Just curious

Okay, you are confused in two ways. First, the topmost portion of the stomach is the STRETCHIEST, not the part that stretches the least. It's called the fundus so you can look it up and don't have to take my word for it.

Second, with a sleeve the entire fundus is taken away. So it's not just a pouch that's longer. It's a completely different shape and size and formed from a different part of the stomach.

The sleeve is long and narrow. So, yeah, it's longer than a pouch. But it's only about as wide as a Pilot pen. The pouch is shaped like an egg. So it's much wider than a sleeve even though it's shorter. Think about how many Pilot Pens you could get into an egg, if Pilot Pens were made of play dough and could be put into an egg, if that helps.

Plus, sleeve also doesn't stretch as much because it's the tough part of the stomach muscle. So it's like those balloons made for helium. If you try to blow them up with your mouth instead of a tank of helium, you can only get them to blow up to about half the size than if you use the tank. The RnY pouch is stretchier so you can blow it up bigger.

Hence, the sleeve holds about 4-6 oz (or around 1/2 c) at 1 year out and the pouch holds about 8-12 oz. (or around 1 c.) at 1 year out.

Now, the VSG currently hasn't been standardize so there are more differences between different surgeons than for other surgeries. In the early days, surgeon were making the sleeves with a 48-60f boughie (so as much as twice as big as current sleeves - or a big fat magic marker instead of a Pilot Pen) and patients could eat as much at 1 year out as RnYers. Regain was also an issue with that size of sleeve.

But most surgeons aren't doing that now and are using sizes in the 32 to 40 f widths.

But the fact that there are differences is one reason it's important to know your own surgeon's stats. If someone's surgeon says "my sleeve patients don't lose as much as my RnY patients" then something about how they do the sleeve is different and you have to listen to that because that's the sleeve *you* are going to get.

OTOH, this is why DS and VSGers are always telling pre-ops to pick their surgery and *then* pick the surgeon. Once I knew I wanted a sleeve, I went out and found the one in my area with the best stats for the sleeve.

Also, even with something much more standardized like RnY, there are differences between surgeons. So even with that you have to ask a lot of questions. How big will your pouch be? Your common channel? What results does *your* surgeon get. Etc. Etc. You don't want to find out afterwards when it's too late that your surgeon gives bigger than average pouches and longer than average common channels and his patients get below average weight loss. (This happened to a friend of mine.)

This chart, btw, shows weight loss at two years from my program for 3 of the surgeries:

http://www.sclaweightloss.com/images/sleeve_graph.gif

You can see that the bypass patients are already starting to regain at 24 months while the VSG and Band patients aren't. But the band patients don't lose as much to begin with so, even with regain, bypass is more effective than a band. But not more effective than the VSG.

I have no interest in arguing about this... it is starting to sound WAY too much like one of the "MY surgery is better than YOUR surgery" DS vs RNY posts.  I don't participate in them because they are pointless.

I do, however, feel obligated to point out that MANY bypass patients did not count on dumping and do NOT regain (you seem to assume that ALL rely on dumping and ALL will regain their weight) and to ask if you can direct me to any diagram of the sleeve that shows it NOT being formed from the entire top curvature of the stomach (the topmost portion of which is where the RNY pouch is formed)?

Lora

First of all, the OP said her shrink recommended she get RnY because the dumping would cause her to change her eating behaviors. I was clearly responding to that when I pointed out that lots of bypassers don't dump so you can't count on it.

I'm not "making it sound" like anything. Statistically, RnY patients have the highest levels of regain. That's a fact. Statistically, DS has the best weight loss. Again, a fact. Does that mean no one should get RnY and everyone should get a DS? Well, I clearly don't believe that or I'd have a DS.

It's important to understand how the surgeries work and what they are good at and what they aren't good at. Pre-ops need this information in order to make an informed decision and pick the surgery that works the best with *their* concerns, values and issues.

Here's your diagram:

http://www.obesesurgery.com/VerticalSleeveGastrectomy.jpg

You can also watch surgeries on the web and see very clearly what part of the stomach they cut away.

I agree that what the OP's therapist said was nonsense, but your last post made it sound like anyone who got a RNY was destined to regain and that simply is not true.  It simply requires that they - like everyone with a band or a sleeve -- be vigilant about what they put in their mouths.

I looked at the diagram you posted.  Perhaps you should go back and look at the diagram on the same site for the RNY because those two diagrams clearly show what every diagram I have ever seen shows: the top portion of the sleeve utilizes the same area of the stomach that is utilized for the pouch.  So I don't understand how you can claim that the pouch is larger than the sleeve or that is uses a stretchier portion of the stomach, because that simply is not true.


Lora

I already answered those questions.

I'm sorry that you can't accept that VSGers can only eat 4-6 oz. on average at 1 year out while RnYers can generally eat 8-12 oz. at one year out, but them's the facts.

It's also a matter of fact that the pouch is formed by dissecting the fundus and therefore is made primarily from the fundus. It's also a fact that the fundus is transected (cut out and removed) with a sleeve. It's also a fact that the fundus is the stretchiest part of the stomach.

I don't know how much you can eat, but I do know that -- at almost 3 years out after RNY-- I cannot eat more than half a cup of food.  All I can base my information on as far as the capacity of each is the procedure diagrams which clearly show a sleeve that is larger than the RNY pouch.  I will admit, however, that in practice surgeons may make the sleeve significantly thinner than depicted whihc would significantly decrease the capacity.

What I know without a doubt, and even confirmed with my surgeon's office, is that the modern RNY pouch is NOT created from the fundus but is rather created from the cardia and a small portion of the lesser curvature.  The PA at my surgeon's office suggested that perhaps the information you are basing your statements on is based on older or alternative methods of the RNY and referenced the following web page which shows and describes some of those methods along with the standard RNY pouch (figure 7): http://www.asbs.org/html/story/chapter4.html

Lora

If you can only eat 1/2 c of food at a time, that's great! But it's not a typical experience from what I've seen from my approximately 50 friends who have had a bypass, many of whom I've eaten with.

I know many RNYers who can also eat far more than that -- and I can on occasion as well -- if they are not eating dense proteins.

Lora

Wow, did not mean to cause such discussion, but lots of very good info from all sides. 

My surgeon says in one year the rny is about 80% and the sleeve 70%... both will work for me it is my choice.  He also thinks I will be ahead of the curve because of certain life style activities I'm ahead of the game. 

It's all 'food for thought' as they say...  pun intended I guess. 

Hi.  Thanks for the info.  I guess I stated it too generically.  She is concerned about the fact that I will be able to tolerate certain foods with the sleeve...  foods that I turn to when stressed, bored, etc. 

My surgeon also thinks I would do as well with a sleeve as I would with RNY and the fact that there are less/no malabsorption issues with the sleeve is one of the reasons I like it.