Help

I'm looking for someone or information about a lap band over bypass, I've been out 14 years. I had a revision and it didn't work, I'm looking to do a lap band over my bypass and hoping someone had one or knows a doctor who does them.

What caused it not to work?

Hello Ccadieux:

I think there are some issues to think about prior to addressing your question about finding a surgeon to perform a "lap band over bypass" procedure after failure of gastric bypass and revision to provide satisfactory weight loss for you.

You stated that your initial gastric bypass and then a revision were done over 14 years ago. I have several questions for you to help me better understand your situation.

When was your initial gastric bypass? Also, as Gwen M. astutely asked, why do you think the initial gastric bypass failed? Did you lose any weight after the first bypass and then regain it? Is this the reason for the surgical revision? Again, why do you think the surgical revision failed?

I know that I asked you a lot of questions, but I'm just trying to make sure I have the picture correct!

At first, I was unclear whether it is possible to do a lap band over bypass procedure. After all, the pouch formed at bypass holds only about 1 oz! But, it is believed that both the pouch and the size of the opening between the pouch and the small intestine do stretch and enlarge over time. These are just 2 of many factors that can cause weight regain after bypass. Because the pouch can stretch over time, a lap band over bypass can be done and may help weight regain after failed gastric bypass or revision.

However, the reason both Gwen M. and I are interested in knowing why both your gastric bypass and then revision failed is that weight regain after these procedures is due to many factors. There are anatomic reasons, like enlargement of the pouch and the opening connecting the pouch and intestine, as mentioned before. But, there are also psychological and nutrtional reasons for post-op weight gain.

The 2 most frequent reasons for post-op weight regain are failure to follow a healthy diet and inadequate physical exercise. A healthy diet consists of eating portion-controlled, high protein, low fat, and very low complex carbohydrate containing meals. Recommended physical exercise time is 150 minutes per week.

As you know, gastric bypass surgery produces weight loss in part by restricting the amount of food that can be taken in at a meal (restriction) and also by reducing the percentage of nutrients in the meal that can be absorbed (malabsorption). Over time, the malabsorption function of gastric bypass wanes, but restriction remains. Lap bands cause weight loss by restriction only.

It seems that the key to whether a lap band over bypass surgery will help you lose weight after both a failed initial bypass and revision is why these first two procedures failed to produce adequate weight loss for you. If both procedures failed because you initially lost weight but then regained it, this points to possible difficulties adhering to a healthy diet and/or inadequate physical exercise. If this is the case, it is likely that lap band over bypass won't help you lose weight either unless you adhere to a healthy diet and/or stick to a regularly scheduled exercise plan.

Prior to undergoing a lap band over bypass, I would suggest tracking all foods and liquids that you take in daily and also record your daily exercise time for at least a week. That should help you determine if you are meeting the requirements of eating a healthy diet and obtaining enough physical activity to enjoy satisfactory weight loss after this procedure.

If you find that you are falling short on a healthy diet and/or physical exercise on a daily basis, you can make appropriate adjustments in your dietary and exercise habits. If you do, you may not need the lap band over bypass procedure because you probably still have a functional "tool" from your bypass revision tool.

However, if you have been following a healthy diet and exercising enough or if there is a different reason for failure of your gastric bypass and revision to produce adequate weight loss, then a lap band over bypass procedure might help. There are many centers listed online that do this procedure. However, I don't know any surgeons personally who do this procedure. I am also aware that some health insurance policies don't cover lap band procedures. Perhaps, other members of this forum know of surgeons who do this procedure.

Best of luck with your ongoing WLS Journey!

Many (perhaps most?) of us do not agree that low fat is part of a healthy diet. And, while exercise is an extremely important component of health, it's a very small component in weight loss.

Hello Gwen M:

I'm not clear about 1 of your statements. When you say "Many (perhaps most?) of us do not agree that low fat is part of a healthy diet," do you mean that you believe a "no fat" diet or a "high fat" diet is part of a healthy diet?

Some fat is necessary in the diet to provide essential fatty acids -- the body cannot manufacture these from scratch. The role of fat in the body is to store energy, aid in absorption of fat soluble vitamins, and help with rebuilding structural components of the body such as cell walls. The recommended types of fat are monounsaturated or polyunsaturated fats.

A diet that is high in fat or a ketogenic diet has been shown to help children with seizures. It has also demonstrated the ability to improve diabetic control in type 2 diabetes mellitus and accelerate fat loss. But, these 2 last effects have not been proven to continue over the long-term. Further, the effects of a ketogenic diet over a longnperiod of time are unknown. Ketogenic diets can also be harmful in people with certain medical conditions such as kidney disease.

I stand by my statement that a healthy diet consists of high protein, low fat (monounsaturated and polyunsaturated fats, and very low complex carbohydrate containing meals.

Regarding adequate exercise, I agree that it is not an important component of weight loss. But, weight loss is only the beginning of the treatment of obesity. Regular physical exercise is essential for maintenance of weight loss.

Gwen M., I look forward to reading a further clarification of your statements above.

Many of the successful vets and other long-term posters here (and a fair portion of newer posters as well) believe that fat is a necessary part of the diet and not something to be avoided. Some of us eat high fat (as with the keto diet), some of us opt for something closer to "not caring" when it comes to fat. For example, I eat high protein, low carb (specifically avoiding refined and processed carbs), and let the fat fall where it may.

I.e., many of us are not opting to eat "low fat" and have not found keeping fat low to be part of a healthy diet.

Thank you for your claification, Gwen M. I can understand that there are so many things to watch in our post-WLS diets that trying to watch fat intake may just make things impossibly complicated.

I guess as I get older, I'm 63, I continue to worry about developing heart disease. I'm only about 1.5 months post-op after RNY and struggling a bit. I'm not too focused on the amount of fat I take in, but I do like to stick with monounsaturated and polyunsaturated fats.

It has nothing to do with tracking fat being "complicated," as many post-ops track everything anyway. It's the active awareness that fat is a) an important part of the diet, b) helps to ensure satiety, and c) not something that needs to be avoided or kept low to ensure optimal health.

I'm sorry you're struggling. Is there something you're specifically struggling with?

Thanks for asking, Gwen M.

I have been posting in the RNY forum about my post-op nausea and vomiting. I have had nausea since right after surgery and it is ongoing. The nausea was initially accompanied by vomiting until a stricture was found and dilated on EGD about 5 weeks post-op. Since then the vomiting stopped.

I'm still trying to introduce solid, dense proteins. But, every time I eat solid food, the nausea starts and lasts for several hours. It usually stops around the time I'm ready to eat my next meal. I am then reluctant to eat more solid protein since the whole cycle recurs. I seem to be only tolerating milk and Greek yogurt now.

All the nausea is very wearing on me and making it difficult to neet my daily protein goal. I believe I'm in a weight loss stall now, but I hope my limited diet is not interfering with my weight loss.

Are you taking a PPI? If you are, it does not sound like it is working. Maybe you should switch to a different one.