Hello dear fellow bandsters..

since almost all of you re reading a lot of stuff about the bariatric surgeries (in your effort to learn more about the band) i wonder if you have a personal opinion about the sleeve gastrectomy or if some of you you would prefer that operation than the band.

thanks for your answers

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Originally posted at www.lapbandtalk.com

I have heard of it, but not sure exactly what it involves.

If as the name implies, it involves a sleeve that goes over the stomach to reduce the overall size, I think it sounds bloody brilliant.

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Originally posted at www.lapbandtalk.com

Actually the surgery involves removing half the stomach and leaving a long tubular shaped stomach.

I consulted with my bariatric surgeon on this surgery vs the bypass and he said one is restrictive (sleeve) and one is both restrictive and malabsorptive (bypass). He did comment and say the Sleeve is like doing half a bypass.

I was opting for the Sleeve but he said with me and my circumstances he felt I would benefit more from the Bypass. He didn't have anything bad to say about the Sleeve though other than to say the long term results are not there to determine just how effective it will be in the future. The bypass has long term data to review.

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Originally posted at www.lapbandtalk.com

He did comment and say the Sleeve is like doing half a bypass.I was opting for the Sleeve but he said with me and my circumstances he felt I would benefit more from the Bypass. He didn't have anything bad to say about the Sleeve though other than to say the long term results are not there to determine just how effective it will be in the future. The bypass has long term data to review.

thanks for your answer.

i would like to know if anyone else has anything to add in Pennys post.

or is it also a common procedure in USA?

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Originally posted at www.lapbandtalk.com

I also pondered whether to go with the RNY or sleeve. I kinda thought a malabsorbtive procedure would be better, but my doctor talked me into the sleeve. His reasoning was this: I have a BMI of 43 but have no other health issues other than sleep apnea. He said if I had other issues such as diabetes, high blood pressure, etc, he would recommend the RNY but didn't feel I needed a malabsorbtive procedure at this time.

I'd never do a malabsorptive procedure, I've got a few friends who are doctors and they are always telling me about the people they see years post-bypass who have all kinds of issues. One friend was telling me about a pt she was managing who was like 2 decades out of bypass, obese (although god knows how big she was before her bypass) and spending literally half the year in the hospital because of electrolyte issues that were very difficult to correct. Electrolyte issues can lead to heart arrhythmias and even death.

While the bypass does have long term data to review, it is unfortunatly not very good reading. What caloric malabsorption it provides is temporary at best - after that it is a restrictive only procedure like the sleeve, and the consensus of study data shows that the weightloss character of both are very similar, averaging in the 70-75% excess weight loss which is better than the bands at 50ish % but less than the DS in the 85-90% range. What isn't temporary about the bypass, however, is the mineral malabsorption, which is with you for life, the most troubling typically being Iron and Calcium. Another long term issue is the problem of the piece of intestine that is joined to the RNY pouch is not resistant to stomach acid like the bypassed duodenum (the part of the small intestine immediately below the stomach that is also the entry point for bile and digestive enzymes from the liver and pancreas.) This means that the suture line between the pouch and intestine never really fully heals and often weeps a small amount of blood, which compounds the iron malabsorption issue. This is also the reason that NSAIDs are not to be used by RNY patients for pain relief - for life.

Regain resistance with the RNY is also not very impressive - being calorically a restriction only procedure like the sleeve, you are pretty much on your own to make the long term lifestyle changes to keep the weight off; there is a school of thought that the sleeve may be somewhat better on the regain front due to it keeping an intact pyloric valve in its reduced stomach. If one is interested in a malabsorptive procedure, they should seriously check out the duodenal switch which does offer long term caloric malabsorption and better regain resistance, less severe mineral malabsorption since the duodenum is only partially bypassed, and like the sleeve (which is a part of the DS) has no limitations on NSAID use. The DS is a more technically challenging procedure than the sleeve or RNY which is why you don't find as many surgeons offering it, but those that do tend to be at the top of the class. All of these procedures have benefits and detriments that need to be evaluated relative to individual needs. but overall the RNY comes off as the less attractive procedure for most - it has similar weight loss and regain performance to the sleeve but at greater cost in lifestyle and medical treatment limitations, but poorer performance to the DS at a similar or greater cost.