Sleeve vs RNY

I saw Dr. Raiche yesterday and was told that I am cleared for surgery, but because of past surgeries and scar tissue I could end up with the sleeve, not sure what to think about this.

Merry Christmas Everyone, 2012 is my Year, yahooooo!!!

Hi Sue -

if you go back on the Message Board to yesterday's posts, you'll see one from Uschi, on a great description of WLS from a physician's point of view.
He has an excellent description of what the sleeve gives you, as opposed to RNY.

Basically in a nutshell, there is no malabsorption, because they don't touch the bowel.
You have a reduced size of stomach, and it's a slightly different shape.
You are fuller faster. That's it 

Hi Gabygee.

Thanks for the info, I would be fine with either one.

The VSG keeps the natural opening and closing of the stomach and removes about 80% of the stomach from along the greater curvature. Imagine your stomach is now shaped like a kidney bean, but after surgery it would be shaped like a skinny banana. So the stomach is about 3-4 times the size of the pouch you get in RNY, and the rest is permanently removed. You don't have a 'remnant' stomach the way you do with RNY.

Weight loss with VSG is on average slightly less than with RNY, and the long term stats are unknown as it has been done as a stand alone procedure for only 6-7 years (it has usually been done as the first half of the Duodenal Switch surgery). Excess weight loss at 5 years averages 55% and resolution of diabetes is 55% with improvement seen in a further 25% or so. 

The plus sides are that your risks of vitamin and mineral deficiencies are lower and easier to treat. Also, because you keep the natural end of the stomach, the pyloric valve, it means you will most likely not have any issues with dumping, or reactive hypoglycaemia (unless you had hypoglycaemia prior to surgery).

Hi Pat, Thanks for all the info, it really helps alot that you took the time to respond.

Thanks again Sue.

 Pat - just curious? Where did you get the stomach vs pouch size data? I'm always curious about sleeve sizes with Ontario surgeons. 

My surgeon (in the US) used a 34 Bougie to create my sleeve. I was told that, depending on the length of your stomach (tall people and men usually have longer stomachs) that my sleeve would hold about 1-2 oz of food at first - 4-6oz max when everything was healed and as stretched as it would get (after 6 months to a year). My sleeve was also oversewn (and I told him to do it TIGHT lol). 

This seems very similar to the size of the pouch that most people with RNY report. Certainly not 3-4x larger. When I sit down with an RNYer to eat - we seem to eat about the same amount. 

I wonder if the Ontario sleeves are larger? Anyone ask their surgeon how the "measure" for the sleeve?

Ontario sleeves are larger, a 40FB is used here, which is typicall 120-150ml vs the 30-50ml of the typical pouch.

 REALLY??  Wow.  Even though all the data and research shows that this has a drastic affect on EWL?  I mean - not just recent data - but 5 year data??

Yep, I was quite surprised. I only just learned this when I spoke to Dr. Hong about my DS. I expected that they do a larger sleeve for DS and smaller sleeve for VSG and he said that they do a 40FB for everyone, VSG and DS! I was shocked, I've read the data too, for VSG only it is imperative that the sleeve be smaller! He seemed to disagree and thought it doesn't make a difference. I didn't continue to argue with him since I'm not having a stand alone VSG, I'm happy with the size for my DS, but I would be uncomfortable with it for VSG.

 Wow.  Me too.  You should post this as a seperate thread for the VSG'ers out there going in.  It would be helpful I'd think to bring in some of the studies that show that the 40FB is the reason that early VSG has poor stats compared to current (where they compare to Rny).  All the US surgeons seem to be doing 32 or 34FB.  Mexican ones too.