Best advice, she needs the problem solver, Dr. Keshishian in California.

You already know this but you need to tell her the sleeve failed her. The sleeve is just another diet with a smaller stomach. She should have had the DS from the get go and the surgeon who sold her the sleeve is the failure. The DS is still her best hope to get down to the weight where she can get her knees replaced and get her mobility back. If a panniculectomy will help her, perhaps it can be done with the DS. Ask Dr. K.

I wish there was something better than the DS. A pill would be great. But there is nothing else out there that will give her a better chance. There is one non-surgical option I can think of and that would be Medifast/Optifast till she gets down to a weight where her knees can be replaced. BUT once that's done, there is a very good chance she would regain.

That's what we were thinking or hoping but Anthone isn't a fan of resleeving, to many risks apparently. He would just do a roux-en-y pouch.

If he wanted to do anything on top, I'd ask for a tighter sleeve.

I'll admit to getting lost in the terminology he used. He wanted to create a roux-en-y pouch out of the sleeve but do the intestines as a DS. That's how I understood it hence me calling it a hybrid of sorts.

Hi Guys,

Posted the other day about my sister's dilemma. Went to see Dr. Gary Anthone (always a pleasure to hear him talk) great human being. Rehash she was 425 down to 315-325 after 1 year with sleeve (200) would be great, just stopped losing weight after 6-7 months. Has some hormone and autoimmune disease issues and has certainly made poor food choices as well, but felt the surgery should have worked better for her year one.

Talked about everything going on, he said adding the DS to the sleeve in place at this point, she wouldn't see a big loss of weight and would probably be disappointed. He said she would need to add some restriction along with the DS. But he's not a fan of re-sleeving and thinks the Dr. that did the first sleeve didn't (hug) the bougie along the staple line and left to much stomach. The original Dr. used a 40 bougie, I had a 32 and she could out eat me at 7-8 months, I'm 10 years out and still have good restriction. She can still eat half of what she used to BTW. So he felt converting the sleeve to a pouch would be better.

So he gave her three options.

1: Get a Panniculectomy, $8-10K?he estimated 35-40 lbs. Her original Bariatric surgeon thought 40-45 lbs. Get some relief and more mobility from a plastic surgeon, then add a bypass with new restriction later.

2: Get a Laparoscopic Roux-en-y with one of the other surgeons he works with, about $24K convert sleeve to a pouch. We know the Roux-en-y will lose it's bypass effect overtime so there is a downside and Get plastics later.

3: Get the DS with him (open procedure) $32-35K and convert sleeve to pouch but do a DS hybrid of sorts would be most effective he mentioned, resolve the diabetes altogether hopefully. Probably help keep the weight off the most long term. Get Plastics later.

She's self pay for all of this and the last option would be a doozee financially, current employer doesn't pay for WLS. Time off not a problem can work from home. But even self pay for WLS hospital said 3-6 months supervised weight loss. Don't really wanna weight that long.

She has a couple appointments with plastic surgeons and another Bariatric surgeon. Anybody been through something similar and what did you do or how would go about it. She needs both knees replaced and mobility is really becoming an issue. Any thoughts are welcome.

Thanks,

Bubba