than one VSGer get all the way to their weight loss goals but still have symptoms of their diabetes. I know of at least one who was considering a revision to add the "switch" part of the DS solely to help with her diabetes even though she had reached her goal weight.
I'm not saying the VSG can't/doesn't/won't work for you, just that the DS works for more people than the VSG does and has stood the test of time. Good luck with your decision!
Besides the weight loss, my main focus of WLS is resolution of diabetes. I know the DS has the best resolution percentage, but it also comes with the most potential problems. The clinic I am talking to believes the sleeve will be sufficient. It certainly seems to have fewer risks and complications, but, still, I want the best chance to resolve the diabetes.
Any suggestions?
I am going back and forth between RNY and VSG .I have to lose about 150 pounds. I have to make my decision about which surgery to do by 12/28 when I meet my doctor for a reevaluation. I would rather not have the Malabsorption but if it would "cure " my diabetes then The RNY is a no brainer. Anyone out there with a simular situation that had type 1 diabetes that could help sway me in one direction or another
on 11/30/10 4:30 am - Woodbridge, VA
Surg Endosc. 2010 Jul 7. [Epub ahead of print]
Laparoscopic sleeve gastrectomy as first stage or definitive intent in 300 consecutive cases.
Basso N, Casella G, Rizzello M, Abbatini F, Soricelli E, Alessandri G, Maglio C, Fantini A.
Surgical-Medical Department for Digestive Diseases, Policlinico "Umberto I," University of Rome "Sapienza,", Viale del Policlinico, 00161, Rome, Italy, [email protected].
Abstract
BACKGROUND: Laparoscopic sleeve gastrectomy (SG) was originally used as a bridge to definitive surgery in high-risk patients. Recently it has been considered as a stand-alone procedure due to its effectiveness on weight loss and comorbidities resolution. This study was designed to evaluate the results of SG on complications, body mass index (BMI), and comorbidities resolution in 300 consecutive obese patients and to analyze the lesson learned from this experience.
METHODS: From October 2002 to November 2009, 300 patients underwent SG. In the first 100 cases (group 1: mean BMI, 54.4 +/- 9.3), SG was intended as a first stage of biliopancreatic diversion with duodenal switch in high risk super-obese patients. In the last 200 cases (group 2: mean BMI, 45.5 +/- 7.3), SG was intended as a definitive procedure. No routine reinforcement was performed in group 1. In group 2, oversewn reinforcement was performed routinely. SG was redo surgery in 21 patients (7%).
RESULTS: Mean operative time was 119 +/- 48.6 min in group 1 and 72 +/- 33.8 in group 2. Conversion rate was 0.6% (massive hepatomegaly). Mortality was 0.6%. Major postoperative complications were registered in 15 patients in group 1 and 11 in group 2. In 3 cases, a reoperation was needed. The mean BMI in group 1 was 46, 43, 39, and 31 at 6, 12, 24, and 36 months, respectively. In group 2, the mean BMI was 32.9, 30.6, and 31.7 at 6, 12, and 18 months [notice mean BMI already started increasing at 18 months post-op]. At 12 months, the diabetes, hypertension, and OSAS were cured on 69%, 62%, and 50% in group 1 and 88%, 57%, and 58% in group 2. In group 2, no patient required second stage.
CONCLUSIONS: SG is a safe and effective treatment for morbid obesity at mid-term follow-up. SG is effective for comorbidities resolution, especially for the treatment of diabetes. Suture line reinforcement allows a significant reduction of bleeding.
PMID: 20607564 [PubMed - as supplied by publisher
on 11/30/10 4:28 am - Woodbridge, VA
Br J Surg. 2010 Oct 21. [Epub ahead of print]
Outcome of laparoscopic duodenal switch for morbid obesity.
Magee CJ, Barry J, Brocklehurst J, Javed S, Macadam R, Kerrigan DD.
Gravitas, PO Box 3627, Bourne End SL8 5GQ, UK.
Abstract
BACKGROUND: The aim of this study was to determine the safety and efficacy of laparoscopic duodenal switch (LDS) as a treatment option in a selected group of patients with morbid obesity.
METHODS: This retrospective analysis of a prospective database assessed the frequency of all complications and alterations in weight, body mass index (BMI), co-morbidity and quality of life.
RESULTS: One hundred and twenty-one patients underwent LDS between April 2003 and March 2009. Median preoperative weight was 160 kg and median BMI 55 kg/m2. All procedures were performed laparoscopically. The in-hospital mortality rate was zero. No ileoduodenal anastomotic stenosis was encountered. There were four clinical leaks (3·3 per cent) managed by laparoscopic drainage and placement of a feeding jejunostomy. Median percentage excess weight loss was 75 per cent at 12 months and 90 per cent at 24 months. Thirty-six of 40 diabetic patients had complete resolution of diabetes within 1 year. There were significant improvements in other obesity-related co-morbidity. Only a few patients developed postoperative protein deficiency, and fat-soluble vitamin deficiencies were easily managed with oral supplementation.
CONCLUSION: The LDS procedure is a safe and effective treatment for morbid obesity and its associated co-morbidity in selected patients. Copyright © 2010 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
PMID: 20967827 [PubMed - as supplied by publisher]
