Sleeve/DS or Bypass(PART TWO)
Hey has anyone on this OH site had a Sleeve done and then had to go do a (Part Two) of the surgery ? I have read a lot that the Sleeve use to be done first and then bypass or converted to the DS i believe! ... Having the Sleeve done doesn't mean that later you would have to have another surgery right? From what Ive read they say pt dont usually have to have it only if the sleeve doesn't work I guess, So what does Doesn't Work really Mean???
Thanks Jennifer
Thanks Jennifer
The sleeve is the first part of the DS, not the RNY. You shouldn't go into the sleeve thinking that you'll revise later. You CAN, but it doesn't have the same effect as if you did them both together at the beginning. The sleeve is intended to be a one-time, stand-alone procedure - no further surgery necessary.
For the few who have revised from sleeve to either RNY or DS, it's because they discovered that the restriction only wasn't enough because they have metabolic issues that prevent them from losing weight with just restriction.
For the few who have revised from sleeve to either RNY or DS, it's because they discovered that the restriction only wasn't enough because they have metabolic issues that prevent them from losing weight with just restriction.
(deactivated member)
on 9/23/11 3:56 am - Woodbridge, VA
on 9/23/11 3:56 am - Woodbridge, VA
Some surgeons do revise a VSG to an RNY simply because they do not have the skill/ability to do an actual DS - RNY is easier. There are fewer DS surgeons in the US than for any of the other three types of WLS procedure. However, it makes WAY more sense to revise a VSG to a DS since the VSG is part of a full DS anyway, so why butcher a perfectly good functioning stomach to bypass the pylorus?
That said, the VSG is often performed today as a STAND-ALONE procedure, not with plans to later be revised. It USED to be mostly used as the first part for those who had very high starting BMIs and were not healthy enough to stay under anesthesia long enough for a full RNY or DS. But today, VSGs are more often done as a sole procedure, not as part of a two-step process.
If you want an RNY or DS, go for that upfront instead of a VSG. But if you want a VSG, don't go into thinking you'll HAVE to have another surgery later.
"doesn't work" has different meanings for different individuals. In the WLS world, "success" is typically defined as having lost at least 50% of your excess weight. However, for some patients, that's not enough (imagine having 200 pounds to lose and ending up with 100 extra pounds still). So, for some patients, the VSG "doesn't work" to get them to a normal BMI or to their goal weight or below the definition for obese - this is more common with higher starting BMIs. It all depends on the individual, the cause of their obesity to begin with, their post-op dedication, their specific comorbidities or other health conditions...
That said, the VSG is often performed today as a STAND-ALONE procedure, not with plans to later be revised. It USED to be mostly used as the first part for those who had very high starting BMIs and were not healthy enough to stay under anesthesia long enough for a full RNY or DS. But today, VSGs are more often done as a sole procedure, not as part of a two-step process.
If you want an RNY or DS, go for that upfront instead of a VSG. But if you want a VSG, don't go into thinking you'll HAVE to have another surgery later.
"doesn't work" has different meanings for different individuals. In the WLS world, "success" is typically defined as having lost at least 50% of your excess weight. However, for some patients, that's not enough (imagine having 200 pounds to lose and ending up with 100 extra pounds still). So, for some patients, the VSG "doesn't work" to get them to a normal BMI or to their goal weight or below the definition for obese - this is more common with higher starting BMIs. It all depends on the individual, the cause of their obesity to begin with, their post-op dedication, their specific comorbidities or other health conditions...
The VSG as a weight loss procedure started out as the first phase of a two stage DS (as the DS uses the VSG along with intestinal re-routing) for those patients who were too heavy or in too poor health to be subjected to the entire procedure at once (some docs would use a lap band for this, followed by an RNY if they didn't have DS skills.) It was found that some patients lost enough weight with the first step VSG to not need the second phase, so it began to be offered as a stand alone procedure.
The VSG is much easier to revise to a DS than an RNY if that fails, but there are caveats. The revision works best if it is planned and/or done promptly after the weight is lost from the VSG, before any significant regain is experienced - if one waits for substantial regain to occur to declare a failure and go for a revision, the overall results are not as good as if the revision was done promptly. Unfortunatly, regain is the main issue where people consider getting a revision, and who's going to pull the lever after they have regained ten or twenty pounds? Further, insurance will not usually cover the revision until one has regained back to their normal WLS approval criteria (35-40 BMW depending on comorbidities.) Also, revisions are typically done open rather than laproscopically, so that's an added deterrent to thinking of the revision as a fall back position if one fails with the sleeve.
Regain is a potential long term problem with the sleeve, as it is with the RNY and bands, which are all fundamentally restrictive only procedures. The DS adds the intestinal rerouting the malabsorbs fats and does do a statistically better job with long term weight maintenance but has the downside of needing more intensive monitoring and supplementation (similar in that regard to the RNY,) than the VSG or bands. Most nutritional issues that we have with the VSG centers around the limited initial and weight loss phase diet and longer term personal nutritional choices.
Most of us here have no intention of revising, though that may change in a few years for those who run into regain problems, or for those starting at the higher BMI's that may not be able to lose enough with the sleeve alone.
The VSG is much easier to revise to a DS than an RNY if that fails, but there are caveats. The revision works best if it is planned and/or done promptly after the weight is lost from the VSG, before any significant regain is experienced - if one waits for substantial regain to occur to declare a failure and go for a revision, the overall results are not as good as if the revision was done promptly. Unfortunatly, regain is the main issue where people consider getting a revision, and who's going to pull the lever after they have regained ten or twenty pounds? Further, insurance will not usually cover the revision until one has regained back to their normal WLS approval criteria (35-40 BMW depending on comorbidities.) Also, revisions are typically done open rather than laproscopically, so that's an added deterrent to thinking of the revision as a fall back position if one fails with the sleeve.
Regain is a potential long term problem with the sleeve, as it is with the RNY and bands, which are all fundamentally restrictive only procedures. The DS adds the intestinal rerouting the malabsorbs fats and does do a statistically better job with long term weight maintenance but has the downside of needing more intensive monitoring and supplementation (similar in that regard to the RNY,) than the VSG or bands. Most nutritional issues that we have with the VSG centers around the limited initial and weight loss phase diet and longer term personal nutritional choices.
Most of us here have no intention of revising, though that may change in a few years for those who run into regain problems, or for those starting at the higher BMI's that may not be able to lose enough with the sleeve alone.
1st support group/seminar - 8/03 (has it been that long?)
Wife's DS - 5/05 w Dr. Robert Rabkin VSG on 5/9/11 by Dr. John Rabkin
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