Failed Lapband...should I go VSG or DS

 I had a lapband done in February 2009. I had it removed in February 2012. It was a total flop. I was always soooo hungry and although the band reduced the amount I could eat in a sitting, I never felt full...I felt constantly deprived. As a result I ended up eating "slider" foods and wasn't able to keep fruits, veggies or lean meats down. Talks about backfiring.

So I am taking another kick at the can. I just assumed the next logical step would be the VSG and had it all booked but I am wondering if I should consider something like the DS instead. My BMI is 52, I have 180 lbs to lose. 

My biggest fear is that I will get the VSG and still feel hungry all the time and will wind up having mutilated my body and still be fat. Does the DS help control hunger? Being hungry and not being able to eat for the rest of my life seems like torture. 

I really need my life back but I am afraid to do something as invasive as the DS. On the other hand I am afriad of going to all this trouble and still being fat. Do many people fail with the DS?

Sorry for the long post...just trying to figure things out.

Jenny

I have a DSm and I don't think a sleeve would have helped me much at all.  The reduction in volumje helps lose the weight, but it's the malabsorption that keeps it off.

You have to be super vigilant about vitamin supplements...a LOT of them... and having the major portion of the stomach that produces the hunger hormone ghrelin is removed in both the sleeve and the DS, but again, the malabsorption is what keeps the weight off with the DS, but IMHO it takes the most work to stay healthy.

If you don't like taking a lot of pills, and you diet well, the sleeve may be enough for you. For me, I didn't want to show up in my surgeons office three years later asking for the "switch" part of the DS due to regain.  My insurance only pays for once in a lifetime bariatrics unless threre's a medical cause for revision, and regain is not one of them.

Everybody's different.  reserach, research research...then choose the surgery you feel will give you the long term results you want.

One of the nice things about my DS...... if I feel hungry, I eat. It just needs to be the right thing, protein foods.

Read DSFacts.com. Good luck with your research.

Two thoughts:

1. with your bmi as high as it is, it is unlikely that the sleeve will be adequate for you. Even many docs who push the sleeve don't recommend it for people with a bmi over 45. With 180 lbs to lose, you need an operation that will give you significant metabolic improvement as well as restriction, and that's the DS.

2. it worries me somewhat that you are thinking in terms of "the next logical step". Bariatric surgeries should not be looked at as "steps". Anyone considering wls should think in terms of what operation will resolve their morbid obesity, not in terms of what step to take next if this one doesn't work. Each operation creates scar tissue and other issues that interfere with the safety and possibly efficacy of any future operations. The best approach is to get it right the first time. For you, the first time is already past, and we can't change that, but you definitely need to make sure you have something that will work well and work permanently this time.

What are you afraid of? The DS isn't "more invasive" than VSG. More extensive, yes, but both are major surgeries, both are invasive. To me, the only "logical" approach is to have the operation with the best chance of working for you.

Larra

 Ok so this is my humble opinion...for me personally the DS was what I needed and wanted because of the great success it has in keeping the weight off and my doctors along the years already knew a lot of my issues were in the absorption section of my insides not the fact that I ever ate too much or the wrong things, which I believe is a lot of what over weight ppl go thru, everyone believes we are overweight because we eat way too much or don't exercise at all, so not true for so many of us, of course there are stories just the opposite.  SO since the band failed for you I would think the VS would do the same thing as all it is doing is making your stomach teeny tiny so you don't hardly eat.  I still get hunger pains but when I eat I only can get in about a tablespoon or two.  And I do find myself eating more but that is because my stomach is so small now, of course I am only abt 5 weeks out.  Just got on soft foods and am finally feeling like it was all worth it.  I am not gonna lie it was a rough surgery and I had already had my gallbladder out 2 years prior and thought oh it can't be much worse then being in that pain.  Of course I am not your "normal" patient and so of course I had the family bad luck cloud over me but it all turned out just fine and I actually spoke up to my doctors office about my issues so hopefully it will never happen to anyone again.  So for being almost 5 weeks out I have lost over 35lbs and tons of inches all over my body.  My mom and I measured every area to see what would go first and it has been fun to see where the weight disappears first.  I had about 135lbs to lose and a BMI of 53.  I am short.  lol  Please feel free to private message me if you have more questions.  But I truely believe the DS is the BEST way to go over any of the other surgeries if you have a lot of weight to lose and your BMI is higher then 45 or if you have co-morbidities.  I had high blood pressure and it is already gone.  Good luck to you!  

Donna

 You already had a purely restrictive surgery that didn't work.  The VSG is a better option but still it's only restrictive.

I would never tell someone who needed to lose 180lbs to go with a purely restrictive surgery.

Just as a point of reference, Standalone or "Isolated: VSG is considered 'restrictive' in that there is no bypass; however, it's mode of weightloss is not purely due to restriction.  There are  three components to it, restrictive, hormonal, and actually minor malabsorption.  Removal of the fundus of the stomach removes 75% of the body's capacity for producing the hormone Ghrelin and long-term serum ghrelin levels are reduced by 50% with stand-alone VSG.   Where VSG decreases ghrelin, the band actually increases it according to the medical literature making the mode of failure for the band quite different than that for VSG. Further, faster gastric emptying with VSG causes minor mal-absorption and triggers the ileal brake, also a hormonal mechanism that signals satiety, as undigested food (fat in particular) reaches the small intestines. 

A good discussion of the hormonal differences between the bariatric surgeries can be found here:

http://bariatrictimes.com/2009/04/17/gastrointestinal-hormon es-and-their-relationship-to-bariatric-surgery/

This reference talks specifically about how the sleeve works for weightloss as well as the long-term challenges:

http://www.bariatricspro.com/imageServer.aspx/doc213335.pdf? contentID=20352&contenttype=application/pdf

Most VSG failure is associated with eating around the sleeve.  Some studies suggest those with long-standing diabetes and liver issues do not lose as well, also.   The hormonal aspect of VSG is part of what makes DS successful although standalone VSG's tend to have more stomach resected. There's no question, however, that the malabsortive component of the DS is what resolves the more recalcitrant diabetes, and it's far more forgiving in terms maintenance.  It's less forgiving, in general, in terms of supplementation. 

 Dont think of steps for chosing the right surgery to help you get  to goal weight. Research all the surgeries, especially the success rate for most long term weight loss, with least chance of regain. Thats the D.S. hands down. I am able to eat all the foods most like my past healthy eating habits, lots of protein, veggies, fruit, even ice cream, and popcorn, sausage, bacon, cheese, dairy. The malabsorbtion is a helpful tool to use to lose and maintain even when I treat myself once in a while. I dont have neausea, or dumping.  My typical foods are most like the Atkins diet. Take a close look at each surgery option as far as lifestyle, and most normal eating for life. Thats the D.S. I eat and drink about 16 oz at a time. my stomach begins small and  stretches as it matures, just like the VSG. Then when it can handle more food, I will be very happy to have the malabsorbtion feature. My stomach at 9 months out from surgery feels fine, no trouble drinking and eating at a normal speed, and no trouble swallowing my vitamin capsuls. The amount of pills I take are not hard to take. Most of them are for non WLS reasons. My blood lab tests determine the amount of vitamins I need.

The surgery itself was just as easy as any other surgery for me. I have had 5 major surgeries .As with each of them I went to sleep, this time I  woke up with a D.S. First day up walking, second day walking the track through the halls, 3 rd day went home. Only 2 small cuts from the laparoscopic technique hurt for a week.  After the 5 th day post surgery I only needed Tylenol for the pain. I drove to the market, shopped the seond week. I have lost 130 lbs in 9 months now, still losing. I expect to go down another 15-20 lbs in the next 2 months. I'm short, and petite with small bones. Now I wear petite size 4. I cant believe I am this small already !!!!

I am so happy I chose the D.S. because I am healthy, and full of energy, no more hip and knee arthritis pain. I can exercise at the gym for hours, and enjoy every min. If I needed to I could take Nsaids, but I dont need them any more since all the weight is gone. At my blood draw yesterday at Saint Mary's Hospital the tec said she could never tell by looking at me that I had ever been MO. What a wonderful observation, she made my day !!!

Every surgery requires taking good care of your health, eating healthy foods, exercising, taking vitamins.  With the D.S there are specific things to do, for successful weight loss- eat lots of protein. I am rarely hungry. When I am, I can eat. Simple as that. I am a happy camper !!!  PM me if you want to talk more, I'd be happy to answer any questions you may have.

One more important thing, go to many surgeons information meetings, meet them, talk to them , and ask questions.  When you meet them you will know which one is right for you. The Dr's who do not do the D.S. will guide you to other surgeries they do easily. Choose a surgeon from the vetted list who does  lots of D.S's  listed on these boards.  They should be extremely experienced, from a "Center of Excellence". You want the best capable surgeon you can get. Read all the articles here, and print them for a notebook you can refer to easily. I did, it helped lots to chose the right surgery for me- the D.S. I wouldnt have any other. I want the most normal life possible. I would make all the same choices over again, if I had a chance to do it over. The team approach is best for all the support you can get. My surgeon has a team of professionals to help at every turn. I know they are a big part of my success.
Sandra  ;-)

As I'm sitting here almost 3 years out eating bacon with peanut butter and drinking my protein coffee... I'd say go with the DS... you need the best surgery and something you don't need to "diet" on allll the time. Its about making the right food choices, but still being able to eat, more of a lifestyle than a diet.
Best wishes

 52bmi? DS in a heartbeat. I had a BMW of 73.2 and the power of malabsorption just barely keeps me on track.i unfortunately was not one of those who sailed right by goal weight and still find it too easy to reach my upper range without constant vigilance. Why be at 52bmi and not have everything working for your success. Equally important.: how big a sleeve, what common channel, how prepared are you for 3 bites then full?