If you were converting from sleeve to DS, would you resleeve?

According to my doctor, my sleeve is stretched to the size of a "tennis ball." I feel like my capacity is now about 1/2 of what is was pre VSG, and about double that of a "mature sleeve." As an example, I can eat a whole sandwich and an apple OR a 9 ounce steak.

I don't recall seeing any malformations on the X-Ray (i.e the ball on top of the banana, or an enlarged antrum). Seemed like the "tennis ball" was right in the middle. I'm pretty confident that my doctor did my sleeve correctly. Not interested in an RNY.

I'm considering a revise to the DS. I'm a 37 BMI (pre VSG =41). Looking to revise because after 5.5 years my EWL is only about 25%. Been that way since about 1 year out. In fact, I never achieved more than 40% EWL. 

So here's the question:

Given the above, would you revise your sleeve while you were getting the DS, or just leave it be? Why or why not? All opinions are welcome!

Thanks in advance, MM

If I had both options, I would resleeve.  I would already know restriction alone is not enough for me.  I need the metabolic component of the surgery added to the restriction.  The reason I would do both is folks who have the whole surgery done at the same time seem to lose more, better, faster, than those who have the surgery done in 2 parts.  I would only do both if my basic health was good other than being heavy.  If I had issues, I would probably opt for just the switch for an easier recovery.

I could eat that steak about 8 months post DS.  The sleeve is supposed to get bigger over time.

The sleeve is usually a little bigger when done with the switch.  My question to you is how much bigger is your sleeve now than it would be with the traditional DS?

Thanks for your response.

When you say, "folks who have the whole surgery done at the same time seem to lose more, better, faster, than those who have the surgery done in 2 parts," are you referring to virgin DSs or sleeve to DS revisions?

I have read the same as you - that revises lose less weight. Not sure if that's because they're usually lighter to begin with, or, perhaps, because they're not as compliant (which necessitated the revise in the first place).

Some people have told me I would lose faster if I resleeve, but, frankly, I'm not that concerned if it takes me 1 year, or 2 or even 3.  As long as I eventually get to a good weight, I'd be happy.

Don't know how big my sleeve is now compared to a traditional DS. I think a more useful measurement might be how big is it compared to a mature DS sleeve. If you can eat that steak and you're doing fine with your DS, then perhaps I  wouldn't need to revise the sleeve.

Does any of that change your calculus?

Wait a minute...  1, 2, or 3 years?  There are exceptions but most DSers lose easily up to the 18 to 24 month mark.  After that it's work.  Maybe not as much as without the malabsorbtion but it's not effortless.  Postop you need to drop as much as possible as fast as possible.

You would be in effect, a 2 part DS.  Can you be successful?  Yes.  You also have the advantage of being male.  Men do better than women for some reason.

What's 'good' for you?  Will you be happy with 50 or 60% EWL?  If you will be happy with that, just get the switch.  What's your CC going to be?  That makes a difference too.

I've heard a lot about the "short weight loss window," but, frankly, I don't get it.  Why should it be any harder/easier once you have the tool?  I understand it could possibly be explained by a stretching sleeve, but since I already have one of those, what difference would it make? What is the physiological explanation for the "window?"

Do you mean 50-60% EWL from where I am NOW (285lbs), or my pre-sleeve weight (325 lbs)?  I'm 6'3". BMI 37.  If it were 50% from my pre-surgery weight, then no, it may not be worth it.

Not sure about the CC yet.  Have a consult with the surgeon on Friday.  Are you an advocate of the Hess method?

With your sleeve you only have restriction only, and if you can eat a 9oz steak it has stretched quite a bit.  My sleeve with my DS was about 3oz, most sleeves are 2oz.  It's the malaborption that keeps the weight off and helps you lose weight.  My CC was 100.  At 7. 5 yrs out, it's harder to lose weight.  I've managed about 5lbs this year, not working really hard, just more protein.  I'm still about 5lbs up from my lowest weight.

Thanks for your reply.  So given my BMI, stretched sleeve, etc would you resleeve?

Hello.  I wouldn't resleeve.  I had a straight DS in Jan 2009.  With DS, your weight loss is 90 percent due to malabsorption and only 10 percent restrictive.  Seems to me the size of your current sleeve is close to what mine was with the switch.  My surgeon described my "sleeve" as about the size of a banana.  I lost 80 percent of what I needed to lose in my first year and I was not severely restricted in my opinion.  At the 2 year mark I had lost 85% of what I needed to lose.   My BMI FINALLY dropped below 25 earlier this year.  The last 15 percent didn't happen without a LOT of work.  I started a house renovation and that significantly pumped up my activity level and as hard as I was working, I wasn't much interested in eating.  Not sure it would be wise to severely restrict (resleeve) and do a DS.  I'm so glad I did DS...

Good luck to you, whatever you decide.

Thanks for your input and congratulations! So you can eat a 9 ounce steak and still lose as much as you have?  That's good to hear because, frankly, I'd prefer not to risk any more complications than necessary.  And so far, knock on wood, I haven't had any.

One more question:  have you found that the DS has changed your food cravings at all?  I kind of think that the body sends signals telling you what it needs.  When I'm not very hungry it craves crap, which has little nutritional value.  But if I'm really hungry, it wants the good stuff because it knows it's nutritious.  I imagine if you have malabsorption, it would crave the good stuff over carbs more often.

Or am I completely wrong?

Honestly, I've had so many changes in my life since 2009, I'm not sure I can answer that question accurately.  I've retired, renovated a condo and rented it out, moved across the country and am currently renovating a trashed house that I rented out for 17 years.  I was very sedentary and now I'm not.  I used to be focused on food and my cravings were always for bad stuff.  During the 1st 6-8 months after surgery, I focused on things I loved to eat that were way high in protein, but that I loved.  I came up with the perfect protein smoothies using Kefiir, protein powder, and frozen strawberries as my base, I made crustless Quiches, I grilled Wild Salmon and put it in fresh salads--I mean I was a good little soldier.  My bugaboo was and has always been sweets and I still craved them.  After about 8 months, I did eat them.  I couldn't eat nearly what I used to be able to put away, but I did eat them.  Though the weight loss slowed down, that malabsorption part of DS prevented me from gaining, and I continued to lose.  I did experience what everyone is referring to that bounce and I gained about 15 pounds from my lowest point.  But then my lifestyle changed and I lost the remainder of the weight needed to achieve a normal BMI.  I do still have bad cravings and I satisfy them with moderation.  I have also found painless ways to eat healthier by modifying recipes I've always loved and adding the protein.  You really have high protein requirements with the DS.  I have to eat 75 grams a day.  I don't always get it all in, but I come pretty close most days.  Bottom line, I still crave crap with DS, but smaller stomach and the malabsorption keeps the pounds off for the most part.  That--along with a less sedentary life style.  Good luck!!