The ABC's of Revision A to Z

Dr. Schlesinger, Thank you so much for the information.  I am going to get the Stomaphyx procedure approximately last of May . I will keep my results posted on this site for the benefit of all concerned.  Again, thank you.   Poinciana

Hi Dr. Schlesinger,

I think the advise you are providing here is invaluable. I am a recent revision from lapband to sleeve due to banding complications spanning 3 years.

I was a very successful bandster who lost 155 pounds and started at a BMI of 53.9 and got down to 28.7 at two years post op. . I had dysphagia, a slipped band, pseudo-achalasia of the esophagus, esophageal dilation, pouch dilation, GERD etc. For several years , I felt docs were blaming me for overeating with the band and causing the dilation issues, but I measured my portions 4-5 ounces and I tried to stick it out since they didnt think my "small slip" could be causing all the problems. After doing some research, I found studies that indicate that folks who have existing LES issues tend to have motility issues which affect them long term with the lapband and might not be good candidates for banding in the first place. I bring this issue up because I was looking at the ABC's of revision you mention that folks who were successful with their bands prior to a slippage or erosion would be a good candidate for another band. I was offered another band, but based on my previous history over 5 years, I feel I made the right decision in swtiching to a sleeve. My revision surgeon took 4 hours to remove the band and revise to a sleeve due to adhesions, stomach and liver and what appeared to be a portion of my stomach encapsulated above the band. Yes, I had a slip, but it would seem that I was not a good candidate for the band. I did not know that I had motility issues prior to banding, so I thought I would bring this up since no one really talks about this. I was told that at least 1% of patients have motility issues that result in band removal and my doc says it is more common than this. Would this be an exception to your rule??

Babs in GA

Babs, Good luck with your revision! Clearly patients like yourself who suffered multiple problems with their Lap-Band would not be good candidates for another band. By my definition, regardless of how much weight was lost, someone with all of these medical problems is not successful. Perhaps it would have been more accurate to say "if you had done well with your band..." Thank you for helping to clarify this point.  Clearly there are people who are not well suited to undergo an adjustable gastric restrictive procedure. Those who suffer from esophageal dysmotility (the muscles of the food pipe do not function properly) are poor candidates for a Lap-Band. The incidence of esophageal motility problems is higher in individuals with Lower Esophageal Sphincter disorders. None the less, the vast majority of people being treated for GERD do not have an esophageal motility problem other than the weakened sphincter. It is an art to match each patient to the weight loss procedure that is best for him or her. This is just one more reason why selecting the "right" surgeon is so important.  Eric Schlesinger, MD, FACS AZ Weight Loss Solutions 

Dr., Speaking of GERD, the stomaphyz website has something for it and I am wonderingf if you have knolege of this new method. My DH has it and any info would be helpfull. Thank U.

Shiela, This is another procedure which I perform.Using techniques and technology similar to Stomaphyx, it creates a valve to stop GERD. To date, it has not been used to treat GERD in DS patients. Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Thanks for the answer. DH = Dear Husband, not DS. My hubbie is the one with the GERD. I know this GERD procedure is new, so I"m wondering how many you have done, and what the outcomes were. Thank you again.

Thank you for all of the wonder information.   I don't suppose you'd consider moving to Milwaukee...

Dr Schlesinger, I have had the DS surgery for the past four and a half years I am having vitamin malabsobtion issues as well as osteo and anemia, and the horrible stinking stools and gas issues. If I have a reversal I know that there is no such thing as a reversal but if I have the intestines lengthened will the bloating,smelly stools, gas and everything else be resolved and how much weight would I be expected to regain. I have already had my plastics and am worried as to how the weight regain will affect the little skin that I have left and what shape would it be in after the regain. Would the reduced size of my stomach still be able to asist me in not gaining too much weight in the future or will I have to resort to another form of wls, if so then what other form of wls would be available for me to convert to other than the lapband as that was my initial surgery prior to the DS but prolapsed five times. I would really appreciate your professional and insightful comments, Thanking you in advance, Hanna

Hanna, In order to answer your questions in a public forum, I will make several assumptions. First, I will assume that you had an aggressive DS with a "common conduit" of approximately 50 cm. in length. Second assumption; you and your surgeon have been working together diligiently to correct your vitamin and mineral deficiencies. The two of you have at least discussed parenteral replacement (shots, IV's, etc.). Thirdly, that you have received extensive nutritional counseling and are stictly limiting your intake of carbs, avoiding fats, eating small meals so as not to "overwhelm" your system, etc. Lengthening your common channel will help improve your absorption of vitamins, minerals and nutrients. In so doing it will reduce your bloating, gas, and malodorous stools. It will NOT resolve these issues. You will still need to be vigorously compliant with your nutrtional program and fastidious about taking your supplements. The "sleeve" portion of your DS provides very little in the way of effective restriction. Just as pouches dilate, so too can sleeves. Any significant restriction requires a stomach component whose volume does not exceed 1 fluid ounce. It is impossible to predict how much of a weight regain you will experience. Much will depend on the exact nature of your revision. If your common channel is 100 cm or less in length, you will still have a highly malabsorptive tool. Your skin will adapt to the increase in weight. Appropriate skin care can diminish the risk of stretch marks. Let's think positively. If all goes well then no further WLS will be necessary. If you should require additional help, your DS can be revised to any ERny, thereby adding a significant restrictive component to your tool. GOOD LUCK! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Dr Schlesinger, Thank you for your reply I really appreciate it.  just one more question if I may, If I was to have a total reversal of my intestines and reduced the stomach/sleeve further will that allow me to at least mantaine my current weight or will the reversal still make me regain all my weight back as my body will revert to its original function prior to surgery and stack on every calorie it consumes because it will no longer rely on the malabsorbtion anymore. Once again I thank you in advance, Hanna