Am I the only one who has had this VSG surgery done 2X's (hope not)?
on 3/29/13 2:50 pm
As you know undoubtedly given that you have now done tons of research, the VSG is not a standardized surgery and each surgeon has his or her technique in cutting and shaping the sleeve. The bougie (French for candle) is only one aspect of sleeve size and effectiveness.
There are several studies out there by very prominent bariatric surgeons that indicate that a larger sleeve is just as effective for weight loss and tends to result in fewer complications and a better quality of life post op. And there are several studies that suggest the opposite. The fact is that there are very few facts that can be asserted here with certitude. Everyone has their own experience and their own truth.
I will agree with you that choosing an excellent and experienced surgeon with a proven track record of success is key. I also agree that the VSG is the way to go in WLS and if I have to get resleeved a hundred times, I will be doing that. Hopefully once will be enough though! I also agree that the surgery is a tool. A powerful tool. But you have to use it the way it was intended. And yes on the exercise and the healthy choices and getting therapy and group support and all that!
The rest, unfortunately there is no standard road map for the VSG. It is very individual.
Best of luck to you in your journey.
I've read and seen on here that as far as Mexico goes the best surgeons are Alvarez and Aceves. Surgeon technique is all over the place though and I have not seen many re-sleeves in the 3yrs I have been on OH. I know my hospital has a "tightening" procedure but I think the results are iffy.
The VSG is not standardized so sleeves are between 30f-42f. I have a 40. I also had GERD going into surgery and was told that I could have more reflux issues with a tighter sleeve. I wasn't willing to risk it and I also do not try to eat to capacity. I always measure and my portion sizes mirror what I ate at 6months out.
Sleeve size is always a hot topic here. My opinion may not be popular but even a tight 32 can be "eaten around", and lots of calories can go down in the form of milkshakes, chips and cookies. I have never seen someone post that regained on lean protein and veggies alone.
http://www.youtube.com/user/72Crabadams Me rambling about my journey : )
I don't want to get argumentative but your research is a little self-serving and might mislead some so I thought I'd speak up. If you think 1 mm of difference in the diameter of your sleeve is going to make a difference, I think you overestimate the measuring potential of a French catheter during a dynamic surgery. The length of your stomach makes much more of a difference than the diameter of the little tube they use as a cut guide.
If you aren't exercising, cut back on your calories and carbs. Really hate it that you felt the need for a second surgery but to each his own.
Good luck in your journey.
800 calories and less than 20 net carbs is the shizzle
on 3/29/13 6:21 pm - Greater Austin Area
I just had to chime in here. There are some people who have been re-sleeved with much better success the second time around. If they have a much smaller sleeve the second time around, of course that would help tremendously! Not being able to exercise or move around in general for 6 months will make a lot of people gain weight. You could have dieted the weight off but it probably would have been really hard if you felt your sleeve was too big and also your hunger was still large. Having a lot of hunger doesn't help anyone in weight loss. I think we all would like to believe we'd never need to be resleeved or need additional surgery, but it could happen. I've seen a couple of really successful VSG'ers (who lost almost 200 lbs) regain a LOT of it back and revised to the duodenal switch for more success. The DS is the same sleeved stomach plus malabsorption obviously.
And I think Dr. Ponce De Leon is an excellent surgeon. I've been on ObesityHelp since 2009, back when I was looking into surgeries at first. It was just a pipe dream back then. I didn't get sleeved until 2012 though. I've heard nothing but the best about Dr. Ponce De Leon and he has been doing bariatric surgery since the early 1990's. He even knows how to do the duodenal switch. He has in fact done the switch on a few people who used to have only the VSG here on Obesityhelp. I think you chose a very competent surgeon. I'm sure he did his best to ensure a tighter sleeve.
From the sound of things, your big weight regain didn't happen until you were injured. I think we can all understand how being immobile would cause someone to gain weight. It can happen to anyone. I'm sure they also pumped you full of IV fluids during your surgeries, which also can cause weight gain. You might have been able to lose it after you were back in healthy mode and able to work out again, but you never know. I don't think there's anything wrong with your choice. It has been done before and it will be done again. I know some other sleevers from other forum websites besides Obesityhelp who have also been resleeved with greater success. They got their sleeves done tighter and also lost more hunger the second time around. I think it's such an individual choice. If you and your surgeon feel it is beneficial and safe, then you must do what you feel you should. And it sounds as if it was the right choice for you. It's good to hear you have far less hunger this time around than the first time. I'm sure that is going to help you out immensely.
Good luck! For revision, most people opt for a DS or RNY as restriction alone does not suffice for their metabolic system OR lifestyles. re-sleeves can be very dangerous. Thank God it looks like you are out of the woods at this point.
I have a larger sleeve and at times for example the entire cold winter where I have been physically challenged (palindromic rheumatism & a twice reconstructed knee which osteo has developed) so I am not able to be as active and don't expect to lose especially when my diet is not up to par. It's very hard all the time to make the right food choices. I had hunger issues as well not of your type with doubling over or anything but this sort of "I've gotta eat right now". My stomach sleeved has been a blessing in that Thank God, I don't get hungry like um, ever. Knock On wood! Does not mean I don't want to eat. my appetite is ferrotious :).
Restriction alone does not work for some especially for those of us who are not tight on our post-op plan.
I wish you the Very,very best with losing all of your excess weight & keeping it off.
All revisions are more dangerous than virgin surgeries due to the scar tissue that builds up from the original surgery. Also, now there are staples in you that have to be worked around. This is why the complication rate is higher for revision WLS.
I'm surprised your surgeon didn't explain this to you.
But then there are a lot of things I find surprising about your story.
I'm gonna just chime in on one part of your post just to back you up a bit......
First, I'm glad you were/are diligent in getting your situation worked out.
The major component to the VSG as it is known is that it is a restrictive type procedure. Restriction playing a major role in weight control. If you don't have the proper restriction to keep you in the window..... it is harder.
The obvious thing here to me is that your sleeve was to big...... if you had enough tissue to be cut/stapled a second time.....your sleeve was to big......
The other obvious thing is that if the same surgeon who made your 36 re-cut you to a 32..... you had significant stretch which is basically from over eating.
A proper 32f starts out with about a 2oz. capacity and matures to approx double it's size 4oz. A bougie 10 numbers higher (42f) can end up 4x the capacity of a 32f. think 12-16oz. Many on this board with 36-38f sleeves claim 6-12oz. capacity. Mainly because the larger the sleeve more of the stretchy tissue is retained.
Sure there are people here with larger sleeves that have done perfect and lost and maintained there weight. They most likely balanced out by making the proper lifestyle changes to make up for any restriction issues and eating correctly.
Work that second sleeve !
So..... was your second procedure a gastric plication?
and if you didn't have any sleeve stretch..... what was the capacity change between the two surgeries ?
I am glad that you have found what works for you and I understand where you are coming from with your post. The majority of the people that are defensive about your post are the people that are early out, and have not yet experienced the difficulties of a stretched out stomach or the return of hunger and cravings. I am almost four years out now, and I can really understand where you are coming from. I am fortunate enough to have friends with VSG with all different sized stomachs, some are much tighter than mine and some, unfortunately, are much looser. I can see for myself that the struggles we all face are just easier to deal with when there is more restriction. Even though my doctor makes relatively tight sleeves, he does on occasion, for different reasons, go tighter still. My close friend has a much tighter sleeve than I have and to be perfectly honest, I envy her. Don't get me wrong, I want her to continue to succeed and I love her, but it is clear to me from watching her journey that her path will be easier than mine. Yes, what we put into our sleeve is very important for weight loss and maintenance, however, that didn't work so well for most of us before surgery, so to expect that it will magically work years out after surgery is a bit naive. Most of us need a strong tool to help keep us from straying to far from our program, otherwise we could have done this on our own. I do want to caution people who have not yet had their surgery that boughie size is just one of many factors that go into making a tight sleeve. I know plenty of people who got a 32F and have loose sleeves, surgical technique as well as length of stomach play a huge role in your overall capacity. Finding a surgeon whose overall commitment is to a smaller stomach is important, not just the boughie size.
Good luck to you on this second go around, I hope that you get everything you need and want from your sleeve; may all your dreams come true and I hope that this makes it easier for you to stay the course in long term maintenance.