ABC's of Revisions V "Making Choices"

Hi Doc, I am scheduled for a revision on April 22.  My surgeon suggested either placing a Realize Band over my RNY or cutting to make the stomach smaller as well as tightening the Stoma.  My question to you is which revision would you suggest to your patients?  I am so keen on the band but he said the results have been better with it.  I am so confused but want to make the right decision. Any advice would be greatly appreciated, Randi

Randi,
Every case is unique. As a basic rule of thumb, I would favor the "Band Over" procedure. Under most cir****tances, the risks of the "Band Over" surgery are less than reconstructing the pouch and stoma. The Band allows the degree of restriction to be adjusted and the Band, in most cases, can make your stoma "tighter" than a reconstruction.
GOOD LUCK!

Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

Dr. Schlesinger, I just have to say how impressed I am that you take the time to talk to us. I believe that for a surgeon to be so available and approachable to a non-clientele base is simply unheard of. Thank you.  I will be undergoing an endoscopy procedure with Dr. Thompson out of Brigham & Women's Hospital mid-next month; all I know for certain is that he will be tightening my stoma opening and I am very concerned that this will in and of itself not be enough to help me reverse this trend of insatiable hunger and weight regain. I had gastric bypass in 2004 and I've worked so hard with healthy eating and regular and vigorous exercise, yet I continue to gain. Can you shed any light on this procedure? Thanks very much. Maureen

Reenie B, There are several different instruments being used or tested for endoluminal surgery. The one truth about all of them is that they are surgeon dependent. The greater the surgeon's experience, the better the outlook for significant tightening. I cannot predict if this will be the answer to your weight regain or just another step along your journey. Here's some generic advise. Stick closely to the nutritional program, both during the transitional phase and when you resume "normal" eating. Avoid liquid calories after your transition. Remember and live by the golden ratio; 3 bites of protein to every bite of low glycemic carbs. Stay focused and keep a positive attitude. Don't allow any "buttons" to trigger an eating response. Rededicate yourself to exercise. It can be as simple as walking briskly for 10 minutes three times a day. If you can do this you will be successful. Don't spend any time worrying if this procedure is "the answer." If it is GREAT! If it isn't the entire solution, then move on to the next step. NEVER GIVE UP! GOOD LUCK! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Dr. Schlesinger,  Thanks for keeping us informed.  I really appreciate your giving us good information so we can make informed decisions.  I am concerned that I am not getting answers to my stomach pain.  Nothing was found on EGD or colonoscopy, but now I am waiting on results of the CAT scan on Friday.  The waiting is very difficult when you are in constant pain.  I am hoping that someone will figure it out soon.  There is concern, but no one seems to concerned, but I sure am getting that way.   I may be making a trip to see you soon, pending if we figure out what's going on.  Any suggestions of where to go from here if the CAT scan doesn't show what's going on? Thanks again.

hi doctor;You are incredible to field our questions in such a generous way..I am scheduled to have some preliminary workups for the ROSE procedure through a clinical trial study at Monmouth medical center in Longbranch N.J. on the 30th.They will be doing an endoscopy that day to see my stoma size,etc. Possibly you have discussed this before,but what are your feelings about this study and the rose procedure..I am a little over 2 years out from rny.I lost 150 pounds from a high of 360 pounds. In the past 6 months i have put on 35 pounds.Any comments would be greatly appreciated..Thanks again for your great support of all of us..Patsy

Patsy,
As you know the ROSE priocedure is still "investigational." At best, I expect it to be on par with the Stomphyx procedure.
My questions to you are: What do you hope to achieve? What is your goal? Hopefully you discussed this with the surgeon who will be performing the ROSE procedure.
If your goal is to lose the weight that you regained, then you have a very good chance of meeting your goal. If on the other hand, your goal is to lose the additional weight that didn't come off with your Rny; I cannot be very optimistic. This is where your goals and desires are so important. You are the person who will eventually decide on your definition of success.
GOOD LUCK!
NEVER GIVE UP!

Eric Schlesinger, MD, FACS
AZ Weight Loss Solutions

Hi Dr. Schlesinger;Thanks again for your prompt response to my question about the Rose procedure.I was hoping to get a jump start to get back to where I was and then to continue on.Thankyou for your honesty about the big picture.I will discuss this with the surgeon doing this at my meeting on april 3oth.the surgeons name is Dr, Frank Borao. I think there is some confusion on the boards about the difference between the rose procedure and the stomaphyx.If you could clarify,it would be greatly appreciated.Also,what is your feeling about clinical trials in general.?.Again thankyou very much..I miss arizona..I am a university of arizona grad..Thankyou Thankyou.....patsy

Hi Doctor.  I'm new to the OH Forum and came across your posts.  I agree - it's wonderful of you to take time out to discuss things!  I had bypass June '03 - had lost 170 lbs and am up 35.  I was part of a ROSE clinical trial in Cincinnati.  I had an EGD in Dec and was told my pouch was fine but my stoma enlarged so I would be a good candidate.  I live in Chgo and travelled to Cincinnati March 7th for the ROSE procedure.  An hour into the procedure they stopped because the tool wouldn't pass through my pouch to reach the stoma - said my pouch was too small.  I asked how since my EGD showed it was fine - they said perhaps it shrunk.  My bypass dr's surgical nurse said it doesn't shrink - they mismeasured.  Would you agree?  Is the StomaphyX similar?  If so, then I guess it wouldn't make sense for me to look into it since the ROSE didn't work - correct?  I have an appt w/my bypass dr on 5/7 to discuss revisions - but he does them open and I don't know if I could do another open surgery.  Do you know the different surgical revisions offered?  I'm looking to lose the 35 plus another 35 I had never lost.  What do you think my best options would be?  Any advice would be appreciated!  Carolyn