Dr. Jossart,

What is a better option for those of us with high BMIs? I am a 440 lb woman, fairly health and active at 32 years old with some early DMII, PCOS, sleep apnea and hypothyroidism.

Is a sleeve the best answer? My reasearch on 65+ BMI is restricted to the RNY, their is little info (that I could find) on the success of VGS or LAP/Realize bands.

Tracy:svengo:

Great question, difficult answer. The reason to do a VSG for a higher BMI is because it might be safer, not because it would have better weight loss. The idea is to stage the higher BMI patient into two operations instead of one with the hopes of making it safer for the patient. The operation that would yield the best weight loss but is more risky, is the duodenal switch. The RNY may be adequate for the higher BMI patient but some data does suggest that once the BMI starts to go over 55, it may not be adequate for weight loss. Again, this is very difficult to answer adequately.