Re: Questions regarding VG portion versus full DS

[Guest guest]

Deb,

I have been laid off since June and am hoping (expecting) to have the

surgery in February (provided all goes well with my insurance.) I think

being laid off is the perfect opportunity to have the full surgery for all

the reasons you mentioned especially since it's really not a good idea to

have to take off for an extended period of time after recently starting a

new job when you need the rest of the surgery. I'm looking at this time as

a gift of time to take care of myself for a change.

Best of luck in whatever you decide. Good luck in your journey.

ann

Questions regarding VG portion versus full DS

Hello, all -

Part of me wants to just do the VG part of the procedure first, see

how much weight I lose over a year, then decide on the malabsorption

part. The quality of life issues and risks that can be a big negative

after WLS are primarily linked to malabsorption. The doctor I plan to

use in VA prefers to do this two-part surgery with patients weighing

over 350 lbs, but since I carry most of my weight in my hips rather

than my belly, it may be an option to do the entire DS. By just doing

the VG portion, I could also see if I have an acceptable weight loss

result before continuing with the more life changing malabsorption.

Weight loss is considerably slower this way, however.

Any thoughts, comments, feedback from people who have done either the

VG alone or the DS? I think the most relevant experiences would be

from people who started with a high BMI over 50 like me (57).

Thank you!

Deb C.

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[Guest guest]

Hi Deb!

The people you mentioned who have lots of problems, have they had the

DS or the RNY? I'd be surprised if you know a lot of people with the

DS who are having those problems long term. There's pleny of helpful

info on this at www.duodenalswitch.com. That may help you make a

decision. I'm a recent postie so I can't speak for long terms but I

have no problem getting in my vitamins or meds so far.

Good luck in whatever you decide!

Tracey in Santee (San Diego)

I'm tempted to ask to do the whole DS in light of these risks, but

really *really* worried about the malabsorption effect. I know lots

of people who have had WLS with ongoing problems... pains, inability

to take meds, vitamin deficiencies, etc.

[Guest guest]

Hello Deb C.:

If I were considering undergoing the vertical gastroplasty or " sleeve

gastrectomy " instead of the full BPD/DS, I think I'd try to get a

second opinion from a BPD/DS surgeon who's done plenty of revisions

(perhaps Dr. Hess or Dr. Maguire)? I'd be interested in such a

surgeon's opinion as to the likelihood that I'd reach goal weight, or

near it, by having the second half of the BPD/DS done after having

regained all the weight I'd lost with the stomach-only portion.

The reason I'd state the scenario so pessimistically is that I

suspect that many or most of Hazem Elariny's patients who have had or

will be having what they call the " sleeve " will not be seeking the

second half of the operation until they've regained most or all of

what they lose after having the first half done. That's because the

surgeon himself is encouraging his patients to believe that they can

and should learn better eating habits via behavior modification,

etc., that should make getting the second half unnecessary. A " you

can do it with just the sleeve " culture is developing among Elariny's

patients, and that atmosphere, combined with the memory of the

unpleasantness of the recovery period after abdominal surgery and the

possibility that " sleevers " will have difficulty getting insurance

approval for the second half after their BMI's have fallen below the

morbidly-obese range, is likely to keep such patients trying

valiantly to keep the weight off with the sleeve alone until their

weight nears or exceeds its previous high.

And the weight is likely to come back, because the sleeve

gastrectomy, like all purely restrictive surgeries, provides one with

nothing more than assistance in dieting. And most diets fail, which

is why we're all here.

Until this year, when Elariny began pitching the sleeve gastrectomy

as a stand-alone operation, weight regain after the first half wasn't

much of an issue because surgeons were performing the BPD/DS in two

parts only on patients whose very high BMI's made prolonged

anesthesia risky. The second part of the BPD/DS was always done, and

it was always done while the weight loss with the sleeve portion was

still proceeding. My understanding is that a revision to the BPD/DS

is less likely to bring a patient close to goal weight after most or

all of the original weight has been regained. Yes, I suppose the

second half of the BPD/DS wouldn't constitute a revision, strictly

speaking, but it does seem that the " sleever " would be in an

analogous situation.

You will lose weight perforce in the first couple of months after a

sleeve gastrectomy, and probably lots of it, because your healing

stomach won't hold much and you'll want less than it can hold. As

the months go on, you'll be able to eat more food and more types of

food, just as we BPD/DS'ers can, but unlike us, you will find

yourself relying more and more on willpower to keep the pounds coming

off. Nearly ten months after my BPD/DS, my stomach is still much

smaller than it used to be, but, were it not for my malabsorption,

could I easily eat enough through the day, in small meals

and " grazing, " to put back on every one of the well over 100 pounds

that I've lost? Absolutely.

The very qualities of the sleeve gastrectomy that make post-op life

so pleasant for us BPD/DS'ers are those that make it a lame assistant

in weight loss for those who've undergone the stomach modification

alone.

I do respect your fears of malabsorption. If you're determined to

stick with a purely restrictive surgery, why not consider the

adjustable gastric band (LapBand)? It's much less invasive than the

sleeve gastrectomy, and, unlike that operation, was designed to stand

alone. It can also be easily adjusted to make your stomach smaller

after the early post-op months of easy weight loss have passed. I

have read that Elariny either is now offering the LapBand or that he

soon will be.

Best of luck.

Kay B.

Lap BPD/DS - 3/01

Dr. Ren