What type of person would the VSG be the best fit for?

Hi all,

My success (still hard to beleive I am a success) with my DS has prompted numerous friends to begin looking into WLS.  I loved my surgeon, Dr. Teel, and would recommend him wholeheartedly to anyone.

Dr. Teel, however, beleives strongly that the best option for almost everyone is a staged DS, (getting the VSG and then waiting and seeing if the rest is needed down the road).  After numerous conversations with him, I see where he is coming from - although I am totally glad I went the full DS route.

Still, DS is a very powerful tool, and I don't believe everyone needs that level of help.  I don't think there is a one-size-fits-all surgery. If someone is a good dieter, and enjoys exercise, I think the VSG might be a good fit.   I was a terrible dieter and am never going to be a person who goes to the gym regularly, so I had very little hope that I would not regain with just the VSG. 

Just wondering what "type" of person you think the VSG would be a good fit for. 

Thanks, Christy

I think the VSG is good for someone who only has a small amount of weight to lose, who is always hungry, who loves the diet and exercise mentality, with no respite.  Oh, and someone who has great insurance that they aren't likely to lose, that won't change, that won't get a "one-surgery-per-lifetime" exclusion and who isn't going to be emotionally devastated when all the hard work they invested in losing weight turns out to be for naught.

I don't know anyone like that.

BIG *like*

I agree with Diana. She stated everything perfectly, IMO. Just because someone starts with a lower BMI doesn't automatically guarantee long term success with the VSG. 

--gina

I do agree with Diana, but I do have to add that I would never reccomend the DS to people I know that would be non-compliant with the regime.  The DS requires you to pay more attention to your nutritional status, and there are people I know who would never ever follow through.  

I like these thoughts. Please chime in more in this direction (I *really* like the term "complacency") when I start the DS IQ Test thread! The psych clearance should involve considering the complacency factor.

My sister, I hope.  And I hope that because even though her BMI is about 52--give or take--she would NEVER be proactive about her health care and she would NEVER disagree with her (idiot) PCP and because of those two things alone, she'd never get as far as having the DS. 

But also because she goes for vigorous "mall walking" once or twice daily, goes to Curves most days and has been known to lose 100 pounds or so on WW...only to regain it all when she starts feeding the stress situations in her life.  I think she would do FAIRLY well if her stomach simply wouldn't hold as much food.  (She's not having surgery yet because she's convnced herself that the stress situations are now under control...but , of course, that's because she is in total denial about those, too.)

And, in any event, it's the only possibility for her.  She would not involve herself with staying on top of her vitamins and supplements...wouldn't sit there and explain to her doctor that he needs to order the OTHER Vitamin D test...would never get the band after having watched me...would not (I hope and for the same reasons she wouldn't get the DS) get the RnY...and, by process of elimination, there we are at the sleeve.

In my sister's case, it will be the sleeve or nothing and I hate to land on the latter.

Low BMI and willingness to live on a starvation diet and a zillion hours of exercise per week, in general.

HOWEVER, I will qualify that by saying that there are a few medical contraindications to an intestinal bypass, such as the need to know for certain you are correctly absorbing medications without which you will die. See the transplant patient who must take anti-rejection drugs or the cancer survivor who knows the time for more chemotherapy will come, for example. (I'm sure there are other cases; maybe the docs can chime in here.)There are no doubt some gut things that make it a bad idea to go with a malabsorptive procedure of any kind (including RNY) as well.

For those people, the VSG is the way to go, assuming they are healthy enough to withstand that much surgery. 

 Personally, I rank the sleeve alone as being a notch better than the lap band but that's about it.  If someone LOVED dieting and exercise, it might work.  Provided they didn't have too much weight to lose and their metabolism was OK.  I would probably be a proponent of the VSG for people *****fused to take adequate supplements but who could manage a couple pills a day.

The reason I rank it better than a lap band is the elimination of at least most of the part of the stomach that produces ghrelin.  It's easier to live with than a lap band too.  But that stomach is going to stretch.  The stomach is very elastic tissue and it's supposed to stretch.  Eventually the VSG person is going to be able to eat more and unless they are very vigilant, they will gain weight.  Then they won't be comfortable exercising so they will do less.  And the vicious cycle starts all over again.  I believe the results for the VSG long term will be better than the lap band but still dismal compared to the DS.  This is speculation on my part because right now, no one knows for sure how successful the VSG will be long term.  Not the patients or the docs.

My opinion, but I believe the staged DS is an accomodation for the surgeon in some cases.  1/2 the DS is a much easier procedure to perform.  It's like an easy out because the patient WILL lose weight with the sleeve and be a success.  Great stats here!  Years later when the patient regains the weight and can't get insurance to pay for another procedure, who cares?  The patient is long gone off the surgeon's radar.  It would take a lot of convincing to make me believe a 2 stage DS is truly and honestly in the patient's best interest.  There are well respected surgeons out there who pretty routinely do the whole DS in one operation on people weighing 6 to 800lbs.  Some of them even do it LAP!  And these surgeons aren't cherrypicking.  People who are that heavy are almost always loaded with comorbidities.  They are a real surgical risk, and yet they usually make it and do well.

So let's say someone does get to go back for part 2 of the DS.  2 or so years post VSG, after their stomach has stretched out to the point where they can eat a small meal.  What's the switch alone going to do for them?  I'm extrapolating a bit here but the answer is not much.  At least not nearly as much as the whole procedure in one operation would have done.  I'm not completely in the ozone here...  I have great respect for data.

Go back to the DS for Diabetes.  For those who are not obese, all that's done is the switch with a short common channel.  What happens to these folks?  They do lose their Diabetes and generally, about 30lbs.  And over the next 2 years, most gain the 30lbs, plus or minus, BACK!  So what does that tell us?  There is a synergy that makes the full DS greater than the sum of it's 2 parts.  These are the numbers published by a doc named Noyes who did the first studies on the switch as a stand alone procedure to resolve type 2 diabetes.

Finally, let's use my H as an example.  He had the DS for Diabetes done in 2004, and his CC is 50cm.  His BMI was 26 or 27 when he had the surgery.  He lost exactly 30lbs postop and then did gain it back over the next 2 years.  Noyes was right on the money!  H says it is easier for him to lose weight now and it's easy to control his weight.  If that generally holds true, that would give the 2 parters some limited encouragement.