Interesting Article on whether Gastric Sleeve is better than Byass or the Band

I so agree Shell.

People please research the VSG board also !!!

I am 3.5 years out with no stretching !!!!   great restriction.

and no dumping for crying out loud !!!

The lack of long term weight loss outcome results--and a whole lot of variation in the 5-year studies--were the reasons I was scheduled for an RNY.  Luckily, a physician friend of mine put me in touch with an experienced sleeve surgeon who spoke with me at length about why there is so much variation in sleeve outcomes.  His practice had outcomes on about 300 patients, the earliest sleeves done in 2007.  They were seeing excess weight loss (EWL) of 60 to 80%, with lower BMI patients getting closer to 100%.  I cancelled my RNY, and had the sleeve 6 weeks later.

Those considering the sleeve do need to find an experienced surgeon with documented rates of EWL.  The last article in the link below talks about the evolution of technique for the Bay Area surgeons Jossart and Cirangle (VERY qualified sleeve surgeons).  Poor technique is a reason why a sleeve might give sub-optimal results.

The reality is that there were 5-year studies published in 2007, and we should see the 10-year studies come out this year.  We do have to wait to see how the sleeve stands up over time.  I have a really strong belief that this surgery will become the gold standard for weight loss surgery, but I agree that this will take time.  I just feel so lucky that I got to have a sleeve and be a normal-weight person.  It feels like a miracle!!!!

http://www.covidien.com/imageServer.aspx/doc213333.pdf?conte ntID=20351&contenttype=application/pdf

The only thing I could add to what you wrote is that just yesterday, I talked to my surgeon, Dr. Cirangle in a support group meeting, about the long term results.  He told me that he could not be happier with what he is seeing in long term results.  He said that with the exception of his first 100 sleeves, which were done with larger boughie sizes, he sees excellent long term success.  He is not seeing any major changes from the five year results in the ten year data.  I can't wait until he publishes as I think this will put so much of this to rest.

The conversation I posted had to do with a few patients that the surgeon was having difficulty dealing with and then another surgeon said he had seen one too.
Basically the issue, in pictures, is this:



There is a major artery removed and apparently for some people there is enough redundancy in the system to make up for that.
Others apparently aren't so lucky.
The sleeve has nothing to do with a partial gastrectomy for therapeutic reasons. they are different.

 Hey, Docd,
This is the first I've heard of this issue.  What are the sequalae that these surgeons are seeing and how do they know this is due to insufficient redundancy?  I'd be interested to know if there is anything in the medical literature.  Anecdotal stuff is mighty chancy.
Thanks,
Jenny

 Oh, shoot, one more question:

If the issue is blood supply, why isn't the experience of therapeutic partial gastrectomy pertinent to VSG?

OK, so medically speaking, I'm a bit over my head here since I'm a family practice physician and not a surgeon, but I've studied enough to hazard an answer.

These guys were talking about what they were experiencing , but they aren't really researchers (just one of those evil medical profiteers!). In the twenty-two years that I've been in medicine, today's scuttle-butt in the doctor's lounge becomes tomorrow's literature, but I don't know of studies printed yet.
It may never happen, and the sleeve/DS may turn out to be the future of WLS.
Like I said the jury is out, but most doctors don't defend it as rabidly as do the owners of the sleeve and the DS. (truthfully that is another main reason that I shied away from the DS  - It seems like they protested way too much)

A therapeutic gastrectomy is different because they are either taking the whole stomach (a "total" for cancer) or just a piece like in a ulcer removal. This removal of the entire fundus is new, rather uncharted waters.

Not necessarily bad, just new.

Please DS'ers I have nothing against you. I'm glad you are having a good surgical experience.
 No more pins in the docd voo-doo doll.
I have enough back pain as it is.

Forgive me, but I HAVE to ask ...how is it that you had no knowledge of the Vagus nerve system as a doctor?! It affects SO many things in the human body!  Did you skip class that day!? The main reason I ask is because my own surgeon was very unwilling to admit that the band affects the Vagus and Phrenic nerve systems, when clearly, it does. It seems as if you weren't even aware of the nerve systems before we discussed it here. So, that baffles me at least a little bit, honestly.

Also, this sounds snarky, but I AM kinda snarky, so I'm going with it... the word, "procedure" is never, ever spelled, "proceedure."    If you're spelling it wrong, people aren't going to take you seriously and that's just the truth of the matter.

I know I sound confrontational, and that's not really my intention... I'm just curious. I think it's incredibly important for EVERYONE to know how the human anatomy is affected by certain procedures.

Oy. 1988. That's not new. If there were issues with removing the fundus, we've had over 20 years to hear about it. Haven't heard a peep.

Hi Docd,
I appreciate you passing on this info.  Can you tell me what symptoms or sequelae they are seeing that are being attributed to poor blood supply?  Just trying to capture what the original issue there is.  I appreciate that today's anecdotal evidence is what leads to tomorrow's research..I don't discount what these docs are saying, just trying to get a grip on how significant it is at this point.

As far as most docs not defending the VSG as vigorously as recipients, I would have to inject a small grain of salt.  Are we including the VSG surgeons with great weight loss stats in that group? My surgeon practically does back flips over how great he thinks the VSG is.  How are you defining "most docs"?

Thanks!
Jenny