AGB revision - what to do next?

Hello everyone. I hope some of you can help me. I had lapband surgery on Apr03, 5 and a half years ago! (wao, time does go by quickly). I was able to loose nearly 70 lbs in about 1.5-2 years, but then started having trouble, basically with my eating habits. The band seems to get tighter with stress and being a working mother of 4, stress seems to be my middle name . That resulted in me resorting to foods that I was able to keep down ... namely the ones NOT good for you. Then a severe pain had me running to a hospital thinking I was having a heart attack. My surgeon said I was having esophagitis. Somehow I have managed to enlarge my esophagus to acommodate more food which basically renders the band unuseful plus I keep having very bad reflux problems with the severe pain it entails. To make a 5 yr history short: the band HAS to go!!....and I've regained almost ALL the lost weight (about 5 lbs short). Needless to say, I feel desperate, frustrated, a total failure to myself and to my family....and with no willpower whatsoever, a terrible example to my children. The question is what to do next? I'm having my revision surgery on Spt. 12, but I still cannot make up my mind as to what procedure to follow. My surgeon recommends RNY, but I'm very skeptical as to the complications not only in-surgery and post-surgery, but all the other complications that are related to RNY that fellow patients tend not to share or recognize: same 'tightening' feeling when pouch is full vs real fullness or satiety, vitamin - calcium -irom deficiency issues, scarring issues at the junctures where intestinal or stoma obstruction may occur, re-enlargement of the stomach, etc. I definetely like the fact that RNY is widely known and currently recognized as the gold standard for WLS. On the other hand, for some reason EVERY person that has found out what Im planning to do comes to me with doubts and advice not to perform such surgery....no help at all there!! Then there's the sleeve, which my brother had 8 moths ago. There are two important facts against it: being relatively new as a sole-procedure for weight loss, there's really no statistical data to support the long-term success claims of VSG, although it has been performed for other reasons for quite some time with the weight loss as a welcome side effect and there seems to have been no health related implications to raise concerns. And then there's the fact that its only restrictive, so people that snack a lot (that would be me) or that like sweets (hello again), would not benefit from the malabsorption component of RNY. So....the only thing I know for sure (as sure as I can get) is that Sept 12 Im having surgery to remove my band.....and to do something else (which I KNOW I need....I dread the thought of not having some tool to help me). I just don't know what to do: sleeve or bypass?? I've had problems sleeping for the past few days thinking of that question, but have not been able to find the answer. I'd love to receive honest-to-god comments from both band-to-RNY and band-to-sleeve patients out there that could help me decide. Thank you!!

Did you ever think of a DS. Check out on this site and type in ABC's of revisions and should answer your questions. I would look at the DS forum. I had a gastric bypass in 1997. I just had a revision to a Entended Gastric Bypass. If I had to do it I would do it over again, I would have the DS. I hope I have helped you. Dawn

When you go to a doctor to get reviewed for a revision, they don't make you feel like a failure do they? How did they make you feel and how did you decide to do it?

My doctor believes in 2nd chances. He says no one is a failure. He has the best personality. He is really sweet and nice. He tells are he patients is that 1 surgery does not fit all. When he did my revision he said none of my intestine was ever bypassed. My stomach was just stapled. I did mange to keep 80 lbs of my orinal weight loss off. Sometimes people stomach's and stoma strech for no reason. My stomach was just fine. I have 75cm of my common channel left. Thats where all the maliborbsion( spelling sucks) takes place. I really wanted a DS but said I was such a bad risk for surgery that he will do the extended revision of my gastric bypass. For the revision for the DS is a very complicated surgery to take the stomach down and redo it. I had 2 other consults with other surgeons and I like my doctor the best. I never seen a surgeon that was so wonderful. You can call him any time and he will talk to you if he is not in surgery. He talks to alot people on the phone at no charge. You don't have to be a patient either. His groups are free to anyone. I called he many times since I am post op now. One day I called him and he had another person on the phone and he called me back later in the day. I never had a surgeon that would return your phone calls. He is a very smart doctor that does revisions and the only one that I know of in Phoenix.  Plus you get life time follow up. I am really glad I pick him. Hope this helps !

Hello, and than you for your reply.  I have not considered the DS...and I think my doctor has never mentioned it because maybe I don't qualify.  Maybe my BMI isn't high enough (<40) and to be frank, my comorbilities are minimal (back pain, leg and feet pain, have not fully recovered from and ankle fracture....but that's about it). 

He prefers the RNY gastric bypass.....I guess it'd be proximal, but I have not asked to be frank.   I have an appointment this week, where I should ask all questions and finish making this decision.  I'm favoring the sleeve since, not having real comorbilities, I think that maybe it's not a good idea to trade weight loss for the potential health issues associated with the malabsorption plus the dumping syndrome.  True, those particular tools (malabsorption and dumping) are what will probably make the bypass the surgery of choice for those of us that snack a lot and like the sweets.  I think I basically eat out of anxiety....especially if I'm at home in the afternoon or early evening.  Those times are really difficult not to have a piece of something. Sometimes is frozen yogourt, sometimes is something crunchy......but if I get out of the house and put my mind into something else, then I can wait for dinner and survive the temptations. 

I'll look into the ABC's of  revisions.....thanks!!

Hello there, I read the post.  Please don't down play your pain in your body.  Pain regardless of where it is located affects us in unusal ways.  I do encourage you to really look at the surgery that will benefit you and possibly lessen or remove the pain in your body.  If the rny is it make sure the length of channel is going to benefit you.  There is the proximal, distal and extended.  I am very glad my surgeon talked to me and not at me.  He shared the information so that I could make the best decsion for me.

On July 1st I had the extended version and I am doing well.  All the best and take real good care of you for you are worth it!!!

 HI,

I am about six months out from my revision from AGB to RnY Proximal (150cm) .. I am doing great! ..I too suffered return of reflux, extended esophagus, band adhesions etc.   

I had regained 50+ lbs of the 90 I had lost by the time of my revision.  I am now down 105+ lbs total, 65+ lbs since my revision .. you need to do your research, but one of the mistaken messages with the band that somehow AGBs don't need to supplement.  Everybody is different and I had to supplement quite a bit (especially iron, calcium and B12) even with a band.

My surgeon never once made me feel guilty or a failure .. his approach was let's cure the disease any way we can .. and the band wasn't going to do it for me long term.

Pain is a sign that your body isn't happy - sounds like your band isn't a good long term solution for you either.  

I wanted a malabsorbtive surgery - I wanted the additional insurance in fighting diabetes AND I wanted the additional fat loss .. which appears to happen for me with the RnY.  I was still having issues with cholesterol and did not see the type of fat loss I had seen from bypass patients.  Even tho' I had lost 90lbs .. the fat loss was not as good as I have experienced with the RnY .. honestly, I am leaner with the same amount of exercise

Strangely -  my asthma (allergy and exercise induced) is asymptomatic right now with my RnY .. that didn't happen w/ my band.  My asthma is not weight related .. and I didn't get exercise induced asthma until I lost 90lbs (go figure) with the band .. but  with the RnY .. currently no issues

Best wishes in your decision making process and best of luck in whatever you decide.

HI,

I am a revision from lapband to sleeve. You bring up valid arguments for pro's and con's for both surgeries. I lost 155 pounds with my band and had it 5 years also, but started having problems at the end of the second year of banding resulting in weight gain. I had a band slip, esophageal motility issues (could not sense full and used my esophagus as a second pouch) etc... Anyway, I was always a volume eater and not a sweets eater so I felt that it was reasonable to go from one restrictive procedure to the other with the sleeve. My logic is for some reason if the sleeve does not work and get me to goal, I can always consider the DS as a second stage procedure. ITs not that I want to consider a third surgery (no one does), but I am a firm believer to pick the option that is the least invasive at the same time successful rather than go with the most invasive with the most complications. But thats me and my warped logic.

THe only way to pick the best surgery for you is to make a list of pros and cons and pick the one with the most pros based on dietary history, present BMI, lifestyle changes required etc... Anyway, I am very happy with my sleeve so far. IT is much more normal than banding is as far as ability to eat protein and live normally.

Babs

Thank you all for your replies.  While my surgery date approaches, I'll keep researching on the subject and hoping some other testimonies help me make up my mind and feel at peace with it.  Right now I'm still on the side of the sleeve for one very simple reason:  my BMI is 38 and I still have no health-threatening comorbilities.  When I think of a RNY or a DS I need to think about the potential risks, not only in surgery and post-surgery, but also in the long run....potencial nutritional defficiencies, hypoglycemia, hernyas, obstructions of the intestines, etc.  Maybe none of them occur, but frankly, why change health for a potential problem when what I'm looking for is a tool to help me lose the excess weight so I can avoid health problems?  I hope I'm making sense.  If anyone sees a weak point in this reasoning, please come forward and let me know.  I'm open for advice.....as a matter of fact I'm hungry for it!!

Thanks again!!!