Hi all,

I've been doing some research & I am very interested in the VSG surgery. My question is... do I have a choice which surgery I get and also do all hospitals have surgeons that specialize in this surgery? I should be going to Humber River Regional.  After all I have read I just feel that this surgery would be better for me in the long run. Also my BMI is 53 and I read somewhere that if you have a BMI over 50 it may be a good idea to start with a VSG. Another question I have for anyone out there who has had this surgery is how much weight can I expect to loose and does it take a lot longer than RNY. I'm not overly concerned how long it takes me to loose the weight if it is a bit slower weight loss than the RNY I'm okay with that.  I just feel so much better about the VSG especially with my high BMI. 

Hey Ronnie.

Generally the surgeon makes the decision as to which surgery you're going to have. Please feel free to bring your opinion, and your research to the appointment with the surgeon. 

I'm not sure about surgeons at all hospitals being able to do the VSG., Other people will know more about that than i do.

My understanding is that virtually any bariatric surgeon is capable of performing a VSG as it is used as a back-up plan for people who go into surgery expecting RNY but who has some unexpected complication that makes RNY impossible at the time. Whether a surgeon will agree to perform a VSG at your surgeon's appointment is a different matter and varies a lot from surgeon to surgeon. Certain centres and surgeons get a reputation as being very open to patients having a choice in their surgery so long as they provide a reasoned argument - I would consider Hamilton to be like this. I can't speak to HRRH and their surgeons, though I've gotten the impression that they are of the "RNY as gold standard" mentality (but I could be wrong).

With the VSG, your expected weight loss is 55% of your excess weight, which is a little less than the expected weight loss with RNY. However, I completely understand your desire to keep your pyloric valve (I felt the same way. I had DS on March 7th). Research indicates that the best surgery for people with BMIs over 50 is the Duodenal Switch (DS). Have you looked into it at all? Do you have other co-morbidities?

Hi Pat, you have a medical background ... I saw Dr. Gmora in Hamilton a few weeks ago and he didn't want to do a VSG even though I've had three abdominal surgeries and have osteoporosis.  He said that if things go wrong with a VSG it is catastrophic (his words) whereas with bypass it is easy to fix.  Do you have any comments or feedback on this?  I felt very optimistic and comfortable with the VSG and now am wondering if I should do more research or just take their word for it as professionals?

Thank you

I actually don't have a medical background, just to be clear, but I'll see if I can answer your question. I think what Dr. Gmora is getting at, is that the VSG is not reversible - they remove most of your stomach and throw it away and there is no way to get it back or reconstruct it. Whereas with the RNY there is nothing removed and it can be reversed - though this is a very major surgery and almost never done and can have serious complications itself.

I've looked at studies that compare the risks for RNY and VSG and they have about equal rates of surgical complication, just different complications. I would ask Dr. Gmora to show you studies or some statistical information to support what he's claiming. Something *could* go terribly wrong with any surgery. The updated position statement from the American Society for Metabolic and Bariatric Surgery says that meta-analysis of existing VSG studies found serious complications (including bleeding, stricture and leaks) to be about 4%, compared to RNY at about 7% (if you consider an ulcer to be a serious complication, the rate for RNY doubles, whereas this is very rare with VSG). Dr. Gmora may be of the opinion that while serious compliations for VSG are more rare, they are harder to treat, which I can't really comment on. But if you look at the mortality statistics, the numbers for VSG are even better than for RNY, so people are obviously generally surviving even the serious complications.

If you still think the VSG is right for you - ask for a second opinion. Dr. Anvari or Dr. Hong can have a look at your case and make a recommendation as well. In the end it is you who has to live with the surgery for the rest of your life, not the surgeon.

Thanks very much Pat and I'll call them today for a 2nd surgeon meeting.

Have a good day.

I had VSG @ HRRH and lost close to 100% of my excess weight.  Results vary references suggest 60% of your excess weight while RNY is 80 % however this is based on a 12 mos result. . .there is criteria that OHIP has set for VSG that some centres apply more strictly than others.

I am out of Hamilton, I did my research too. I was more comfortable with the VSG, because of the risks(rny vs vsg) and bowel issues that I have already. I asked for VSG told doctor my concerns and on April 2, 2012 and had it done. I am only a month out, but I don't regret my decision at all. I am really comfortable and happy with my decision. And the first time in 20yrs I am losing weight 34lbs including 2 weeks pre-op diet. My starting BMI was 46. Hope that helps you..

My surgeon suggested the VSG for me because I was over a 50 BMI with the possibility of having the DS a year and half down the road depending on how well I do from now until then!! So far 2 months out and down 70 lbs!! I was told at my last appointment that the speed I am losing weight with the VSG is not normal and I am way ahead of schedule!! I was told that you normally lose less per month with the VSG than you would with the RNY, but everyone is different and some can be very successful with just the VSG!! I would definitely talk to your surgeon about having the VSG no harm in asking!! Make sure you've done your research and have all you questions ready!!! Good luck!!!  

I also had vsg, everyone has given you great info so I don't have much to add. I think a lot of docs are stuck on rny as the gold standard but if you are prepared to discuss most seem willing to hear you out. Many have had other surgeries here so it is just a matter of being willing to talk to the surgeon.

You are looking into this at a good time - you have a much better chance now, than you would have had even 12 months ago.  There seams to be a slow acceptance of VSG now.  Good luck!

 I had a vsg done in december in hamilton and i do not regret it at all infact i am glad i had that one instead and so far i have lost 95 lbs

I had the VSG at Toronto Western - although not by choice.

I have lost 90 pounds in 3 months....but I still have another 113 to go until goal. I am having good results so far so I am looking forward to making it to goal one day.

FYI......The Schedule of Benefits which is essentially the billing bible the physicians use and is available on the Ministry of Health website says that…..(NOTE: I have edited this as it is quite long with other criteria and actual $ amounts so if you want to read the full thing I suggest you visit the Ministry of Health web site and search Schedule of Benefits)

29. Bariatric surgery (Surgical Preamble) S120 (gastric bypass or partition), S189 (intestinal bypass) and S114 (sleeve gastrectomy) are insured services only when all of the following four criteria are satisfied:
1. Presence of morbid obesity that has persisted for at least the preceding 2 years, defined as:
a. Body mass index (BMI) exceeding 40; or
b. BMI greater than 35 in conjunction with any of the following severe co-morbidities:
i. Coronary heart disease;
ii. Diabetes mellitus;
iii. Clinically significant obstructive sleep apnea (i.e. patient meets the criteria for treatment of obstructive sleep apnea); or
iv. Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite optimal medical management);
2. The patient's bone growth is completed (18 years of age or documentation of completion of bone growth);
3. The patient has attempted weight loss in the past without successful long-term weight reduction; and
4. The patient must be recommended for the surgery by a multidisciplinary team at a Regional Assessment and Treatment Centre in Ontario
.
Digestive System Surgical Procedures (Stomach)  
# S120 Gastric bypass with Roux-en-Y anastomosis, for morbid obesity    $$$$
# S115 Reversal of previous vertical banded gastroplasty    $$$
# S114 Sleeve gastrectomy    $$$
Note:
1. S114 Sleeve gastrectomy is only eligible for payment when:
a. a Roux-en-Y gastric bypass is not possible due to small bowel disease/adhesions or previous surgery; or
b. performed as a planned staged surgery in patients with a BMI > 60 to enable the patient to lose weight.
2. S120 is an insured service only when all of the conditions set out in the Surgical Preamble are satisfied.
Commentary:
1. S120 does not include the service described as adjustable gastric banding by laparoscopic or open surgical method. See section 37.1 of Regulation 552 under the Health Insurance Act.
2. Morbid obesity refers to patients with a Body Mass Index (BMI) > 40.]

 

 

Essentially it means that for the most part the doctor will not get paid if they aren't able to provide a good medical reason why you need to have a VSG over the RNY (such as scar tissue or say an intestine that is too short to re-route to your new pouch). I'm sure that the payment amount and the possibility of not being paid must play into some doctors decidsions to do nor not do one over the other.

I believe a good doctor will take your concerns and preferences into consideration and hopefully you will end up with the surgery of your preference.

My doctor at St. Joe's in Toronto (from HRRH group) was awesome. I love my VSG.

Good Luck.

 

I had the RNY so I can't add anything to this discussion but I wanted to wish you luck on your journey. You are doing the right thing by researching and asking questions!

GOOD LUCK!!