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

Rich-
-whatevere you are doing is working for you so keep it up.
I don't agree with #1, #2 makes a lot a sense to me, #3 i'd agree with 50% and really try to minimize caffinated beverages altogether.

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

Try dr. Nahimas out of St. Francis in Hartford. He will tell you if it's possible based on your situation. He did my band to rny surgery this past May and he actually literally saved my life months later in another surgery due to internal bleeding from a ruptured ulcer. I have nothing but outstanding things to say about him.

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.