[DocSanae]

I spent all day today at a WLS workshop. It was very educational, with a lot of new concepts and review of data.

Here's a short summary on what was said of sleeve gastrectomy.

This is a relatively new procedure, which the speaker, Michel Gagner M.D., (Professor of Surgery, Weill Medical College of Cornell U., Director of Minimal Invasive SUrgery Center and Chief of Division of Laparoscopic Surgery at Mt. Sinai School of Med.) started doing in year 2000. In the US, there is an ongoing study on it sponsored by NIH, and 7 bariatric centers in the US are involved in this, including Prof. Gagner.
While the percentage in the US is still small, it is the most popular procedure in Europe, especially in Sweden.

The ratio of WLS surgery in the US is, 77% gastric bypass, 16% lap banding, and 3% gastric sleeve. Gastric sleeve is rising rapidly.

This procedure can be done independently as a restrictive bariatric surgery, or it can be done as the first part of duodenal switch, in which case the switch is formed as a second surgery. This two part surgery was devised to bring down the mortality/complication ratio of DS done in one fell swoop.

Basically, the what is done is this.
The stomach looks like the flappy ear of an elephant, and that flappy part is cut off, and the rest is left as it is. This is the first part. Later, if the patient's weight loss is not enough, the switch, a bypass, is made.

The surgery is performed on BMI over 50 in the US (less than that in Europe), and sustained effective weightloss over the long term is somewhat better than bypass. Also, the resolution of various co-morbidities is the same as, or just a bit better than bypass with the exception of calcium deficiency.

The down points of this surgery is that
1) the sleeve can enlarge which leads to weight regain, but this can be controled by changing the surgery to DS.
2) a high incidence of developing acid reflux, especially those with hiatus hernia.

This does seem a promising new procedure in that
1) the success ratio is the same as, or may surpass, that of gastric bypass
2) if the desired weighloss is not achieved, the second operation can be done.
3) less malabsorbtion (however, when switched to DS, the rate of deficiencies increase some.
4) surgery mortality rate is very low.

Do not forget to ask your surgeon what his surgery statstics are.

[DocSanae]

Sleeve is still a new surgery, but it does seem a good option.
I say, talk it over well with your surgeon, ask about his own statistics, and if you feel comfortable, it may be the choice for you.
The advantage over Roux en Y bypass is that if revision (switching to DS) is needed, it can be done relatively easily.
Also, the fact that your surgeon does only open RenY, would be in favor of the sleeve for you since he does lap for that. However, keep in mind, with any/every lap surgery, the surgeon will always prepare to go open if the need arises, so even with sleeve, your surgeon will switch to open surgery if the neccessity is there.

[Cockney]

I had the sleeve on April 4, I have lost 90 pound since then. Like Doc said I have to take Calcium every day. Also apparently there is a potential problem with the gall bladder that is countered by a six months course of pills. I have not had too many problems with acid reflux. What I really like about it is that I (personally) find I cannot overeat if I tried. I put vitamin e oil on my scars before I go to bed. One have almost disappeared already and just look like skin blemishes.

[applesauce]

what is the problem with the gal bladder ? I am due to have this surgery in 6 weeks (with a bit of luck *LOL*) but am having my gal bladder out at the same time as I already have stones. Every time I have lost weight before my gal bladder plays up hence I want it out at the same time to prevent that pain.

applesauce

[DocSanae]

The gall bladder is ths the storage place for bile, which is produced by the liver. Bile includes both enzymes necessary for digestion, and waste product excreted from the liver. With the normal digestive system, bile is pushed out from the gall bladder when it shrinks in reaction to food passing from the stomach to the duodenum. With the bypass surgery, this route is removed from the route that food will now travel. This makes the post ops susceptible to gall stones, because the bile stays in the gall bladder, eventually turns into sludge (like mud) then harden further and become stones, which spell trouble. If your liquid intake isn't enough, this is going to add further trouble, and in this case, kidney stones also get likelier to develop.
So, some surgeons take the gall bladder out at the time of bypass surgery as a percaution, while others will prescribe their patients medication to prevent formation of stones.

[jenlynn]

Hi everyone! This is the procedure that I had done laproscopically on December 5th, 2007.

It is relatively new here in the states but is used extensively in the UK and elsewhere with results that are equal to that of RNY without the open incisions or dumping syndromes.

The weight loss is comparable to RNY too.

I have lost over 37 pounds since Dec. 5th (roughly 6 weeks post op) and I can eat most anything now. In smaller portions of course. I was on clear liquids until I left the hospital then full liquids for another week, then on to fork mashable foods and now introducing foods one at a time to see what I can and cannot tolerate yet.

If anyone has any questions, I will do my best to answer them.

I had this surgery because I also have lupus and this was thought to be the better choice for me. My beginning weight was 267 lbs. FYI

Jenlynn

[POODLEGIRL]

I had the sleeve done in October 2007. I am satisfied with my choice for many reasons - no dumping, not having to rely on supplements so heavily, less possibility of blockage just to name a few. Another thing that has helped me is that emotionally I have an advantage. With any person of weight, eating is a full time job and when you no longer have that job, you have to adjust to it emotionally. If I had to worry about fats and sugars like the RNY'ers do, that would be another emotional issue for me to have to grow accustomed to and I think that would make it harder for me emotionally. When I sit at a restaurant and watch as others eat or get pukey after eating my 5 bites, I take an emotional hit. When I plateau, it is difficult too. All of these things need to be taken into consideration when considering surgery. In retrospect, I would do it again in a heartbeat and I am glad I chose the sleeve. Good food choices are a learning process and I wish everyone good luck with that. As for sleevers getting to eat anything - don't be too sure about that. Many things that I thought I would be able to eat post-op just don't agree with me. It is a journey and I wish you all bon-voyage.

[stimpy911]

Originally Posted by DocSanae

This does seem a promising new procedure in that
1) the success ratio is the same as, or may surpass, that of gastric bypass
2) if the desired weighloss is not achieved, the second operation can be done.
3) less malabsorbtion (however, when switched to DS, the rate of deficiencies increase some.
4) surgery mortality rate is very low.

Do not forget to ask your surgeon what his surgery statstics are.

Can it be switched to an RNY rather than a DS?

[DocSanae]

Originally Posted by stimpy911

Can it be switched to an RNY rather than a DS?

Anatomically/theoretically speaking, it could, but it is going to depend on how much of the portion of the stomach that the pouch is made of is left. With sleeve, the outer curvature of the stomach will be removed, making it into a tube. If the tube is too narrow, it is possible that there's not enough left for a pouch. This has to do with which part of the stomach is best fit for a pouch--the section that doesn't stretch much, as compared to the portion that does.

[jdforeman]

Despite the fact I'm a former RN and hospital/healthcare administrator (and have worked in the health insurance industry!) I tried for years to get my WLS covered by several insurance plans and was unsuccessful. I researched WLS surgeons and facilities in the US and was ready to schedule a date for lap band surgery at $18,000-$25,000 when I discovered a better and more affordable option for sugery. Dr. Alberto Aceves of the Mexicali Bariatric Center did my sleeve a year ago. I weighed 243 lbs at the time of surgery. I'm 155 lbs today. My goal is 135 lbs and I'm still losing at the rate of 1 to 1-1/2 lbs per week. I had absolutely no problems after surgery and today can eat anything I want in small amounts. One unexpected and welcome benefit is that I'm rarely hungry and don't crave sweets, fatty foods, fast foods, etc. Food is no longer the priority in my life! Yipee! The vertical sleeve gastrectomy (VST) or sleeve has been performed since 2002 and studies to date show that patients lose 70-80% of their excess body weight after 3 years, comparable to bypass surgery. Obviously, long-term (10 year) outcome data isn't available yet. It's being done by fewer surgeons in the US than in Mexico. It's better than the band or bypass for several reasons: no risk of slippage or erosion; it's permanent (this may be an advantage or disadvantage to some); reduced hunger and cravings; no need for fills; no risk of dumping; less risk of nausea, vomiting and diarrhea; less need for supplements. After I discovered the sleeve option, I never gave considered other choices. It was a no brainer for me.