Ask The Expert: Dr. Sergey Lyass Answers Your Questions

Q: I'm almost four months post-op from my revision to RNY (from VBG). So far, I've lost 65 lbs. Though I've had a few slip ups along the way, my diet is mostly light and healthy with lots of veggies, fruit, good carbohydrates, and of course plenty of protein. Two days ago, I started having pains in my stomach area... more like cramps that come and go. This lasted most of the afternoon, all evening, and into the night yesterday. I felt better this morning, but eating even light foods and small quantities seems to trigger the pains. They come and go much beyond the actual eating. This is my second evening now with the cramps, and it looks like I might be going through the same thing as last night. Can you shed some light on this? If possible, I would so appreciate it if someone could call me about this problem so we can talk about it rather than email about it. - Susanna

Dear Susanna,

I think you need to see your surgeon as soon as possible. Most probably you have inflammation at your pouch, possibly ulceration. After it is diagnosed by endoscopy, it can be effectively treated with acid blocking medications and diet modification. There are other possibilities that have to be ruled out gallstones and bowel obstruction. The last one is the most worrisome and can lead to severe complications if left untreated. That is why I recommend you to see your surgeon. - Dr. Lyass

Q: I had gastric bypass in 2002. Blue Cross/ Blue Shield of Texas paid for everything. I weigh 191 lbs. and my BMI is 32. For the last couple of months, I have been having problems with belching all the time and nausea all day long. I went in to see my doctor and he sent me to have an EGD. I have not gotten the test results back yet. What are some options for revision surgery? Will my insurance pay for the procedure? I don't have the sense of fullness anymore. Any information would be helpful in getting approved for revision surgery. Thanks a lot for your support. - Cynthia

Dear Cynthia,

Most of the insurances will cover revisional surgery unless it is specified in your insurance plan that you may have only one covered bariatric procedure. In order to be a candidate for revisional surgery, you need to have an anatomical reason for failure (enlarged pouch or slipped band).

If you gained weight after bypass and you have an enlarged pouch or a very wide connection between the stomach and bowel, you may benefit from a complete re-do of the anastomosis (more invasive option) or a gastric band may be placed around your pouch (less invasive, but with less reliable results). Some surgeons also perform conversion to distal bypass (elongation of your Roux limb), but it may be associated with side effects like protein malnutrition. - Dr. Lyass

Q: In March 2005, I was banded by a well known Mexican doctor. I have lost 75 pounds, but now that weight loss is up 25 pounds, leaving me a total of 50 pounds gone. I have gained this weight and went to have a fill. The fill doctor said that it appeared that the pouch had stretched and that she wanted to withdraw all the fluid and put me on Prilosec. This was done in October. She said that she thought the band should work without a fill because it was a small sized band. The band really couldn't take a normal 1cc fill because she felt it was too small, but she felt that once the Prilosec took effect, I could come back and we would try for a fill. My questions are: Why has the band stretched? Can it be fixed? Does this render my Lap-Band broken and damaged? How do I have it fixed, how much will this cost, and will I ever be able to get this band to work? Thank you! - Lisa

Dear Lisa,

If your pouch is dilated, it is unlikely that you will tolerate further adjustments (fills). Most probably any fill will result in pouch dilation. There is only a 20% chance you will be able to lose more weight keeping this band. Most likely your band has to be replaced with the new one. - Dr. Lyass

Q. I am going to have RNY surgery and I have a question for you. What happens to the bypassed stomach and intestines that are not used? Do they leave them in the body? And if so, why? Is it receiving any blood supply? If not, doesn't it die and become toxic? Thanks for answering my questions! - Eldy

Dear Eldy,

The stomach and intestines stay inside the body. They receive blood supply and continue to function by secreting hormones and juices. - Dr. Lyass

Q. I'm am having VSG surgery tomorrow and am totally amped to get back on my bike after six years. I decided to set an exercise goal to keep me on track. I registered to ride in a 50 mile, one day ride that takes place at the end of July. I was reading over the training plan when the paragraph stressing the importance of hydration really caught my attention. Considering that I wo't be able to chug fluids anymore, I'm concerned about staying properly hydrated. How can I make sure I get the fluids I need during my training rides and the final ride? Should I just sip from my camel back every few minutes? Please help. - Tracey S.

Dear Tracey,

Yes, you should sip fluids every few minutes or during the break. - Dr. Lyass

Q. I had gastric bypass 11 years ago. I started out at 400lbs. I got down to 330 and stayed there until 2008. I got worried in August of 2008 and changed a few things around and as of now, I weigh 294 pounds. I am not gaining my weight back, but the doctor that I am currently seeing is telling me I need a revision since my surgery is so old. I would love to lose more weight, but am afraid that I cannot take the time off from work to do this. What are the current options out there? On the average, what is the recovery time of most of the procedures? I am getting nervous.

I pat myself on the back for not gaining the weight back after all these years, but don't want to get stressed out and start gaining. This is really worrying me! Thanks in advance for your help and for listening. - Lydia

Dear Lydia,

My answer is much the same as my answer to Cynthia's question. If you gained weigh after bypass and you have an enlarged pouch or, a very wide connection between the stomach and bowel, you may benefit from a complete re-do of the anastomosis (more invasive option) or a gastric band may be placed around your pouch (less invasive but with
less reliable results). Some surgeons also perform a conversion to distal bypass (elongation of your Roux limb), but it may be associated with side effects like protein malnutrition. Recovery time after banding is 3-5 days, after other types 7-14. - Dr. Lyass

Q. Why do some surgeons allow RNY patients to take pills after surgery and some don't? What are the reasons for and against? I had RNY last month and was given pills while still in the hospital. My friend who had RNY at the same time still can't take pills unless they are chewable of in liquid form. Just wondering. - Jan

Dear Jan,

It depends on the size of anastomosis. The surgeons who make it really small do not suggest to take whole pills.- Dr. Lyass

Q. Does you have any tips for heartburn? I am eight days post-op from Gastric Sleeve. I am having a hard time drinking liquids as it hurts from the first sip. My doctor prescribed Prevacid twice a day. I am worried that I am getting too dehydrated. I am tired and feeling weak. - Ashley

Dear Ashley,

You can try Levsin and Reglan. If it does not work, you need an X-ray to rule out stricture. - Dr. Lyass

Q. What vitamins do I need to make my hair quit falling out? I’m 1 year post-op. - Cindy

Dear Cindy,

It should stop falling out when your weight stabilized. Try Zinc supplements or biotin. - Dr. Lyass

Sergey Lyass, MD, received his medical degree from the 2nd Moscow Medical Institute (now Moscow Medical University) in 1985. He has been trained in General Surgery in Israel at the Hebrew University- Hadassah Medical Center, Jerusalem, and completed his surgical training at Cedars-Sinai Medical Center's Department of Surgery. Dr. Lyass completed fellowship in the Minimally Invasive and Bariatric Surgery at Cedars-Sinai Medical Center. For more information, visit his OH profile here or visit his website here.