I am listening to a radio show and there is a Dr Freedman (in Alabama I believe) on the show who says he doesn't do the sleeve because he has a problem with it - says there is a study by a Dr in California who recently did a CT study of his 5 year sleeve patients and it show their stomach was completely stretched out. This Dr Freedman said he doesn't do the sleeve because of the risk of regain and sites this study. Does anyone know about this study or can you find any info on it??

I found this abstract of a German study published this Feb. Basically, the way I am reading it it says that sleeve size doubles (approximately) by about six months after surgery. This corresponds to the reports of people here on the forum that they can eat more six months after surgery. Please note that 196 ml (the mean stomach size after six months) is a bit bigger than 3/4 cup. If there is a CA doctor with 5 years of data, it's likely to be Jossart or Cirangle. I cannot find anything new on their website but someone else may come across the published article in a journal somewhere.

Three-dimensional stomach analysis with computed tomography after laparoscopic sleeve gastrectomy: sleeve dilation and thoracic migration.

Baumann T, Grueneberger J, Pache G, Kuesters S, Marjanovic G, Kulemann B, Holzner P, Karcz-Socha I, Suesslin D, Hopt UT, Langer M, Karcz WK.

Source

Department of Diagnostic Radiology, University Hospital Freiburg, Albert-Ludwigs-University, Hugstetter Straße 55, 79106, Freiburg, Germany, tobias.baumann@uniklinik-freiburg.de.

Abstract

BACKGROUND:

Laparoscopic sleeve gastrectomy (LSG) is frequently performed as a definitive bariatric procedure today. Quantitative data on the detailed anatomy of the stomach after LSG are yet sparse.

METHODS:

Thirty-two multislice computed tomography (MSCT) data sets acquired in 27 LSG patients (22 female, 5 male) with a dedicated examination protocol and post-processing were evaluated for gastric volume, stomach length, sleeve length, antrum length, staple line length, and maximum cross-sectional sleeve area. Obtained parameters were compared to time after surgery, weight loss, and the occurrence of postsurgical regurgitation.

RESULTS:

Mean gastric volume was 186.5 ± 88.4 ml. Gastric volume correlated significantly with the time interval after surgery. Sleeve sizes of 105.3 ± 30.2 ml during early follow-up confirmed correct primary sizing of the sleeve, whereas marked dilation to 196.8 ± 84.3 ml was found in patients with a follow-up of 6 months and longer (p = 0.038). Sleeve area and staple line length were also positively correlated with time after surgery. No correlation was found between gastric volume and excess weight loss. In ten patients an intrathoracic migration of the staple line could be noted, with four of these patients developing persistent regurgitation after LSG. Regurgitation was present in only 2 of 17 patients without sleeve herniation.

CONCLUSION:

Multislice computed tomography allows for a comprehensive and quantitative evaluation of the anatomy after LSG and thus provides new insights in the process of sleeve dilation. Intrathoracic migration of the staple line could be identified as a possible cause of persistent regurgitation.

Thanks - I have dug around and wasn't able to find anything either - I just wonder if this Dr is stuck on RNY although he said he has Labband patients as well - really frustrated when I hear they negativity from a Dr.

He doesn't like the sleeve but is still doing the Band?? I wonder about his research skills...the band has terrible stats for complications, regain, and weight loss compared to the sleeve, RNY, and DS.

Yes, I thought the same.

Thanks Foxbins...

...No correlation was found between gastric volume and excess weight loss..... I found a study that also shows this...

see page 10 study... This looks to me like the difference between bougie sizes might not be that big a deal.

It talks about how fast the stomach empties out relating to Excess weight loss more...

Sleeve Gastrectomy Abstracts.pdf

Ok just found a study that suggests some regain after 5 years. This is a 2011 report. They are saying 43% failure after 5 years. They do suggest looking at similar numbers for other procedures - wonder what the rate is for RNY?

http://www.nxtbook.com/nxtbooks/matrix/bt_supp0511/index.php?startid=3#/8

Ok just found a study that suggests some regain after 5 years. This is a 2011 report. They are saying 43% failure after 5 years. They do suggest looking at similar numbers for other procedures - wonder what the rate is for RNY?

http://www.nxtbook.c...hp?startid=3#/8

interesting study.

...No correlation was found between gastric volume and excess weight loss..... I found a study that also shows this...

see page 10 study... This looks to me like the difference between bougie sizes might not be that big a deal.

It talks about how fast the stomach empties out relating to Excess weight loss more...

That gives me hope - my Dr uses a 40.

Weight regain is a risk we assume by having a restrictive procedure like the VSG and from what I have seen there is little to choose in that regard between it and the RNY and bands. The more relevent question to me is for that risk, how much complication/side effect risk does one want to assume, and the RNY and bands are much worse than the VSG in that regard. To get a worthwhile improvement in the long term regain area it seems that one needs to go to the DS with its metabolic changes that move one closer to a "normal" person.

Given the quality of what passes for medical "research" and the poor understanding of statistics shown by the medical profession in general, I would seriously question the sanity of a doc like this who swings his opinion based on one study. If he is having problems with weight regain within his practice, that may be a reason to shy away from the procedure, or at least figure out why it is happening and what patients are successful, and if his results are markedly differnent than his peers' results, and why.

Very interesting link!

The 43% failure rate was I believe partly calculated based on the number of people they could not follow up with.

What I also found very very alarming was how GERD and ACID REFLUX really increased at 6+ years out. That seemed associated with a couple of things, one of them being over eating... I would like to think that i have the self control to follow the rules forever, but it is a concern.

It's funny, even with the "failure rate" I still think it is an awesome tool. I can see it is something I need to use long term and not just til I get to goal. I thought the GERD/Acid Reflux thing was interesting also. Not worrisome enough for me to go to RNY though. I have one friend who had an out and out DS to begin with, she has had great weight loss, very near goal at 8 months out. But I think DS is not for me today, who knows if I would need to revise what I would choose.

Just read the article on weight regain. interesting but the samples are very small -- 26 in one study and 41 in another. I believe one had 96 patients but that is still pretty small to generalize to the total population of vsg patients. Also mean EWL is just the arithmetic average. Some people would be lower and some would be higher than the percentage they present. In a small sample, one or two "deviant" people with huge weight gain could throw off the mean. Using a median (50% above it; 50% below it) might be more meaningful as a middle point. Hard to know without seeing the entire database. As one of the formerly super obese people they mention in the article, at least this is a sign to me to be really vigilant forever about what I put in my mouth. Water, healthy eating, and exercise is a way of life during and after weigh loss and I imagine a lot of people slow down on those, hence the weight gain.

Those articles freaked me out a little ... I think one mentioned regrowth of the fundus? Does the stomach begin stretching out again? I thought that couldn't happen with the sleeve!

I agree with the comments about the small sample sizes in these studies, which could lead to skewed conclusions. I'd like to studies of sample groups of at least 100 patients, not 40 or less.

I go to an in person WLS support group at a local hospital ... I am the only sleeved patient (everyone else is gastric bypass). There are several people there who are 3+ years out and they are dealing with weight regain issues (some have had a lot of problems with weight regain). It does make me realize how important it is to make major changes (food choices, exercise) and stick to them in order to avoid a problem with weight regain down the road.

My doctor talked to me a little about this. He said the studies include all ages of adults up to people who are 70 years old. All weight ranges permitted for bariatric surgery, and of course all ranges of motivation. He said he would like to see studies done by separating the ages and weight ranges and those that continued to make exercise part of their lives. I can see where you might have some different results (especially with regard to exercise) if these types of studies were done. During my pre-surgery class the nut said we should very rarely or never eat deep fried foods. One of the ladies in the back said "Really? Never? You mean I can't eat those after I get to the solid food stage?"

Khy

This is so depressing, I probably shouldn't have clicked on this thread right now, I've been in a glum funk since yesterday about a lot of things and this is just fuel to the fire ... Let's just say worst case scenario it is 5 years later and although a person has been diligent about changing their lifestyle, the stomach has still stretched out a lot and now the person is pretty much on a severe diet just to maintain. Can they get a "tighten" tune up? Resize the stomach back down to smaller? Is that possible?