ABC's of Revision IV Everybody deserves a second chance!

Dr. Schlesinger, I had my appointment today and was evaluated for the ROSE procedure.  The surgeon suggested that I have a lapband over my pouch especially since my pouch was enlarged.  He said that he thought this was the best option but he would consider me for the ROSE if my insurance didn't want to pay for the lapband.  Can you tell me what your thoughts are about doing the band over the pouch and if it is successful? Kathy

 

Kathy,
If your pouch and stoma are significantly enlarged, a Lap-Band over a Rny can have dramatic results. Did you discuss a malabsorptive revision as well? These are the major points to discuss with your surgeon. Your status needs to be reviewed by your surgeon in detail (current anatomy, details of your initial WLS, dietary behavior, max weight loss, weight regain, desired results and goals, expectations, risks, etc.) . Don't neglect a review of a recent malabsorptive panel. Once this has been done, you should be armed with the information you need to make your best decision.
Good luck!

Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

recent reabsorptive panel?  Is this a study by professional to be read?  Or is a lab test?

That was without a doubt the most informational post I have ever read. Thanks so much for educating us on the revisons. I am 4 yrs out  from having rny. Ihave gained 36 lbs back. I would do it all over again in a heartbeat. But, also feel that my failure at this is more emotional and much more scarey than having the surgery in the first place. I was under the imppresion that a  lot more of these revisons have been done by doctors. Are you saying that it it has not been done very much and that each doctor in general will want you to go on a 6 month weight loss program before even considering you for the procedure?

Kathy,
Let's clear up some of the confusion.
Not all WLS surgeons perform revisions. Of those who do, a significant number offer only one or two operations (not all options). Many have a "favorite" procedure. Some of these doctors will try to convince you and themselves that their "favorite" procedure is the one that is right for you.
Some programs require elaborate testing and nutritional regimens before they will genuinely consider whether or not you are a candidate for a revision.
Bottom line: Be a savvy consumer. Check each surgeon and program out thoroughly before "signing up."

Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

Hi, I too at times feel like this surgery failed me.  I had lap RNY in July of 05, weighing in at 280 on the morning of my surgery.  I got down to about 185 and then the weight loss stopped--I was disappointed because I am only 5' 3" and was hoping to get down to about 135, but because 185 pounds was such an improvement over 280 lbs, I did not complain that much .I was not exercising and I admit that was a huge mistake on my part, but I assumed because of how little I was eating that I should still be loosing.  I now weigh 220, so I have gained about 35 lbs (20 lbs in the last year).  I work with and eat lunch every day with a lady that had the same surgery I had, performed by the same surgeon and she eats more than me, snacks on candy and has been  down to her goal weight for the past year--in fact she says that she is a little worried about loosing any more weight. I am confused!  I don't know if I am a candidate for revision or what is going on with my body.  Honestly this is the first time I have been back on the forum since I had the surgery.  I have not seen my surgeon because I have been embarrassed about the weight gain, but I just made an appointment a few days ago to go in and see him.  Although I do not have any of the issues I had at 280 lbs (high blood pressure, acid reflux, insulin resistance) I still feel a little cheated.  What are some possible reasons for my weight gain?  Does the fact that I am a diet soda drinker somehow affect my pouch or stoma size?  I admit I graze during the day and I have noticed that I have been a lot hungrier lately than I have been since my surgery.  In fact there are some things that I eat that I am really surprised at how much I can eat (like steak) while most other times I am full after 4 or five bites of my dinner.  I guess I am curious to find out if  I compromised my surgery or if there is a chance that there is something structurally wrong.   I know this post has been long and rambling but I want to know what my options are.  If there is any advice you can offer I would greatly appreciate it. Susan

Susan,
Don't get discouraged. Most of the answers to your general questions can be found in ABC's of Revision II, which you can find posted here.
Stop beating yourself up. Let's focus on future success.
Life is not fair. WLS should never be viewed as a competition. Please stop comparing your results and behaviors to your co-worker. This is not helpful and has the potential to be self destructive. I invite you and anyone else who would like to discuss the specifics of their situation in privacy to call me @ 480-419-2280.
I applaud your courage. It should be easy to go back to see your surgeon, but I know that it can be nerve wracking. None the less it is an outstanding place to start. Staying closely connected to your surgeon,program and support group provides the best chance for long term success.
Good luck!

Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

Thanks so much for your post.  I would be interested in calling you and speaking to you about my situation as soon as I know what that situation is.   Let me ask this first--would it be appropriate for me to schedule an upper GI with a local gastroenterologist before I visit my surgeon (who is located an hour and a half away and my appointment is not for another 2 weeks) or is it something that he needs to order.  I was thinking that maybe if I went ahead and knew if there was something wrong when I went in to see the surgeon, maybe we could go ahead and figure out a plan, that is granted he even does any revisions.  What would you recommend? Also, one other question--are there revision surgeries that can be done by endoscopy?   I am curious as to what revision surgeries are considered minimally invasive. Thanks for taking time out to provide us with such valuable information.   Susan

Susan,
Ask your surgeon if he/she would like an upper GI (it's an X-Ray exam) prior to your visit. I will sometimes order this study prior to seeing a revision candidate. You do not need a gastroenterologist (GI) for this exam. Your revision surgeon may also want to perform an endoscopy. Call his/her office and ask what they would like.
The only FDA approved endoscopic revision procedure currently available is Stomaphyx.
RESTORE, ROSE, EROS are investigational and are in the clinical trial phase.

Eric Schlesinger, MD, FACS
Az Weight Loss Solutions

can you explain the difference between these procedures? I understand that stomaphyz is done with a plastic fasoner. how are the others done? thank you