Revision - Band Over Bypass - - Dr.s in CT/RI?

Has anyone had a band over bypass with a Dr. in CT ir RI? I cannot find one except Dr. Ehlrich but he is not in network with my insurance. Any help is appreciated! Thanks

 Hi I'm having bypass Mon. My dr suggested this for me because I have diabeties. I have a friend that had the band done with him also. He is Dr. Carlos Barba. He is in Farmington CT. If you would like more info let me know. My surgery is at the Hospital of Central CT. I think he goes to one of the Hartford Hospitals.

I am not aware of any of my colleagues performing bands on bypass. This is a very controversial procedure with significant risks, and a very limited and poorly documemted track record. I would urge you to have an open dialog with your bypass surgeon before proceding in this endeavor.

 Opps sorry miss read.

Thank you for responding. I did get approval from my insurance to see Dr. Ehlrich. My question is if not a band over bypass, what are other options? Revise the RNY I have already to make the stomach smaller, bypass more intestine, possible? However, I am not aware if Dr. Ehlrich does this procedure. What do you recommend for your patients who are looking at revision? The DS is not an option. Thank you!

To be honest, there really aren't any good options for revision. What needs to be determined first is whether there is any mechanical failure causing your weight regain or failure to lose weight (I don't know which of these apply to you). Staple line failures causing leak into the "old" stomach can occur amd lead to weight regain. This is very rare with surgical techniques from the past 10 years though. When a true mechanical problem exists then revisions can be very successful.

More commonly hoewever is weight regain with a dilated pouch or stoma. These "failures" are often due to either behavior issues (eg. Not "listening" to their pouch, chronic overeating, chronic grazing) or just an inability to "sense" when their pouch is full. Revision by making the pouch smaller or elongating the intestinal limb has less than a 20% success rate and an over 10% major complication rate.

Newer experimental procedures include endoscopic tightening of the stoma (ROSE, Stomaphyx, or sclerosing). While the complication rates seem to be acceptable and short term success does occur in some, weight regain occurs in the majority of patients. These procedures are not typically covered by insurance.

The most common cause of inadequate loss and regain is lack of education and poor behaviors and fad diets postop. Remember that 10-20% of weight regain is to be expected in most bypass patients at the 2-3 yr point before a stable plateau is reached. Some essential behaviors to adopt are rigorous journalling and meal planning.

OK, that was my short answer! This is a difficult dilemma and an individualized approach is needed. Again, talk with your surgeon to evaluate your status and assess your options.

Best wishes,

Jonathan Aranow, MD, FACS
Middletown, CT
860-347-9167

I just want to thank you for actually taking the time to respond and in detail. I have met Dr.s who were less than helpful and provide no real talk or explanations even when sitting in front of them. It seems you provide excellent support and one who choses your services could greatly benefit. Again, thank you! Vanessa

 hi there ms. williams, i came across your post and right now i'm in the same position you were in and i was wondering how did your quest go? did you have the band or something else? i'm really interested in finding out what happened to you and what procedure you had and the results, i would appreciate your time and honesty in your reply, thank you

Dr. Aranow,

I read and reread your statement and I just had revision from RNY to DS which has proven to be one of the most effective revision surgeries. The doctor explained how Lapband, VSG, RNY, and DS worked and after listening to him I am wondering why any doctor would recommend lapband or RNY to a patient. DS seems to be the most effective and if I had the choice back in 2004 I would have chosen this surgery but many doctors do not have the experience in performing this so they do not advise their patients of the surgery. I do not believe I was a failure but I do feel as if my surgery failed me which is quite a common theme in RNY patients. My stretch stoma was not a behavior issue. I really don't have any a question, I am just wondering why you are saying there are no effective revision procedures when there are.