Vsg to DS.. the countdown begins...getting anxious

[LindaDarnell]

So my final pre-op appointment wás last week,and my revision of VSG to DS is 2 weeks away. Anxiety is starting to set in! During my pre-op, Dr Pullat discussed the benefits I will receive from a traditional DS and why he thinks I will lose weight. We talked about him going more aggressive with the size of my instestine than he was with my husband. He then mentioned that my previous surgeon sent him a report of a GI that I had done last summer. But his office didn't forward the film for Dr P to review. So while the report said that my sleeve is anatomically sound for weigh loss, Dr P is concerned that I may have extra capacity via fundus, based on the volume I can now eat, and my hunger levels. So when he starts my procedure, he's going to run an endoscopy to determine if I have extra fundus to be removed! WHOAAAAAAAAAA... I was not ready to hear that! I had psychologically prepared myself for just the switch...but now that I may have to get sleeve tightened as well.....i dont think im ready for that! Obviously theres the pro that if he does remove more fundus then that will give my tool more power than the switch alone. But the con is definitely the recovery process. Im trying not to think about it but i am nervous

 

[A Dixon]

While it's easy for me to talk, as I haven't had any surgery yet, I think that if you trust this surgeon enough to do any surgery, you can trust him to act in your best interests regardless of where that tales you! Good luck!

 

[Munchkin]

Sounds like he wants to give you the best possible shot to lose all the weight!!!

 

[Larra]

As long as he doesn't make an excessively tight sleeve, you should be ok. Just make sure he is doing the standard of care DS with 2 anastomoses.

 

[DSRIGGS]

While it's easy for me to talk, as I haven't had any surgery yet, I think that if you trust this surgeon enough to do any surgery, you can trust him to act in your best interests regardless of where that tales you! Good luck!

Unfortunately we have found that not to be true in some cases. My original DS surgeon "blanked" me up severely. Do not accept what a bariatric surgeon tells you blindly.

Regarding the OP and stomach capacity. The switch is what will maintain your weight loss for the long run, and as Larra said you do not want a tiny sleeve because that can lead to major issues including severe GERD and possible stricture. Studies have been done showing that weight loss with a smaller bougie does not yield any different results weight loss wise than a larger bougie. Now bougie size alone can be misleading because some surgeons suture/staple tight to the bougie and others staple loosely. ....so ending stomach capacity can differ greatly between two different surgeries.

IMO the most important thing you need to know is what type of DS is your surgeon planning. The original HESS DS where the total SBL is measured and then your CC is made at roughly 10% of that length and the total AL is made at 40% of the Total SBL.....or is the surgeon going to do a standard limb length. If you read any of my posts you will see that I am a huge advocate of the HESS DS because a standard limb DS left me with really bad nutritional deficiency that required me to be revised to lengthen my total AL. If your surgeon is going to do a standard limb length DS and you can't convince him to do a HESS, he needs to tell you what length of CC and AL he plans on giving you.

 

[LindaDarnell]

Unfortunately we have found that not to be true in some cases. My original DS surgeon "blanked" me up severely. Do not accept what a bariatric surgeon tells you blindly.

Regarding the OP and stomach capacity. The switch is what will maintain your weight loss for the long run, and as Larra said you do not want a tiny sleeve because that can lead to major issues including severe GERD and possible stricture. Studies have been done showing that weight loss with a smaller bougie does not yield any different results weight loss wise than a larger bougie. Now bougie size alone can be misleading because some surgeons suture/staple tight to the bougie and others staple loosely. ....so ending stomach capacity can differ greatly between two different surgeries.

IMO the most important thing you need to know is what type of DS is your surgeon planning. The original HESS DS where the total SBL is measured and then your CC is made at roughly 10% of that length and the total AL is made at 40% of the Total SBL.....or is the surgeon going to do a standard limb length. If you read any of my posts you will see that I am a huge advocate of the HESS DS because a standard limb DS left me with really bad nutritional deficiency that required me to be revised to lengthen my total AL. If your surgeon is going to do a standard limb length DS and you can't convince him to do a HESS, he needs to tell you what length of CC and AL he plans on giving you.

He talked about having to measure me once im on the table to get the precise measurements he wants. Which i remember the conversation being about 10% of something...i wrote it down but cant remember off the top of my head right now. He contrast that with how he did my hubby who was a lightweight and mainly getting the DS for diabetes resolution. Dr P said he knew going in how small he did NOT want to on him, and had his measurements in mind pre-op. He adjusted accordingly during the procedure

 

[LindaDarnell]

As long as he doesn't make an excessively tight sleeve, you should be ok. Just make sure he is doing the standard of care DS with 2 anastomoses.

Yep, we talked again about the anastomoses...and he reassured me that he performs only a traditional DS bc of low data supprting good results with the other single loop procedures. He and another Dr at MUSc did perform a few several years ago as part of a clinical trial....but the results didn't bear out as good as the traditional DS.

 

[Butterfly]

I hear you about the anxiety. My surgery is on Tuesday and I'm super nervous. Bu you know what? We're going to be okay!

 

[LindaDarnell]

I hear you about the anxiety. My surgery is on Tuesday and I'm super nervous. Bu you know what? We're going to be okay!

Yes we are!!!

 

[DSRIGGS]

He talked about having to measure me once im on the table to get the precise measurements he wants. Which i remember the conversation being about 10% of something...i wrote it down but cant remember off the top of my head right now. He contrast that with how he did my hubby who was a lightweight and mainly getting the DS for diabetes resolution. Dr P said he knew going in how small he did NOT want to on him, and had his measurements in mind pre-op. He adjusted accordingly during the procedure

Sounds great. Best wishes to you. You will do well.

I had a revision to my DS in 2015 and the sleeve wasn't touched, just had my total Alimentary Limb extended....So I was thankful for that. If your Dr believes it is necessary to resleeve he obviously knows what he is doing and why. Hopefully he doesn't have to do so as it is an easier recovery eating wise, but if he does I am sure it will be just fine.

 

[Larra]

Hey @DSRIGGS you need to edit your post! Just read it for yourself, carefully, and you'll see what I mean.

 

[DSRIGGS]

Hey @DSRIGGS you need to edit your post! Just read it for yourself, carefully, and you'll see what I mean.

 

[DSRIGGS]

 

[Marquis Mark]

I was a sleeve to DS conversion. My doctor removed excess fundus. No problems. It's not like a complete resleeve. He just tightened it up. Just wanted to let you know....

 

[LindaDarnell]

I was a sleeve to DS conversion. My doctor removed excess fundus. No problems. It's not like a complete resleeve. He just tightened it up. Just wanted to let you know....

Thank you! What was your recovery like?