Sleeve or RN-Y
Weightloss with the sleeve is achieved through both restriction and reduction of hunger hormones in the body. Different people lose hunger to differing degrees, but I have virtually none at 14 months postop.
Excess skin doesn't become less or more with speed of weight loss. Either you are going to have it or not. It depends on various factors, genetics as some families have stretchier skin, amount of weight lost, age, smoking, and how long a person has carried that weight. But rate of weight loss doesn't affect the amount of skin left.
This is the way I look at it:
RnY and sleeve give similar results but RnY costs more and has a higher long-term complication rate. As a self-pay that made the sleeve a no-brainer for me. It might be different if I had insurance that only paid for bypass.
The other thing is that I knew from my research that my biggest problem was with ghrelin giving me an insatiable appetite. The sleeve removes the part of the stomach that produces ghrelin therefore I felt like it had the best chance of curing that problem for me.
HW - 225 SW - 191 GW - 132 CW - 122
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The RNY and DS both give smaller appetites with malabsorption. If you think your weight problem is more than just what or how much you eat, then you may need that metabolic change that these two give you. The DS is the most drastic, but yields better long-term results statistically, but many do fine with RNY, too. I know I needed more than just eating less, so I chose the DS for the biggest bang for my buck, and nearly 7 years out, I'm still at my goal.
Valerie
DS 2005
There is room on this earth for all of God's creatures..
next to the mashed potatoes
The sleeve is actually pretty metabolically active. Malabsorption is not the only way to be metabolically active. The removal of ghrelin that the sleeve provides is huge and results in improvements in all the other hormones involved in digestion. You don't get any of that with a band -- in fact in one study band patients actually had their ghrelin levels *double*. And with bypass, it seems like ghrelin levels are all over the place -- in some studies they are less than before but not as small with a sleeve, in others they are the same with a sleeve and everything in between.
HW - 225 SW - 191 GW - 132 CW - 122
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The sleeve is actually pretty metabolically active. Malabsorption is not the only way to be metabolically active. The removal of ghrelin that the sleeve provides is huge and results in improvements in all the other hormones involved in digestion. You don't get any of that with a band -- in fact in one study band patients actually had their ghrelin levels *double*. And with bypass, it seems like ghrelin levels are all over the place -- in some studies they are less than before but not as small with a sleeve, in others they are the same with a sleeve and everything in between.
http://fattyfightsback.blogspot.com/p/links-for-people-researching-vsg.html
From that page:
Comparing ghrelin & leptin in RnY vs. Sleeve (Leptin levels rose in both, but ghrelin fell more in sleeve. Conclusion: The markedly reduced ghrelin levels in addition to increased PYY levels after LSG, are associated with greater appetite suppression and excess weight loss compared with LRYGBP.
Comparing ghrelin & leptin in Band vs. Sleeve Conclusion: Plasma ghrelin levels are down-regulated with LSG operation but up-regulated with LAGB operation. [Fancy way of saying went down with sleeve and up with band]
Diabetes with Sleeve vs. RnY vs. Band - Conclusion: All three bariatric procedures are effective in treating diabetes, with a 3-year follow-up evaluation showing an effect that lasts. The AGB procedure was the least effective. The antidiabetic effect was similarly precocious after GBP and SG compared with AGB. This difference may indicate that a hormonal mechanism may be involved, independent of weight loss.
Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial.
http://www.ncbi.nlm.nih.gov/pubmed/19638921CONCLUSION:
Both procedures markedly improved glucose homeostasis: insulin, GLP-1, and PYY levels increased similarly after either procedure. Our results do not support the idea that the proximal small intestine mediates the improvement in glucose homeostasis.
Early postoperative insulin-resistance changes after sleeve gastrectomy
http://www.ncbi.nlm.nih.gov/pubmed/19916040?itool=EntrezSyst em2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordin alpos=36CONCLUSIONS:
After SG the improvement of insulin action occurred rapidly and independently of EWL. The results of the present study confirm that a hormonal mechanism may contribute to changes in insulin resistance following SG.
There's more stuff about the sleeve at that link for anyone who is interested.HW - 225 SW - 191 GW - 132 CW - 122
Visit my blog at Fatty Fights Back Become a Fan on Facebook!
Starting BMI 40-ish or less? Join the LightWeights