New Research!! VSG Failure Rate as high as 37%

That was what I was trying to say...it has a better rate of success (altho not by much) and it is still far less risky compared to the others.

Personally for those who aren't in the 50+ BMI, IT should be the gold standard not the RNY.

Liz

 I was wondering how they defined "failure".

 Geez, only 50% of EWL seems way too low of a standard for "success" of a WLS procedure, IMHO ..   And nothing about retention of EWL (i.e. re-gain)  involved ..  

50% EWL (whi*****ludes people who lost more originally and regained) is the standard in the weight loss industry for defining success. It's used for non-WLS studies as well as for WLS studies.

While it's an arbitrary standard, it's good to have a standard because then we're comparing apples to apples when we compare studies and success rates.

In terms of statistics and individuals and also using EWL as a measure of success, you need to keep some things in mind:

(1) Statistics describe the behavior of groups and can't be used to predict what will happen to an individual. In any study that says (as an example) that the average EWL is 70% there are individuals who lost 100% of their EW (or more), some who lost nothing, some who gained, and everything in between. It doesn't mean everyone lost 70% of EW or even that *most* people lost 70%.

(2) EWL is a squirrely stat because it's not an independent variable. It matters what your start weight is.

Therefore, EWL is really only useful to compare relative effectiveness of different WL methods and, even then, if the two populations being studies have wildly different starting BMIs, it can make a good comparison impossible.

In the chart, on page 5 of the Allergan Patient Handbook, 78% of those banded people in the study failed to lose 50% (or more) of their excess weight.  And that's from the poeople making and selling the POS.

 
Couple of problems here....

THe people they were studying were folks that had sleeves before they started using a smaller bougie and some of them it was known pre op they would revise to DS so their sleeves were even larger.

It is already known that the larger the sleeve the higher the regain.  Since the time of the folks in this study the sleeves have been made about half the size as the study folks.

A more accurate study might be the Cirangle study because half way through his study he saw that the larger sleeves produced higher regain so he began using smaller bougies.

Yes, I have to agree with our account WaSaBubbleButt.... and also add it's my understanding that your stomach doesn't restretch and that VSG does not have malabsorption issues to deal with....

in the meantime... we are all part of this great experiment out there in science and that the new gold standard won't be written till the 20teens on outcomes to various weight ranges...

Oh, your Sleeve is going to stretch---otherwise you'd starve to death. (*grin*)

I started out with a larger sleeve, since I had a full DS. I do still have rerstriction, but much less than I did at, say, one year out. I'm just guessing, but I'd say that over timie, your Sleeve will double in size---no matter what size it started out at.You may even get a greater per centage of stretch in a smaller size, because you simply NEED to put more food into it in order to survive.

All this article really says it that the Sleeve is slightly more effective than the RNY, which is about what everyone's BEEN saying for a while now.

 Actually this study addresses the bougie size issue if you read the whole thing. It says that bougie size is irrelevant. 
The bold is the initial address of the issue. The first paragraph is the "common motif of several articles" and the second paragraph is the newer contrasting evidence (some of which is unpublished) which finds that: Finally, a review of multiple other authors’ results have found initial sleeve size and weight loss percentages to be independent of each other.[1–3,4]

A common motif in several articles has been the effect of the initial resected fundus volume and bougie size, as well as the role of gradual gastric remnant dilation in the failure of SG.

Following 120 patients who underwent SG over five years, Weiner et al[11] reported a 13-percent failure rate, with a resected gastric volume of less than 500cc being a predictor for such failures. In a subsequent unpublished presentation of longer term follow-up data in patients who underwent a second procedure, the same group reported prepyloric dilation, fundal extension, and improper eating behavior as causes of sleeve failure in 54, 8, and 38 percent of cases.[9] Similarly, in 2009, Jossart[12] reported improved mid-term weight-loss outcomes in his subset of patients with a larger resected gastric volume versus those with less, albeit at the price of increased short-term complications.

In contrast, however, in five SG conversions to Roux-en-Y gastric bypass (RYGB), Langer et al[13] demonstrated that weight regain was not due to initial inadequate gastric fundus reduction. In a different study,[14] the same Austrian group could not correlate radiographic evidence of sleeve dilation with postoperative weight regain at one year after sleeve gastrectomy. Finally, a review of multiple other authors’ results have found initial sleeve size and weight loss percentages to be independent of each other.[1–3,4]

But other studies show that bougie/sleeve size does make a difference, not for weight loss but for future regain.

I just can't put a lot of stock in this study.