lapband to revision questions

I had lap-band surgery in dec 2005 but for the past year i have had issues because i sat in the red zone so long it created a 2nd pouch and have no restriction. i have severe scar tissue from car accident when i was a child and have had part of my intestine removed and a portion of my colon removed. I have also had 3 hernia surgeries. My skin is so tight from my skin pulling apart and i have gained back 30 pounds and never got to goal. I was 25 pounds away from goal but because my issues from the additional surgeries i am too tight but still no restriction. I am considering getting revision but have a lot of questions. My current height is 5'2" and weight is 171 and my BMI is 31. See below:
1.) Revision to plication or revision to VSG?
2.) Why do they keep the band in when they do plication?
3.) If we take the band out does it create more scar tissue? 
4.) What happens to the portion of the stomach that they turn over? Does it get oxygen, what is the purpose of not removing that portion of the stomach?
5.) Can I have the band removed and the sleeve performed? 
6.) Why plication over VSG?
7.) What data is available about the success of plication?
8.) With my current condition how bad will the scar tissue be from having the band so long and previous surgeries.
I am looking for more information as I am going back to my surgeon for a consult and i am not sure what i want to do. I have struggled for over a year in my current condition. I am also considering getting a second consult. any advice is appreciated. Thank you.

OK I'll give this a try:
1.Personally I would chose the VSG since the plication is very new and I don't trust folding over the skin.
2.I guess because that is how that particular surgery is performed.
3.There is scar tissue under and around your band already, it happens to everyone.
4.See question one. I myself see no reason to leave the skin there, seems to me that just leaves more area to have problems in the future.
5.Yes it is very possible and many bandsters end up doing this for various reasons.
6. I myself wouldn't chose plication over VSG.
7.Not sure it is a fairly new procedure only a couple of people here have had it done and they don't post often.
8.Hard to tell with out the doc doing some tests. With the VSG it may be possible to remove some of the scar tissue with the surgery.

Hope I've been able to answer some of your questions and hopefully others will post too. You might also post this on the VSG forum. Good luck to you!

Here are my opinions:

1. VSG (I'm still a little leary of plications at this point).
2. That makes no sense to me. I just don't see the wisdom of doing that. To me that is just asking for trouble.
3. My feeling is it would not create as much scar tissue as would be formed by continuing to leave it in.........but that is just my guess.
4. This is the part about the plication I don't understand. The big plus of the VSG is no, or reduced ghrelin. By leaving that portion of the stomach there..........ghrelin continues to be produced.
5. It depends on the extent of the damage from the band. If there is just minimal damage then they both can be done in the same procedure. If the damage is more severe then they want to remove the band and then wait (I'm thinking 6 wks.-6 mos.?) to let the stomach heal before they will do the revision.
6. Don't know. I don't really see it as a plus, but that's just my opinion from what I know about it so far.
7. Not sure about that either.
8. Really don't know.

Best of luck with the revision!!!

A surgeon friend of mine is studying the Plication/Band combination that they are doing VERY successfully at Duke.
He says the main advantage of plication is that when you remove the fundus in a sleeve, you lose several important blood supplies and it's the cause of scarring /stenosis that is sometime seen in the vertical sleeve.
Additionally if the plication is too tight , they can snip a few stitches and loosen it up, thereby keeping some adjustability and reversibility.
he says that the plication pretty much prevents band slippage and somehow makes the weight-loss faster and deeper (more like  RNY numbers he says). I guess its harder to cheat and slide foods through the band if there isn't a big stomach on the other side.
there isn't yet a lot of data on plication/band
you can contact the bariatrics department at duke to ask what they know.

as a side note, its been my experience that a procedure that a surgeon hasn't been trained in and doesn't have privileges to do... is a "bad procedure, and not what you need".


I know that muddies the water some for you, but its important to have all the information before making a decision.


BTW - I'm new here, and am unfamiliar with the term "RED ZONE"
forgive my ignorance, but what does that mean?

1)Please, please if you revise go with the VSG.

2)Not sure but if the band has already caused problems for you, then why would you want to keep it in?

3)Very possible. Everyone is different in regards to scar tissue formation.

4)Exactly why I recommedn the VSG.  It will be stitched together and possible form more adhesions/scar tissue.

5)Depends on the amount of damage the Dr finds when he goes in.

6)Why indeed.

7)I've only seen a few posters here that have had it done, haven't seen much success.  Here is one article showing adequate (EWL 50%) up to 3 yrs not sure what happens after that 3 yr mark. http://bariatrictimes.com/2010/05/19/laparoscopic-greater-cu rvature-plication-an-alternative-restrictive-bariatric-proce dure/

8) Only your doctor will be able to answer that one for you.