Are there any sleeve un-success stories?

[WASaBubbleButt 41]

It's the same procedure. People just have different names for it, probably because it's new. My surgeon calls it a veritcal gastrectomy and no sleeve in there at all.

These procedures should *always* be done lap, if at all possible. If you find someone who says they "prefer" to do them open, RUN. That means they aren't skilled enough to do them lap.

Now, you may have unique things about you that require you to be done open, but the good surgeons always start out lap and only open up if they run into situations that call for it.

How many they should have done is more what you feel comfortable with. I went to the guy who had done the most in the US (or at least the West Coast -- it's not like they have an offiical scorekeeper so maybe Gagner, on the East Coast, has done more than him, but probably not). So obviously, experience was very, very important to me. :laugh:

Your surgeon should have done AT LEAST 250 bariatric procedures. That's actually been documented -- that there is a big learning curve and it takes about 250 to get the hang of bariatric surgery.

If you are going for a sleeve, I would want him to have done 250 sleeves or 250 bypasses or 250 combination of the two, at a minimum. 250 lap-bands would not reassure me. I'd want him to have experience with staple lines and bands don't have staple lines. I also woudn't go to someone who only did bands and is now adding in the sleeve. I want someone who can do something harder than what he's going to do to me and not someone who I'm his hardest patient.

If you find someone you love, with good stats, and they have been doing bypass for years, but have just started doing the sleeve, you are going to get a decent operation, most likely. I know plenty of people who have gone to guys like that and been their 3rd or 4th sleeve and they've been happy.

OTOH, there are pitfalls. Some things to consider:

Do they understand how important it is to use a small boughie or are they going to use the same size as the DSers get? Do they understand how to deal with some of the weirdnesses that pop up? Is their after-care all bypass oriented and they are going to tell you not to eat things bypass patients can't have or not to use NSAIDs or other stuff that doesn't apply for sleeves? Do they get good results with their sleeves?

As an example, I know someone who went to a guy local to me who had a good rep as a surgeon (not as a person, but as a surgeon) and that person had some weird scar tissue on the tummy so he made her sleeve shaped like a femur and not a banana. Um, bad idea. Her stomach immediately twisted in on itself. In the end, he told her that he had to revise her to a bypass or she'd die. So now she has a bypass. Is it a coincidence that this doctor doesn't really believe in the sleeve and hadn't done too many of them? I think not.

Also, if you go to the surgeon and they tell you they haven't had as good a result with the sleeve as with bypass, that's a sign -- something about their technique or their after-care program doesn't work as well for the sleeve as it should.

Me... personally... I wouldn't go to anyone with less than 250 sleeves AND 250 bypass procedures. I wanted someone with a LOT of staple line experience.

Something you will hear sleeved people discuss a great deal is that if a surgeon isn't skilled enough to do the more difficult bypass staple lines, they won't be doing any staple lines on the majority of us. If they can only do an easy staple line, that's a concern. What if the person has a weird shaped stomach or they find a leak during surgery? I want someone that has already dealt with this previously and knows how to fix it before they wake me up.

I know your doc doesn't do any leak tests and while I agree it comes down to personal opinion, I wouldn't go to anyone that doesn't do leak tests. Mine does three leak tests and that's what I wanted. Many of us travel for surgery and some leaks won't show up immediately. I didn't want to get home and THEN discover there was a problem. With three leak tests I knew there was no leak and I was comfortable about going home.

[MacMadame 81]

Actually, LapSF will do a leak test, if you want one. They just don't do them routinely. Someone I know who traveled here from PA asked for a leak test before she went home and they said "sure".

They'll also do them if you have certain symptoms in the hospital.

I've just seen too many people on OH who had leak tests, went home, and two weeks later the leak showed up, to put a lot of faith in them.

[Oregondaisy 2,021]

I can tell anyone that living with the band is a learning experience. It's not the magic cure that some people think it is.

I thought I was fine. I could eat anything I wanted. Nothing got stuck. I got full on the amount of food I was supposed to eat for someone who has a band. I didn't throw up or pb as we call it.

All of a sudden, I started throwing up in my sleep. I called my doctor and his office told me if I had a problem, I would be throwing up in the daytime. I insisted on a test. It turned out the barium sat in my

esophaugs for over 15 min. without going through the band like it was supposed to. I had to have 1/3 of my fill removed and my surgeon said I can't have any more fill because I had no symptoms other than in the middle of the night.

I wonder how long the food was sitting in my esophagus

like the barium was? The entire time, I thought I was doing fine.

If I had known about the sleeve, I would have gotten it instead of a band. I would never have to worry about having the right fill ever again. I was a self pay too,

and now I worry that the band is going to erode my stomach, only because I know it has the possibiliy to do that. If I had gotten the sleeve, I would never have that worry.

[WASaBubbleButt 41]

Actually, LapSF will do a leak test, if you want one. They just don't do them routinely. Someone I know who traveled here from PA asked for a leak test before she went home and they said "sure".

They'll also do them if you have certain symptoms in the hospital.

I've just seen too many people on OH who had leak tests, went home, and two weeks later the leak showed up, to put a lot of faith in them.

Hmmm, I haven't. I read those boards too and I haven't seen such a trend. I've seen the crappy doctors that don't do the right leak tests and they don't know they are sending someone home with a leak. Such as Pleatman, he does the OR leak test but he tests the portion of stomach he removed, not the portion remaining. He has a high leak stat. Contrerras sent someone home with a leak, but the docs that use the right tests and check for microperforations I haven't seen that at all. There are people who go home and eat the wrong diet and cause their own leak. Keep in mind, the microperforations are the leaks that might not show up right away (regarding symptoms) and if they had the fluoro exam it would very likely be caught before the symptoms were severe like Contreras' patient.

My doc has done over 450 sleeves, does three leak tests, and has never had a leak so I tend to trust the testing a great deal. That's one of the reasons I went to him for my sleeve. Leaks are a risk of this surgery regardless of surgeon skill. I wanted to know if there was a problem before I went home, not after.

[MacMadame 81]

I don't know if it's a "trend" or not, but all 5 people with leaks that I know about had leak tests. Same with my Aunt (who had the full gastrectomy last year due to stomach cancer).

They didn't all go home and eat food too soon either, though I'm sure some of them did. But most people are good about that sort of thing, thank goodness.

LapSF was doing leak tests and not finding leaks in the OR but then people would go home and develop leaks. They speculated that the leak test was actually stressing the staple line and causing the leak. (They aren't the only surgeon who believes that, btw.) They stopped doing this test and haven't had a leak in over a year.

[Rainbowswt 0]

I had the sleeve done on July 2007, It has been a great experience!. I am size 4 now and I am very happy. This surgery makes losing weight very simple. I think it´s a lot better not to have a strange body inside of you so, you don´t have to worry about the fact that a band needs to be removed in the future.

[WASaBubbleButt 41]

LapSF was doing leak tests and not finding leaks in the OR but then people would go home and develop leaks. They speculated that the leak test was actually stressing the staple line and causing the leak. (They aren't the only surgeon who believes that, btw.) They stopped doing this test and haven't had a leak in over a year.

Not all leak tests would stress the staple line. For example the one done under fluoro. You drink an ounce of nasty tasting Gastrograffin or Conray. It's like Water, not thick in the least. That wouldn't stress the staple line and doctors would know they are sending people home without a leak.

[Oregondaisy 2,021]

What do you do if you get a leak? And how do you know if you develop one?

[WASaBubbleButt 41]

What do you do if you get a leak? And how do you know if you develop one?

It depends on the leak. Usually the severe leaks are caught in surgery and corrected right then and there. Microperforations... those are tiny. Usually they leave the drain in and let the body heal itself.

When it's not caught and repaired in surgery if it is a huge leak they give you a feeding tube, drains, and you do not eat or drink anything until it heals.

Remember Adrianne? She had her surgery by a crappy TJ doctor and she had a leak. He didn't know how to fix it and each time he tried he made it worse. She was on a feeding tube for something like 6 months.

TJWood had a leak from a band infection. If you look up his posts you can see what he is currently going through.

This is why you need the best of the best sleeve surgeons. You can't just go to anyone. You don't want to be a guinea pig for a surgeon learning staple lines.

[Oregondaisy 2,021]

You already know which doctor I will be going to. I have been thinking about it a lot lately, how to arrange the time off work, see my dad, and get the surgery all at once. It's kind of a juggling act with my dad's situation. I am sure I will not be able to go back to work as fast as I did with LB surgery.

[WASaBubbleButt 41]

You already know which doctor I will be going to. I have been thinking about it a lot lately, how to arrange the time off work, see my dad, and get the surgery all at once. It's kind of a juggling act with my dad's situation. I am sure I will not be able to go back to work as fast as I did with LB surgery.

One week is necessary, two weeks is ideal for a sleeve. It's very similar to banding for time off.

[Oregondaisy 2,021]

right, but I had my banding on a fri and went back to work on monday. I had no recovery to speak of. I know that won't be the case with all this scar tissue around my port.

[WASaBubbleButt 41]

right, but I had my banding on a fri and went back to work on monday. I had no recovery to speak of. I know that won't be the case with all this scar tissue around my port.

Yeah, removing the port is what hurt the most for me. That hurt like crazy for about 2 weeks. In the morning getting out of bed was no easy task. That was the worst part of the whole revision.

[Oregondaisy 2,021]

Has the original question been answered?

Are there people who have the sleeve who aren't able to make it to goal?

[MacMadame 81]

Yes, there are. Average excess weight loss is similar to RnY so it ranges from about 60 to 80 % depending on starting BMI. Which means there have to be people who don't make it to goal.