Vertical Banded Gastroplasty vs the Sleeve
with the VSG, we remove part of the stomach. We also remove ghrelin, which makes the VSG one of the best surgeries out there (along with the DS).
From a physiological standpoint, differences are huge. You don't have the reduction in ghrelin with a VBG. You have to deal with food getting stuck and food intolerances like with a Band.
If I went to a surgeon and he still did the VBG and promoted it, I would have serious concerns about using him/her.
Lap-Band June 14, 2001. Dr. Rumbaut, Monterrey, Mexico.
Lap-Band removed after 7 years and converted to Sleeve Gastrectomy on July 7, 2008 by Dr. Roslin. I've had three happy healthy Lap-Band babies.... and one VSG baby. 5 years out from revision to VSG. Gained 55 pounds in past 5 months, now considering DS. :(
However, the sleeve has only been done as a standalone procedure for about 5-6 years and at first they were sizing the stomach quite a bit larger than they do now so there isn't a lot of data published that follows patients with the smaller sleeves for more than 3 years.
From my research, it seems that the farther out you go, the more the results converge on a 50% EWL no matter what surgery you have. I saw a slide at a surgeon's seminar that showed 55% for RnY and 51% for Lap Band at 14 years out, for example.
Now, I think EWL (excess weight loss) is not necessarily the best measure of success and these numbers that are an average of all WLS patients can be misleading. After all, if 50% of the people gain every drop back and 50% stay at goal, that's a 50% EWL but it means your odds are only 50/50 of being healthy. That would suck!
What I really want to know is what percentage get to goal, what percentage stay at goal, what percentage do regain but still retain significant weight loss and what percentage gain every last drop back. Those numbers are pretty much impossible to come by. I have seen both 75% and 80% retaining significant weight loss (over 50% EWL) thrown out there but not in any scientific articles, just conversations and newspaper articles.
I think how successful you will be comes down to what your food issues are and how committed you are to dealing with them. Different surgeries work better with different personality types and food issues than others and some food issues/personalities will do well with *any* WLS and, conversely, some will sabotage any WLS.
For me, the sleeve makes sense because my primary issue is hunger. I am hungry every 1-2 hours and I rarely feel full. The sleeve and the DS have the best hunger control -- because the DS has a sleeve component. I don't need malabsorption though because I already have decent eating habits -- not the best, but I love a lot of healthy foods and am not fond of a lot of junk -- I couldn't survive on a typical DS diet, for example. I just can't eat that much fat.
The other cool thing about the sleeve is that you can revise it to anything. If a few years out, I find I really do need malabsorption after all, I can get it turned into a modified RnY, a DS or even put a lap band around it. Hopefully it won't come to that, though.
I have been looking into this since Feb. I knew I couldn't get off work easily until Sept-Oct so I passed the time doing research. I've got over 100 bookmarks and downloaded pdfs! I'm now starting to print off selected ones and mark them up with highlighter and pen just like I'm back in school. My surgeon probably thinks I'm nuts! I know my family does.