Starting Weight: 270
Surgery Date: July 7, 2008

Week 1  July 14   -14 pounds    256
Week 2  July 21   -8 pounds       248
Week 3  July 28    -0.5 pounds  247.5
Week 4  Aug 4      +2 pounds     249.5
Week 4 Aug 11     -0/5 pounds  249.0
Week 5 Aug 18    -6.0 pounds   243.0
Week 6 Aug 25    -0.5 pounds  242.5
Week 7 Sep 1     -3.0 pounds  239.5
Week 8 Sep 8     -1.0 pound  238.5
Week 9 Sep 15   -4.5 pounds 234.5
Week 10 Sep 22
Week 11 Sep 29
Week 12

OK, so I'm six weeks out.  The good news is that life w/ a sleeve is much better than a Band.  I have a normal stomach.  Nothing gets stuck.  No "deer in the headlights" look because I'm about to PB. 

The bad news is that the weight is coming off very slowly and I can really eat a lot.  Much more than many VSGers I talk to.  I know I have a long stomach, but still... I'm surprised.  I'm trying to look at this in a positive light... that my calories aren't being reduced as much as many, so hopefully I won't destroy my metabolism.... but still, it's frustrating.

I have a feeling that the only way I will continue to lose is to exercise every day... similar to how things were w/ my Band.

I'm grateful for the normalness.  Wishing, in a way, I would have had the DS, though.  Because then I don't think I'd be so worried about the weight never coming off... even if I lost slowly.

I guess this just goes to show how necessary this operation was for me.  If weight loss is still slow w/ 90% of my stomach gone--then I didn't have a chance with 100% of my stomach still there!

Well, I got home this afternoon from the hospital.  I have to tell you that I'm in less pain with my sleeve than I ever was with my Lap-Band... a very nice surprise. :)

I had a great experience.  Great doctors and nurses.  Here's all of the details for those pre-ops who may be wondering...

I had to arrive at Lenox Hill two hours before surgery, so we got there around 8:00 a.m.  My surgery was originally scheduled for 10:30 a.m., but we ended up going in at 11:30 a.m.  I did a bit of paperwork and then gave a urine sample and some blood.  I had been on clear liquids the day before, and was NPO since midnight.  I actually didn't feel too dehydrated because I had drunk a ton the previous day.

Being July, I got to see a lot of new residents and fellows.  I took the opportunity to educate them on the sleeve, ghrelin, and the like... as most were not familiar with it.  I met with the anesthesiologist and Dr. Roslin's PA prior to surgery... then they walked me back.  They told me they would put in a foley cathetar once I was asleep... and the breathing tube would be put in and taken out all while I was asleep.  I was given a shot of heparin in my arm.  The shot itself didn't hurt, because I have nice big fat arms and it's just sub-cutaneous (like insulin).   The actual heparin itself burned a tiny bit... but not much.  (I had heparin shots twice per day while I was there.)

The operating room was so cold!  I had forgotten that.  Anyway, the anesthesiologist started my IV and was talking to me... and the next thing I knew, I was waking up in recovery.  It was a monitored area with about 10 beds (at least my area).  It was actually a very nice sunny room, and I had a great NYC view.  The nurses kept checking on me to make sure I was OK, etc.  I couldn't believe how little pain I was in.  I actually wondered if Dr. Roslin had gone through with the surgery.  I got stuck in recovery for about 8 hours because they were waiting on a room for me.  Still, everybody was very nice and I was just sleeping on and off, so I didn't care.  They let my husband come visit me briefly.  The pain doctor came by to visit me to make sure I wasn't in any pain.. . or had any nausea.  We talked about how I would be managed. (PCA pump... morophine... with some torodol as well.)

I was then moved to my room in the evening.  It was a private monitored room in what used to be surgical ICU.  Very nice.  The private room was a nice surprice, especially in NYC.   I was on bed rest until Tuesday a.m.  I had compression booties on... that filled with air and were quite nice and massage like.  The cathetar didn't bother me at all.  I was told I could have clear fluids after my leak test the next day.  They did provide me with these pink mint flavored swabs that I could dip in warm water.  They were heaven.  Made my mouth feel totally refreshed.

I woke up in the a.m. and one of the nurse's aids helped me give myself a sponge bath.  Then I got a clean gown... clean sheets for the bed... and waited for patient transport.  A hillarious guy who loved the Mets took me down to X-Ray.  Have to say they had some funky super-duper wheelchairs.  Much sturdier than any I've been in.  Went down to X-Ray and was taken right in.   Had to only swallow maybe three mouthfulls of gastrograffin...so it wasn't that bad.  Yes, it's nasty.... but doable.  No leaks!   Unfortunately, I had to wait for the official report to make it up to my surgeon and nurses before they'd bring me a tray.

Dr. Roslin visited me with a gaggle of surgical residents...and they all looked at my incisions.  He said everything looked good on the swallow test and I was given the green light for clear liquids.  He also said my surgery only took 1 hour and 15 minutes...which is amazing.  Very little damage from my Band.

So, about three hours later, I was finally given a clear diet tray.  Chicken broth, green jell-o, and decaf tea with Sweet -n- Low.  The tea tasted delicious.  The chicken broth tasted like a bouillion cube in hot water.  The jell-o was good. 

I slept on and off... had some visitors... received some beautiful roses... and walked around the halls. 

Dinner was the same clear liquid stuff, only this time I got orange jell-o. 

Had incredible nurses and student nurses the whole time I was there.  Felt so lucky to have such great nurses. 

Had another visit from the pain specialist to make sure I wasn't in any pain.  She said I'd probably be put on oral meds (crushed) since I had passed my swallow test... either percosat or vicodin. 

Oh, they took my blood sugar and it was only 66.  No diabetes meds in two days either.  So I was given a glass of apple juice.  Yum.  And I don't even like apple juice.

This morning, they took out my drain and IV...and then I waited to go home.  I was given the OK for full fluids... but told to keep it runny... no mashed potatoes.  I was surprised I had a drain, but glad I did when I saw the yucky stuff that drained into it.  Not a lot...but still.  It didn't hurt coming out. 

So, now I"m home... and drinking lots.  No real problem with water or fluids... although I'm sticking to warm beverages right now.  Have had some blended soup, Propel, and warm sugar-free Carnation Instant Breakfast.

Best thing I brought with me? Sugar-Free Lollipops for when my throat was really dry. I didn't eat them until I'd been given the clear for fluids though. (And no chewing, of course.)

Obes Surg. 2008 Mar;18(3):251-5. Epub 2008 Jan 24.
11-year experience with laparoscopic adjustable gastric banding for morbid obesity-what happened to the first 123 patients?
Tolonen P, Victorzon M, Mäkelä J.

Department of Gastrointestinal Surgery, Vasa Central Hospital, Hietalahdenkatu 2-4, 65280, Vaasa, Finland.

BACKGROUND: Few long-term studies regarding the outcome of laparoscopic adjustable gastric banding for morbid obesity have so far been published. We report our 11-year experience with the technique by looking closely at the first 123 patients that have at least 5 years (mean 86 months) of follow-up. METHODS: Data have been collected prospectively among 280 patients operated since March 1996. Until March 2002 (minimum 5-year follow-up), 123 patients have been operated laparoscopically with the Swedish band. We report major late complications, reoperations, excess weight losses (EWL) and failure rates among these patients, with a mean (range) follow-up time of 86 months (60-132). EWL < 25% or major reoperation was considered as a failure. EWL > 50% was considered a success. RESULTS: Mean (range) age of the patients (male/female ratio 31:92) was 43 years (21-44). Mean (range) preoperative weight was 130 kg (92-191). Mean (range) preoperative body mass index was 49.28 kg/m(2) (35.01-66.60). Patients lost to follow-up was nearly 20% at 5 years and 30% at 8 years. Major late complications (including band erosions 3.3%, slippage 6.5%, leakage 9.8%) leading to major reoperation occurred in 30 patients (24.4%). Nearly 40% of the reoperations was performed during the third year after the operation. The mean EWL at 7 years was 56% in patients with the band in place, but 46% in all patients. The failure rates increased from about 15% during years 1 to 3 to nearly 40% during years 8 and 9. The success rate declined from nearly 60% at 3 years to 35% at 8 and 9 years. CONCLUSIONS: Complications requiring reoperations are common during the third year after the operation, and almost 25% of the patients will need at least one reoperation. Mean EWL in all patients does not exceed 50% in 7 years or 40% in 9 years and failure rates increase with time, up to 40% at 9 years.

Obes Surg. 2006 Jul;16(7):829-35.
A 10-year experience with laparoscopic gastric banding for morbid obesity: high long-term complication and failure rates.
Suter M, Calmes JM, Paroz A, Giusti V.

Department of Surgery, Hôpital du Chablais, Aigle-Monthey, Switzerland.

BACKGROUND: Since its introduction about 10 years ago, and because of its encouraging early results regarding weight loss and morbidity, laparoscopic gastric banding (LGB) has been considered by many as the treatment of choice for morbid obesity. Few long-term studies have been published. We present our results after up to 8 years (mean 74 months) of follow-up. METHODS: Prospective data of patients who had LGB have been collected since 1995, with exclusion of the first 30 patients (learning curve). Major late complications are defined as those requiring band removal (major reoperation), with or without conversion to another procedure. Failure is defined as an excess weight loss (EWL) of <25%, or major reoperation. RESULTS: Between June 1997 and June 2003, LGB was performed in 317 patients, 43 men and 274 women. Mean age was 38 years (19-69), mean weight was 119 kg (79-179), and mean BMI was 43.5 kg/m(2) (34-78). 97.8% of the patients were available for follow-up after 3 years, 88.2% after 5 years, and 81.5% after 7 years. Overall, 105 (33.1%) of the patients developed late complications, including band erosion in 9.5%, pouch dilatation/slippage in 6.3%, and catheter- or port-related problems in 7.6%. Major reoperation was required in 21.7% of the patients. The mean EWL at 5 years was 58.5% in patients with the band still in place. The failure rate increased from 13.2% after 18 months to 23.8% at 3, 31.5% at 5, and 36.9% at 7 years. CONCLUSIONS: LGB appeared promising during the first few years after its introduction, but results worsen over time, despite improvements in the operative technique and material. Only about 60% of the patients without major complication maintain an acceptable EWL in the long term. Each year adds 3-4% to the major complication rate, which contributes to the total failure rate. With a nearly 40% 5-year failure rate, and a 43% 7-year success rate (EWL >50%), LGB should no longer be considered as the procedure of choice for obesity. Until reliable selection criteria for patients at low risk for long-term complications are developed, other longer lasting procedures should be used.

PMID: 16839478 [PubMed - indexed for MEDLINE]

Obes Surg. 2007 Feb;17(2):168-75.Click here to read Links
Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results.
Favretti F, Segato G, Ashton D, Busetto L, De Luca M, Mazza M, Ceoloni A, Banzato O, Calo E, Enzi G.

Department of Surgery, Regional Hospital - Vicenza, Italy. ffavret@tin.it

BACKGROUND: This study examines 1,791 consecutive laparoscopic adjustable gastric banding (LAGB) procedures with up to 12 years follow-up. Long-term results of LAGB with a high follow-up rate are not common. METHODS: Between September 1993 and December 2005, 1,791 consecutive patients (75.1% women, mean age 38.7 years, mean weight 127.7 +/- 24 kg, mean BMI 46.2 +/- 7.7) underwent LAGB by the same surgical team. Perigastric dissection was used in 77.8% of the patients, while subsequently pars flaccida was used in 21.5% and a mixed approach in 0.8%. Data were analyzed according to co-morbidities, conversion, short- and long-term complications and weight loss. Fluoroscopy-guided band adjustments were performed and patients received intensive follow-up. The effects of LAGB on life expectancy were measured in a case/control study involving 821 surgically-treated patients versus 821 treated by medical therapy. RESULTS: Most common baseline co-morbidities (%) were hypertension (35.6), osteoarthritis (57.8), diabetes (22), dyslipidemia (27.1), sleep apnea syndrome (31.4), depression (21.2), sweet eating (22.5) and binge eating (18.5). Conversion to open was 1.7%: due to technical difficulties (1.2) and due to intraoperative complications (0.5). Together with the re-positioning of the band, additional surgery was performed in 11.9% of the patients: hiatal hernia repair (2.4), cholecystectomy (7.8) and other procedures (1.7). There was no mortality. Reoperation was required in 106 patients (5.9%): band removal 55 (3.7%), band repositioning 50 (2.7 %), and other 1 (0.05 %). Port-related complications occurred in 200 patients (11.2%). 41 patients (2.3%) underwent further surgery due to unsatisfactory results: removal of the band in 12 (0.7%), biliopancreatic diversion in 5 (0.27%) and a biliopancreatic diversion with gastric preservation ("bandinaro") in 24 (1.3%). Weight in kg was 103.7 +/- 21.6, 102.5 +/- 22.5, 105.0 +/- 23.6, 106.8 +/- 24.3, 103.3 +/- 26.2 and 101.4 +/- 27.1 at 1, 3, 5, 7, 9, 11 years after LAGB. BMI at the same intervals was 37.7 +/- 7.1, 37.2 +/- 7.2, 38.1 +/- 7.6, 38.5 +/- 7.9, 37.5 +/- 8.5 and 37.7 +/- 9.1. The case/control study found a statistically significant difference in survival in favor of the surgically-treated group. CONCLUSIONS: LAGB can achieve effective, safe and stable long-term weight loss. In experienced hands, the complication rate is low. Follow-up is paramount.  Note the BMI is 37+ in these long-term Lap-Banders!!!

http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=12630607&cmd=showdetailview&indexed=google

Five Year Results on the Magenstrasse and Mill Operation

Obes Surg. 2003 Feb;13(1):10-6. Links

Comment in:

Obes Surg. 2003 Apr;13(2):318.

The Magenstrasse and Mill operation for morbid obesity.

Johnston D, Dachtler J, Sue-Ling HM, King RF, Martin G.

The Academic Department of Surgery, Leeds General Infirmary and the University of Leeds, Leeds, England, UK. david@medisoft.co.uk

BACKGROUND: Our aim was to evolve a simpler, more physiological type of gastroplasty that would dispense with implanted foreign material such as bands and reservoirs. The Magenstrasse, or "street of the stomach", is a long narrow tube fashioned from the lesser curvature, which conveys food from the esophagus to the antral Mill. Normal antral grinding of solid food and antro-pyloro-duodenal regulation of gastric emptying and secretion are preserved. METHODS: 100 patients with morbid obesity (83M, 17F, mean age 40 years) were treated by the Magenstrasse and Mill procedure and followed-up for 1-5 years. Mean preoperative BMI was 46.3 kg/m2, and mean excess weight was 106%. RESULTS: Operative mortality was 0. Major complications occurred in 4% of patients. There were few side-effects, although mild heartburn was fairly common. Mean weight loss was 38 kg (+/- 14 kg), equivalent to 60% of excess weight, achieved within 1 year of operation, after which no further significant gain or loss of weight occurred. CONCLUSIONS: The Magenstrasse and Mill procedure is the simplest and most physiological gastroplasty yet described. Many of the drawbacks of vertical banded gastroplasty, adjustable banding and gastric bypass are avoided. It is safe, has few side-effects and leads to major and durable weight losses, similar to those produced by other types of gastroplasty.