swanfray

Benefits of VSG; why did you choose it?

10 posts in this topic

So I got my surgery date today for August 7th, 2017. I made the choice of having the gastric bypass procedure. Now, I researched over the past few months and I was/am fully aware of all of the responsibilities that comes with rny and I thought I would be okay with it because I am fairly a responsible person. However, now that I've set the date I find myself being petrified of all of the risks that are associated with gastric bypass and I'm looking into vsg. It seems that there is a decrease in complications than in comparison to gastric bypass, is that accurate? Also, I have a large amount of excess weight to lose so I am afraid that I won't be able to lose all of it with VSG. What are your experiences? This will help a lot with my final decision.

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There are several discussions on this topic here. One of the most recent: 

 

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5 hours ago, swanfray said:

So I got my surgery date today for August 7th, 2017. I made the choice of having the gastric bypass procedure. Now, I researched over the past few months and I was/am fully aware of all of the responsibilities that comes with rny and I thought I would be okay with it because I am fairly a responsible person. However, now that I've set the date I find myself being petrified of all of the risks that are associated with gastric bypass and I'm looking into vsg. It seems that there is a decrease in complications than in comparison to gastric bypass, is that accurate? Also, I have a large amount of excess weight to lose so I am afraid that I won't be able to lose all of it with VSG. What are your experiences? This will help a lot with my final decision.

Welcome! Gretta pointed you in a great direction! You can also use the search field to search for words like "choose" or "decide", you will see some similar topics in the results :-)

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Read all these great threads, but the bottom line is that BOTH surgeries are relatively low risk, and both can have great results.  In fact, most people do really well which ever procedure they decide on.  There are some specific issues to be aware of; those with GERD probably are not the best candidates for sleeve for example.  The key to success with either procedure is to follow the plan. 

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Posted (edited)

22 hours ago, swanfray said:

... However, now that I've set the date I find myself being petrified of all of the risks that are associated with gastric bypass and I'm looking into vsg. It seems that there is a decrease in complications than in comparison to gastric bypass, is that accurate? Also, I have a large amount of excess weight to lose so I am afraid that I won't be able to lose all of it with VSG. ..

Hi swanfray, excuse the long post but this may be of interest to you and to others lurking about, looking at the Forum. 

Risks are low. Over 90% of people have no complications. I find it useful to look at numbers and not the "let me scare you to death" garbage on the internet. Your surgeons should have information to give you on their success and complication rates. The experience of your surgeon is important; newbie surgeons have more complications occur in their patients. (I chose a very highly experienced surgeon). 

Surgical death rates (let's be blunt) are about 1 per 1,000 for VSG, and about 1.5 per 1,000 for bypass. Complications tend to occur in people at the highest risk for other reasons - if your diabetes has been out of control, heart attacks in the past, smoking... but of course if you have diabetes out of control and have had heart attacks your life span is already statistically short(er). Elsewhere here on the Forum we talk about the risks avoided by having surgery. People tend to focus on the surgery and forget they are at very elevated risks of death because of obesity (hypertension, diabetes, sleep apnea, etc etc.). Overall death rates go DOWN because the immediate small risk of death more than balances out the longer-term but much higher risks of obesity. 

Don't forget that the gastric sleeve was devised as the first step in a 2-step procedure for doing the bypass in high-risk people. First the sleeve, then several months later, the bypassing of the first part of the small intestine as the second procedure. People found that the weight loss with the first part of the staged procedure was pretty good, and some patients probably said "let's hold on the second stage since I am losing so much weight" and well there you have it.

Yes complication rates are higher for bypass - you are having more done, your intestines are being cut and reconnected... but the rates for both are similar to those for elective (no emergency) gall bladder removal. If you are willing to drive a car for 10 years then your risks would be about the same, since the risks for driving a car are about 1 death in 10,000 people per year. If you aren't petrified by the prospect of riding in a car for 10 years then you shouldn't be petrified of the surgery, at least if we are rational people (but most of us, including me, are not). :rolleyes: 

Leaks happen in about 1% of people. Everyone has a test to look for a leak the day after surgery. More leaks occur after bypass than sleeve - more being done to re-route you with a bypass. Strictures are more common after bypass because the main course of the intestine is cut and reconnected, unlike what happens with a sleeve. GERD is more common after a sleeve. Dumping and rapid alcohol intoxication is more common after a bypass. About 1 in 5 people  with a bypass develop a nutrient deficiency unless they take vitamins and minerals (much lower for sleeves, but numbers not accurately known). Bypass is a bit more effective overall for weight loss but the difference between the two is not very big. Bypass looks like it is more effective at curing diabetes but how much more effective is unclear. 

If you look at complication rates that are not lethal, a lot of surgery is classified as having a complication because the person had nausea or puked a few times. Some drugs keep me from peeing, I get urinary retention. That happened after my surgery; I just asked the team to stop the un-needed medicine I was on that had caused it, and 8 hours later I peed fine. Hard to get excited over stuff like that. I am NOT trying to minimize this class of complications but it is important to have some perspective. 

The "average" person does not lose all their excess weight, even after bypass. The average person may not stick to the diet, may not have their psych issues addressed, may have only poor social support, or may not get any exercise. Each of these has been proven to be important to weight loss. Here you will be supported to address each of these, and my guess is that your chance of success is higher if you make a good faith effort to have these in place. Not 100% perfect, but reasonable adherence to the diet, not be overtly crippled by psych issues and food, have some social support, and do even just modest exercise. My two cents is that while the average weight loss is different for the two = perhaps 70% for bypass, 60% for sleeve - what we see here on the TT Forum is that a lot of people are in the 70-110% excess weight loss, irrespective of the type of surgery, because their HEADS are in the right place. The key is NOT the surgery, it is the HEAD issues. So, after all this ... (sorry for the long post!)...

I would choose my surgery based on what you are trying to accomplish. Do a bypass if you have diabetes that is bad or have significant GERD. Do a sleeve if you want to avoid any chance of malabsorption or want to avoid the small but real difference in complication rates between the two. You can do a modest amount of exercise and make up the difference between a sleeve and the bypass in terms of "average" weight loss.

THE KEY though is keeping your head. Surgery only changes your intestines, not the person in charge of your life after surgery. If you do the head stuff right then the flavor of surgery is not very important. 

(Again, sorry for the long post)

 

Edited by BurgundyBoy
added sentence about surgeon experience

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Thank you guys for all of this information, I really appreciate it. These responses, along with the help of finding the right forums, has descalated my nerves by a lot and caused me to view wls a bit different. Thank you guys :rolleyes:

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Posted (edited)

57 minutes ago, BurgundyBoy said:

Hi swanfray, excuse the long post but this may be of interest to you and to others lurking about, looking at the Forum. 

Risks are low. Over 90% of people have no complications. I find it useful to look at numbers and not the "let me scare you to death" garbage on the internet. Your surgeons should have information to give you on their success and complication rates. The experience of your surgeon is important; newbie surgeons have more complications occur in their patients. (I chose a very highly experienced surgeon). 

Surgical death rates (let's be blunt) are about 1 per 1,000 for VSG, and about 1.5 per 1,000 for bypass. Complications tend to occur in people at the highest risk for other reasons - if your diabetes has been out of control, heart attacks in the past, smoking... but of course if you have diabetes out of control and have had heart attacks your life span is already statistically short(er). Elsewhere here on the Forum we talk about the risks avoided by having surgery. People tend to focus on the surgery and forget they are at very elevated risks of death because of obesity (hypertension, diabetes, sleep apnea, etc etc.). Overall death rates go DOWN because the immediate small risk of death more than balances out the longer-term but much higher risks of obesity. 

Don't forget that the gastric sleeve was devised as the first step in a 2-step procedure for doing the bypass in high-risk people. First the sleeve, then several months later, the bypassing of the first part of the small intestine as the second procedure. People found that the weight loss with the first part of the staged procedure was pretty good, and some patients probably said "let's hold on the second stage since I am losing so much weight" and well there you have it.

Yes complication rates are higher for bypass - you are having more done, your intestines are being cut and reconnected... but the rates for both are similar to those for elective (no emergency) gall bladder removal. If you are willing to drive a car for 10 years then your risks would be about the same, since the risks for driving a car are about 1 death in 10,000 people per year. If you aren't petrified by the prospect of riding in a car for 10 years then you shouldn't be petrified of the surgery, at least if we are rational people (but most of us, including me, are not). :rolleyes: 

Leaks happen in about 1% of people. Everyone has a test to look for a leak the day after surgery. More leaks occur after bypass than sleeve - more being done to re-route you with a bypass. Strictures are more common after bypass because the main course of the intestine is cut and reconnected, unlike what happens with a sleeve. GERD is more common after a sleeve. Dumping and rapid alcohol intoxication is more common after a bypass. About 1 in 5 people  with a bypass develop a nutrient deficiency unless they take vitamins and minerals (much lower for sleeves, but numbers not accurately known). Bypass is a bit more effective overall for weight loss but the difference between the two is not very big. Bypass looks like it is more effective at curing diabetes but how much more effective is unclear. 

If you look at complication rates that are not lethal, a lot of surgery is classified as having a complication because the person had nausea or puked a few times. Some drugs keep me from peeing, I get urinary retention. That happened after my surgery; I just asked the team to stop the un-needed medicine I was on that had caused it, and 8 hours later I peed fine. Hard to get excited over stuff like that. I am NOT trying to minimize this class of complications but it is important to have some perspective. 

The "average" person does not lose all their excess weight, even after bypass. The average person may not stick to the diet, may not have their psych issues addressed, may have only poor social support, or may not get any exercise. Each of these has been proven to be important to weight loss. Here you will be supported to address each of these, and my guess is that your chance of success is higher if you make a good faith effort to have these in place. Not 100% perfect, but reasonable adherence to the diet, not be overtly crippled by psych issues and food, have some social support, and do even just modest exercise. My two cents is that while the average weight loss is different for the two = perhaps 70% for bypass, 60% for sleeve - what we see here on the TT Forum is that a lot of people are in the 70-110% excess weight loss, irrespective of the type of surgery, because their HEADS are in the right place. The key is NOT the surgery, it is the HEAD issues. So, after all this ... (sorry for the long post!)...

I would choose my surgery based on what you are trying to accomplish. Do a bypass if you have diabetes that is bad or have significant GERD. Do a sleeve if you want to avoid any chance of malabsorption or want to avoid the small but real difference in complication rates between the two. You can do a modest amount of exercise and make up the difference between a sleeve and the bypass in terms of "average" weight loss.

THE KEY though is keeping your head. Surgery only changes your intestines, not the person in charge of your life after surgery. If you do the head stuff right then the flavor of surgery is not very important. 

(Again, sorry for the long post)

 

I can not thank you enough for this detailed response! Appreciate it :D

Edited by swanfray
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I was set to have the Rny .  My insurance approved it and when I went to set the surgery date I changed to the sleeve..l was worried about deficiencies , my bones ect..My surgeon said if I didn't lose all the weight I wanted that with the vsg we could do revision.  That l would have somewhere to go..My thought was if this is a tool and the work is up to me I should be able to do this.. I have seen others sleeves on this site with my stats that have lost just as much weight as bypassers ...Good luck on you journey..

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Great post, Burgundy Boy, on the pros and cons of the 2 most popular types of bariatric surgery. A couple things to keep in mind. The sleeve is a relatively new procedure, as compared to the bypass, so there are fewer studies available measuring the results. Medicare just started paying for the sleeve less than 5 years ago. Second point. Not all surgeons check for leaks the day after surgery. My surgeon quit checking for leaks about a year before my surgery. I asked him why, and he said that he had not had a leak in 3 years, and therefore did not think that any potential benefit would outweigh the pain and discomfort (and expense) that all patients would suffer from the test for the leak. He said that any leak would become apparent within a few days and could be remedied then fairly easy.

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While I did have a leak test, mine was done during surgery using a blue dye. Many surgeon's use this method these days to test for leaks. No discomfort, plus the surgeon can fix anything they find on the spot.

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