Expert: John Pilcher, MD - 3/15/2010

Question
I'm female, 5ft 8.5ins, weigh 320lbs and my BMI is 48/49.I also have PCOS. For 5 years I have been trying to get insurance approval for WLS. Now i'm self paying. 5 years ago I weighed 270lbs and was going to have the lap-band surgery. Now, having researched the lap-band's limitations I realize it isn't going to be enough to help shift the excess pounds. I have always had problems with carbs / sugar but have been working hard to try and limit them and lose weight. While i've researched extensively both the gastric sleeve and the RNY i'm torn between choosing one over the other. I've heard the RNY can produce greater weight loss (up to 80 to 85% EWL and the gastric sleeve up to 60%EWL) Is there one proceedure that has better, long term results for PCOS patients normally?

Answer
Michelle,
I have been pleased with the early results of the sleeve for my patients BUT the Roux-en-Y Gastric bypass is definitely the gold standard.  In a case like yours with some degree of hormone abnormality (PCOS) I think the hormone "rebalancing" effect of the gastric bypass is an additional advantage.

Having said all that, I also believe the patient's impression of the procedure is important, so if you find you are having a hard time getting excited about the gastric bypass then the sleeve is still a reasonable option.

Best of luck!
Dr JP