DS is better than Sleeve - DUH.

DianaCox

Bad Cop
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3938871/ (Full text)

N Am J Med Sci. Jan 2014; 6(1): 35–38.
doi: 10.4103/1947-2714.125865
PMCID: PMC3938871
Comparison of Vertical Sleeve Gastrectomy Versus Biliopancreatic Diversion
Iswanto Sucandy, Joseph Titano, Fernando Bonanni, and Gintaras Antanavicius

Abstract
Background:
Vertical sleeve gastrectomy (VSG) was originally performed as the first-stage of biliopancreatic diversion with duodenal switch (BPD/DS) for superobesity as a strategy to reduce perioperative complications and morbidity. VSG is now considered a definitive procedure because of its technical simplicity and promising outcomes.

Aims:
To analyze the outcomes of laparoscopic VSG and to compare them with those of single-stage laparoscopic BPD/DS.

Materials and Methods:
A retrospective review of 200 consecutive patients who underwent VSG and BPD/DS between 2008 and 2011.

Results:
A total of 100 patients underwent laparoscopic VSG and 100 patients underwent laparoscopic BPD/DS. The patients in VSG group were older, but gender distribution and body mass index were comparable. Mean operative time for VSG was significantly shorter compared with that of BPD/DS. A single patient in each groups required open conversion. Staple line leak (n = 1) and intraluminal hemorrhage into the newly-created sleeve (n = 1) occurred in the BPD/DS group. Mean length of stay was shorter after VSG (3.1 vs. 3.9 days). At 6 months postoperatively, excess weight loss between the two groups revealed statistically significant difference, favoring BPD/DS.

Conclusions:
Despite promising outcomes and technical simplicity of VSG, BPD/DS provides significantly superior excess weight loss in morbidly obese patients.
 

Larra

Well-Known Member
And if they follow those patients longer - 6 months being barely post-op - they will see the difference in weight loss magnified as time goes on. They will also see better weight loss maintenance of the DS patients once they reach the maintenance phase. And they will also see much better resolution of most comorbidities with the DS patients.

I like the way they describe the VSG as a stand alone as "promising". Sometimes promising delivers. Sometimes it doesn't.
 

Munchkin

Full of Fairy Dust
There still is nothing out there better than the DS. And of course, 1/2 a DS doesn't work as well as the whole thing. No big surprise here.
 

DianaCox

Bad Cop
I think there certainly are some for whom the VSG is a better option, especially if they can get and stay healthy (never mind thin) long term without the malabsorption, or if they cannot follow the requirements for safely owing a DS. But I think those people are in the minority
 

star0210

Well-Known Member
Just with the 40 lbs of regain I've had, my cholesterol shot back up and I'm back on cholesterol medication.
:(
 

robs477

Now an Angel in heaven
I think there certainly are some for whom the VSG is a better option, especially if they can get and stay healthy (never mind thin) long term without the malabsorption, or if they cannot follow the requirements for safely owing a DS. But I think those people are in the minority
I agree. I personally know of two separate folks who are over 5 yrs out (one is my Ortho), with the VSG and they have kept all the weight off. IMHO...I think it works best for BMI's under 40 and for folks who may not have an over absorption problem to begin with, but just ate the wrong foods all the time and or too much of it. I think one of the keys to success with the VSG or any WLS is to stop eating when your full, or actually before you get full and MINIMIZE how much you re-stretch the sleeve back out which will limit the production of all those Peptides mediating energy homeostasis (ghrelin, leptin, adiponectin, and insulin), as well as a host of other hormonal and chemical interactions they have yet to identify and completely understand. The more stomach area, more production of all those chemicals, which in turn make you more hungry and eat more, but, even more importantly, they tell your body to store instead of burn real time, thus the more re-gain. With the DS you have the secondary malabsorption component which is like a no fault insurance policy, but, it can still be abused also, just not as much.
 
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