VERTICAL SLEEVE GASTRECTOMY

Question
I抦 a 20 year old female, 4 foot 11 inches and my BMI fluctuates between 39 and 42. I have borderline high blood pressure (treated), pre-diabetic (treated), insuline resistance (treated), urinary stress incontinence (treated) and sleep apnea (using a CPAP). I抳e been researching bariatric surgeries for a while. My father had open RNY a year ago and has done great, no complications and 100% excess weight loss. I considered this a good second option, especially since my insurance would cover it if my BMI is 40, but being so young, I was concerned with my future. Nutritional deficiencies, malabsorption of medicine, hernia's and things like that. I was never good at taking vitamins consistenly. My father, my best friend and my primary care doctor discouraged the Lap Band which was my first option. After researching it, I became concerned about the chances of re-operation. Finally I found a happy medium, the VSG. My only concerned is that I haven抰 found any long term data. Then I found a website saying that this use to be the number 1 performed bariatric surgery but the results was short lived, weight regain occured alot and surgeons stopped performing it. So my question is, was that accurate? And what bariatric procedure would you (unofficially) recommend to me and why?

Answer
Hi LadyBug:

I think the website you found was confusing the Vertical Banded Gastroplasty with the Vertical Sleeve Gastrectomy.  It's a common mistake.  The VBG was at one time the number one bariatric procedure, but had horrible long-term results.  We simply don't have long-term data for the VSG.  I've seen some three-year data... and some five year-data for a modified VSG (included removal of the omentum and shortening of the small intestines.)  From everything I've seen, the worst case scenario is that the VSG would be no better than any other restrictive operation--meaning an excess weight loss in the 50-60% range.  Best case scenario puts it in the 70-80% range.

At your age, I do think the VSG is a good choice.  Your BMI isn't that high, so there's good reason to believe you could be successful with a restrictive only operation.  It's good that you know yourself regarding vitamins and such.  If you want some data to share with your Dad, go to http://www.asbs.org/Newsite07/resources/sleeve_statement.pdf  There have been some recent studies published as well which can be found on www.pubmed.com  Just type in "Sleeve Gastrectomy."

One thing you do need to know is that you will still need to take some supplements with the VSG.  A multivitamin, sublingual B12, as well as additional Vit D and Calcium.  Removing a majority of the stomach means that you will produce less intrinsic factor which will affect vitamin B12 absorption. There have also been some studies showing increased risk of osteopenia in partial gastrectomy patients. (Gastrectomies performed for reasons other than weight loss.)  There were no cases of deficiencies reported in the 5 year results for the DAIR procedure (VSG, omentectomy, and shortened small intestines)--so that is promising.  But the potential does exist.

In choosing a surgeon, please choose one that has done at least 100 procedures.  It's also important to ask what size bougie (a tube) your surgeon sizes the sleeve with.  Most surgeons these days recommend a 32 French...although some go up to a 40 French.  The difference is minimal with one French being 1/3 mm. Some surgeons use strictly staples to portion off the stomach, others use staples and either hand sew the sleeve or use an additional reinforcing technique.  

Good luck! I hope this helps.

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