Well now I am confused! Do we have a DS and VSG for dummies?

[VDLT]

hello all. I am looking to revise from band to sleeve. I am so glad I found this site! I did not realize the regain was so common with VSG. I thought the restriction would be adequate for maintenance. I *think* I did well on restriction alone with the band even though I did turn to sliders when the daily vomiting started. But now I am looking at my choice more closely and would like to make the most informed decision that I can.

I have read and read the forums here. There are some champs among you! I have learned a lot but unfortunately a little piece here and there. I was wondering if we had stickies I might have missed with am overview of the surgeries.

 

[VDLT]

Adding on(part of post disappeared) ... I have a general understanding of both procedures but would like to delve deeper. Is there any information you could point me to about regain for with the VSG and the reasons? I would think that with appropriate restriction maintenance would be possible.

I mistakenly thought the DS was reserved for higher BMI but nod see that @southernlady and many others started with lower BMI. I don't want to necessarily second guess my initial decision but want to make a more educated decision as to my revision.

Are there posts on here I might have missed that give a broad overview of life changes with the DS? I feel like I am missing the forest for the trees. Thank you all so much! Know I am open to questions, suggestions, and swift kicks.

 

[southernlady]

I have read and read the forums here. There are some champs among you! I have learned a lot but unfortunately a little piece here and there. I was wondering if we had stickies I might have missed with am overview of the surgeries.

The best overview of the different surgeries WITH statistics is actually found at http://www.dssurgery.com/procedures/compare-weight-loss-surgical-procedures.php There is a chart of the four accepted by the ASMBS and their statistics.

The four accepted by ASMBS (and as a result, insurance companies) are these: The Adjustable Gastric band aka lap band (and you know how well that one doesn't work, the Sleeve Gastrectomy aka VSG, the Gastric Bypass (proper name is RNY), and the DS (aka BPD/DS).

There are another NEW one (the name is still IN flux depending on who is doing it) called the SADI or LoopDS or SIPS. That one is not an accepted standard of care YET. We hope that it replaces the RNY as the new one retains the pyloric valve.

Since other places do an excellent job of explaining them I figured why reinvent the wheel but I DO need to place a pinned post explaining where to find the info and thank you for that reminder.

As for the reason for the regain with the VSG is fairly simple, it is not a malabsorptive procedure. And the stomach has this great ability to re stretch over time. So if your metabolism is not broken and simply limiting your food has worked in the past, then it is possible that the VSG would be a good option. Esp for lighter weights like me BUT it also depends on comorbids involved. BUT it means you have to be vigilant and very aware of your own personal eating habits and any issues with food.

Hope this helps.

 

[JackieOnLine]

hello VDLT

do you have a feeling for how many calories you can consume and maintain? or, put another way, how low do you have to go to lose?

my general feeling is if your metabolism is shot (maybe from dieting? or yo-yoing up and down) you need a DS and if it isn't, a VSG might be enough. it has been said the VSG provides what the band was supposed to, restriction.

ah, I see you have previous threads: let me go read them before I say more.

 

[JackieOnLine]

As for the reason for the regain with the VSG is fairly simple, it is not a malabsorptive procedure. And the stomach has this great ability to re stretch over time.

I think there is a great variety in how true this is. I don't know how much of the larger capacity over time is the swelling from surgery going down vs "stretching" and I know the part of your stomach that is stretchy-est is the part they take out.

I am a binge eater and have over-eaten like crazy and yet I still have restriction if I eat dense protein*.
but I started out with a very small sleeve and early out (in fact for at least a year) I could not eat anywhere near the amounts some people report.

*so, for me, it comes down to what food choices I make.

sort of like a non-op but not really because before surgery (even though I was technically a light-weight) I could not have lost the weight. I am sure of this.

 

[Jo777]

Ditto-ing @JackieOnLine. I have not experienced much "stretch" since I was about little past 1yr out (credit goes to our surgeon).. I still cannot eat 4oz of chicken breast.. If I want to eat a big bowl of pasta, sure.. but just as with a band, pasta is a slider in it's own way as it's broken down fast and empties out of the stomach faster than a meal of dense protein. I had a small tight sleeve, and went from eating 1.5 oz meat, to maybe 3-3.5 and a little veggie now, about 3/4-1C capacity if all squooshed together.

So, while my capacity has not changed much since healing and relaxing of the tissues was complete- I have had a aprox 30lb regain over my comfy zone (145) over two years time due to liquid calories and slider carbs. When I eat properly and well, I still eat very small portions and get full on them. My stomach works just the way it's intended (great restriction) but my poor choices were on me. Carbs (and alcohol) can be the downfall of ANY surgery, and grazing can do in the VSG..

 

[VDLT]

Thank you for the links @southernlady I really appreciate it!

@JackieOnLine and @Jo777 thank you so much. That is what I am wondering even if I didn't explain it well. My concern is whether regain happens due to ineffectiveness of the surgery itself for some reason, or if it depends on eating habits. My surgeon uses a 36 bougie. I am not sure if that is common or small enough to keep me on track.

 

[southernlady]

Thank you for the links @southernlady I really appreciate it!

@JackieOnLine and @Jo777 thank you so much. That is what I am wondering even if I didn't explain it well. My concern is whether regain happens due to ineffectiveness of the surgery itself for some reason, or if it depends on eating habits. My surgeon uses a 36 bougie. I am not sure if that is common or small enough to keep me on track.

It really depends on WHY you need WLS...if your metabolism is not busted beyond hope and you are careful about your choices, the VSG is good. But most of us have dieted our way to a busted metabolism and need the extra that malabsorption gives us.

I was great at losing weight, sucked pond water at KEEPING it off.

 

[Jo777]

I think it is very hard to give any definitive answers.. you really Need to understand yourself and why you need surgery.. I was a fat toddler, fatter kid, obese teen.. reaching 310+ at my highest.. I dieted all the time, losing 30-60+ at a time, only to regain. Finally got out of a bad relationship at 21-22, and lost from 310+ to 155 in about 1.5yrs or a bit less on my own VLC diet (800 cal).. You would think my metabolism was busted, but frankly it never was.

My first diet was 7-8 years old, and I went through every you can name over a couple decades, from Optifast, Nutrisystem, to WW.. I lost like gangbusters but never maintained, until the VSG. Despite adding about 15lbs a year for the past two.. these last two have been the most trying my my LIFE, and in other times, the weight would have piled back on.. the VSG gives me a pause.. just a bit more time to reign things in.. which is what I needed. I got a good surgery, and a well made sleeve- I have read of others not so lucky in that regard.. so a good part of it does fall on the surgery too. Thing is I Knew What To Do, the VSG just gave me a helping hand to do it better than I could without it..

My gain was solely from poor choices and mostly from self-medicating bad life situations with liquid cals (huge work stress, now gone, and my parents fading health- my father has since passed, and mom has been medicalized for her dementia.) So, stress is lifting, balance is coming back, and as follows- my weight is slowly trending down without my worrying too much about it.. No, I cannot drink like a fish, nor does that make me feel good anyway nor can I nibble non-stop on carby crap all day and expect to be healthy, but frankly, no one can, regardless of surgery type.

Know thyself. If you are broken, and truly need the big-guns, with all the added responsibility that entails, and you are willing to still avoid the carby crap or liquid cals that can sink even the DS, then by all means- the DS is a great surgery when it's needed. For me, I have been acting a frank careless hedonist for nearly 2 years, and I'm at this moment, 176lbs, when my "normal" BMI is 157ish, and my comfy weight is about 10lbs down from there.. not too shabby for a restrictive only surgery.. I knew for me, I didn't want to medicalize myself to the degree the DS would have required, but that is ME. Things can change. I was self-pay, and if I need in the future to revisit something, I'm all for it- but so far, it's been working.. though I've been mucking things up.

edited to add: Dr. Aceves used a 36f on me from what I recall, but that is just a guide not an overall specific measurement of capacity.. so one can't say that you will have uber-tight restriction vs more relaxed.. and frankly, while I can only fit in a few oz of meat and veggies at a time, I could go back in a couple hours and have more, and over and over.. so it really comes down to behaviors and habits. Do I actually physically feel hungry- no, not usually.. unless I haven't eaten in 6++ hours.The restriction is a great reset button, where you go from there..

 

[more2adore]

I love all the VSG honesty in this thread.

I have read in several places that while it is possible to stretch your sleeve, it requires repeated and regular overeating of its capacity, and that it will NEVER stretch to its previous capacity regardless. I'm hoping that's true, but I'm doing my part by measuring the food I eat to make sure I stay right at 4 oz. or less as that's what my surgeon said my sleeve capacity would be. I want this restriction to last as long as humanly possible so I can get as much weight loss as possible out of my VSG (I have an unusually high amount to lose). I haven't really been hungry since surgery. It almost never happens. It's lovely.

 

[JackieOnLine]

yes, what Jo said

it really comes down to behaviors and habits.

and what Liz said - if your metabolism is not broken

 

[VDLT]

@Jo777 I can't thank you enough for taking the time to write and for being so honest about your experience. I am so sorry you have had such a rough time the last couple of years. Kuddos to you for managing to not gain EVERYTHING back and for recognizing and admitting where you have strayed. I have no doubt you will get back to your comfort zone with modifications, you are darn strong!
You gave me EXACTLY what I was looking for and I can't tell you how much it means to me. You have clarified my decision.

 

[VDLT]

@southernlady and @JackieOnLine I don't know if my metabolism is broken. I have always had a hard time losing and an even harder time maintaining. I can lose with Atkins albeit slowly, and my main problem is that I usually give up after two or three months of working a diet to the letter and losing 3 pounds. WW, JC, nutri.... they all kept me so flippin hungry all the time. I know that is on me. I found the band helped me a ton because I am a volume eater and it just kept me from stuffing my face. I knew how to eat around the band and did so a few times because of being frustrated that I could not really eat at one sitting and feeling hungry. I think that if I am able to actually eat food and be satieted with a small amount that I would not go back for more in a few hours.

You have given me something to think abou though in that maybe I should have my metabolism tested.

 

[Jo777]

@Jo777 I can't thank you enough for taking the time to write and for being so honest about your experience. I am so sorry you have had such a rough time the last couple of years. Kuddos to you for managing to not gain EVERYTHING back and for recognizing and admitting where you have strayed. I have no doubt you will get back to your comfort zone with modifications, you are darn strong!
You gave me EXACTLY what I was looking for and I can't tell you how much it means to me. You have clarified my decision.

Thanks, I don't feel particularly strong.. but I also don't put my head in the sand, used to though! Without the VSG, I would have been up 75, or more likely, nearly back to the starting point by now.. Last time I had a huge loss (310-155), after the initial bounce back to 175 the first year (ha, seems to be the spot eh?)..my depression kicked back into gear, and I gained about 50-60lbs (without drinking, as I never really drank even just socially until I was in my mid-later 20's), and then gained on average 25+lbs or so until I got back to 275-285 at the end, where I held for a while before I said fuckit and opted to get surgery as I wasn't a kid anymore and just could not even fathom doing it on my own again.

@southernlady and @JackieOnLine I don't know if my metabolism is broken. I have always had a hard time losing and an even harder time maintaining. I can lose with Atkins albeit slowly, and my main problem is that I usually give up after two or three months of working a diet to the letter and losing 3 pounds. WW, JC, nutri.... they all kept me so flippin hungry all the time. I know that is on me. I found the band helped me a ton because I am a volume eater and it just kept me from stuffing my face. I knew how to eat around the band and did so a few times because of being frustrated that I could not really eat at one sitting and feeling hungry. I think that if I am able to actually eat food and be satieted with a small amount that I would not go back for more in a few hours.

You have given me something to think abou though in that maybe I should have my metabolism tested.

Def get checked, if you do have a hard time losing, you may need something more than a restrictive procedure.

Also, just because you are satisfied with a smaller amount, be on the lookout for the grazing habit.. I thought the same, and when stressed, guess what I did? Big trick, that I didn't follow of late, if you graze- graze on stuff like HB eggs, cheese, jerky.. things that will FILL you and satisfy you.. it's self-limiting, it's hard to overeat on hard boiled eggs, easy on slider stuff as you know from the band.. different mechanism, but still possible in it's own way.

 

[southernlady]

if you graze- graze on stuff like HB eggs, cheese, jerky.. things that will FILL you and satisfy you.. it's self-limiting, it's hard to overeat on hard boiled eggs, easy on slider stuff as you know from the band.

See, I KNEW I was also a grazer...keeping stuff like hard boiled or deviled eggs, cheese, etc is a big factor in getting in all my protein daily and allowing me the freedom to graze.