Revision to ds after vsg?? why?

The DS is NOT a two step surgery.  There is a synergism between the significantly reduced intake (due to the sleeve) and the metabolic changes due to the switch.

People revise from the sleeve because the sleeve stretches and they go back to eating what they used to eat and regain.

The sleeve helps you loose the weight (along with the metabolic changes of the switch) but it is the switch that helps you KEEP the weight off.

I would NEVER advise a two step approach unless there was absolutely no other option (someone whose weight or other medical conditions just don't allow that much OR time for example).

I was only 100 lbs overweight and got the DS (the real thing... both parts) and have NEVER looked back. 

~Becky

My BMI was 43.6 when I was sleeved five years ago, and today I am looking at a DS for weight gain and my diabetes returning.

My sleeve never brought me to goal, but did bring me to what matched my lowest adult weight, 190 when I was 19.  This occured three years post-op, when I went from where I settled at around 6 months post-op (220) to 210, after giving birth to my 4th child. I then dropped another 20 pounds thanks to breast feeding. :) 

When my son weaned, I started to regain, and it hasn't stopped.  My eating did not change.  I still have some restriction.  My exercise actually went up (I itrack steps with a FitBit Zip)... but still the gain has continued.

I am now about 25 pounds below what I was sleeved at.  About 50 pounds lower than when I had my first bariatric operation, a Lap-Band in 2001.

Even with "just a sleeve", I've had Vitamin D and PTH issues.  The D was low and my PTH was elevated at my 6 months post-op labs... with vitalady's help I got them back on track.  I just did my 5 year labs and they are messed up again.  My protein levels are basically the lowest "normal" one can be.  My B12 is the lowest "normal" as well.  All with just a sleeve.

I can understand at 20 why you might want to postpone the second part of the DS... but honestly, it's highly likely you will need it.  

I would ask myself...what weight would I be happy with?  When I had that discussion with my surgeon (who is also pro-DS), he said, well, if you'd be happy at 190, then a sleeve should get you there.  The sleeve didn't, but breastfeeding did.  Unfortunately, I'm not willing to keep having kids to stay at 190. :)

I'd also ask yourself how willing you'd be to undergo surgery a second time...and more importantly, would your insurance cover it (or your parent's insurance).  Many insurance companies have a one bariatric surgery per lifetime type policy.

The sleeve might get you to a BMI of 30-35... but honestly, I'd be surprised if you'd stay there.  I see so many fellow sleevestrs looking for revisions now. Reminds me of the early days of the Lap-Band.  I don't think the Sleeve is as evil as the Lap-Band or as pointless... I just think that restriction only works basically best for people in the 30-35 BMI range.  (Even though insurance companies don't agree with me. :))

You can have a look at my blog for more detail about me, and see my signature here for my WLS history.  If I could go back, I would have had the whole thing at once, but there were no surgeons in Arizona doing DS in 2006.  The one I went to in Phoenix had been doing them, but when I got to my consult with him he said he was switching to bands, and tried to convince me to have a band.  I did very well with the VSG at first, and I have several friends who had the VSG within a year after mine.  All but 2 of us have kept all of the weight off for 6-7 years.  (By all I mean staying within 10lbs of so of goal.)

Some people do very, very well with just the sleeve.  Having the 2 stage procedure wasn't too bad, but I did self pay both times, which is a lot of money, obviously.  

If you do go with sleeve only, make sure your MD is going to give you really good restriction, because your stomach will stretch.  I was one of the first my surgeon did, and now he says he probably was too conservative, and should  have made it smaller. 

Good Luck!

Tonya

Some people are fat because they eat too much. Other people are fat because their body is just too darned efficient at storing energy. If you're fat because you eat too much, then---the Sleeve *might* be enough. If you're fat because your body is just too efficient, then you will lose weight with a Sleeve but you won't keep it off.