lap band to RNY?
Hi everyone!
I was just wondering if anyone here had their bypass AFTER unsuccessfully being banded. I had my lap band installed in Feb of 2007 and after 2 port revisions and countless attempts at adjustments and whatnot, my surgeon has determined that it's "just not working" for me and has suggested bypass surgery. I've only lost about 30 lbs with the band and have done everything EXACTLY by the books, and in addition to not losing weight, I've developed terrible reflux.
I'm now considering having the lap band removed and having the bypass surgery, but I feel extremely apprehensive due to the lack of success and the bad experience I've had with my lap band. I'm most fearful that because I had so many issues with my band, I may run into problems with the bypass as well, and not have the option this time of reversing the surgery.
If anyone here has been in my situation or knows of any articles I can check out to get more information on this very specific topic, I would SO GREATLY appreciate it!!!! Please feel free to send me a message if you have any specific questions about my lap band experience that would help you better answer my question; I'm not a shy person! haha
Thanks again!
I was just wondering if anyone here had their bypass AFTER unsuccessfully being banded. I had my lap band installed in Feb of 2007 and after 2 port revisions and countless attempts at adjustments and whatnot, my surgeon has determined that it's "just not working" for me and has suggested bypass surgery. I've only lost about 30 lbs with the band and have done everything EXACTLY by the books, and in addition to not losing weight, I've developed terrible reflux.
I'm now considering having the lap band removed and having the bypass surgery, but I feel extremely apprehensive due to the lack of success and the bad experience I've had with my lap band. I'm most fearful that because I had so many issues with my band, I may run into problems with the bypass as well, and not have the option this time of reversing the surgery.
If anyone here has been in my situation or knows of any articles I can check out to get more information on this very specific topic, I would SO GREATLY appreciate it!!!! Please feel free to send me a message if you have any specific questions about my lap band experience that would help you better answer my question; I'm not a shy person! haha
Thanks again!
StacysMom
on 3/24/09 7:33 pm
on 3/24/09 7:33 pm
I have posted research articles on revisions but they are for failed RNY. They may be of help to you anyway, simply because they discuss the choices if the RNY you are planning does not work for you, or if it works for you at first and then stops working before you've lost your excess weight. Here are the links:
www.obesityhelp.com/forums/revision/3886215/Everyone-should-read-this-Revision-Procedures-for-Failed/
and
www.obesityhelp.com/forums/revision/3886208/Great-article-on-RNY-revisions-from-Bariatric-Journal/
From the articles, you will probably note that the DS is the most effective surgery for weight loss, especially as a revision. If you get the sleeve, instead of the RNY, it will make it much easier for you go move forward into a complete DS if the restriction of the sleeve alone doesn't work for you. If you go ahead with the RNY and it fails you and you want the DS, the pouch that has been cut into your stomach would need to be reconstructed and then the sleeve stomach would need to be made. It is a very complex operation and only a handful of surgeons in the US know how to do it. The sleeve has about the stats as the RNY, so you may have the same effect from the sleeve, and if it doesn't work for you, you would already be half way to the DS,and not have to risk a complicated surgery.
Most surgeons do the RNY and/or lapbands and will steer you away from any surgery which they do not perform. The may use scare tactics to do so. Be sure and take that into account when interviewing doctors. Yours is the body which will need to be cut open again (not theirs), if what they have recommended doesn't work for you in the long term.
www.obesityhelp.com/forums/revision/3886215/Everyone-should-read-this-Revision-Procedures-for-Failed/
and
www.obesityhelp.com/forums/revision/3886208/Great-article-on-RNY-revisions-from-Bariatric-Journal/
From the articles, you will probably note that the DS is the most effective surgery for weight loss, especially as a revision. If you get the sleeve, instead of the RNY, it will make it much easier for you go move forward into a complete DS if the restriction of the sleeve alone doesn't work for you. If you go ahead with the RNY and it fails you and you want the DS, the pouch that has been cut into your stomach would need to be reconstructed and then the sleeve stomach would need to be made. It is a very complex operation and only a handful of surgeons in the US know how to do it. The sleeve has about the stats as the RNY, so you may have the same effect from the sleeve, and if it doesn't work for you, you would already be half way to the DS,and not have to risk a complicated surgery.
Most surgeons do the RNY and/or lapbands and will steer you away from any surgery which they do not perform. The may use scare tactics to do so. Be sure and take that into account when interviewing doctors. Yours is the body which will need to be cut open again (not theirs), if what they have recommended doesn't work for you in the long term.
I won't advise you what revision to get, but would suggest you look into all the options before deciding what to do next. In my case getting rid of the band was the first thing I decided on - you can only try something useless for so long!
Your options are bypass (RNY) of different types, duodenal switch (DS) and sleeve. Since your band sounded like a mechanical failure, you don't have much to go on, but which might suit you best will depend on:
- whether you have comorbities like diabetes: this is cured with DS (which is why I chose it) and mostly cured with RNY
- how good you are at dieting. With a sleeve and distal/proximal RNY you have reduced capacity, but still have to watch what things you eat; low fat for example. With extended RNY and DS you have malabsorbtion too, which gives you more leeway with food choices - I can eat high fat and high protein but like everyone I still have to watch the carbs.
- if you have to take NSAIDs for pain relief for anything - RNYers can't take these, sleevies and DSers can
- if you mind taking vitamins. The other side of the eRNY and DS scale is that you have to replace the vitamins you aren't absorbing and get tested regularly. Sleevies don't have to do this.
- how much weight you have to lose. DS has the best stats for overall pounds lost and being able to keep it off long-term (that old malabsorbtion again) but it is the most complex of the surgeries so you have to balance that too.
So your first step is to lurk on all the boards, see what issues people talk about, see what information you can find. Then just allow it all to sink in and feel what you might be comfortable with. Everyone will try and 'sell' you their surgeries (me included, can't help it!) but in the end only you can decide.
Second time round is scary, but there are a lot of people on all the boards who have had two surgeries and been successful. Then find a good revision surgeon who can do what you want. Best of luck!
Your options are bypass (RNY) of different types, duodenal switch (DS) and sleeve. Since your band sounded like a mechanical failure, you don't have much to go on, but which might suit you best will depend on:
- whether you have comorbities like diabetes: this is cured with DS (which is why I chose it) and mostly cured with RNY
- how good you are at dieting. With a sleeve and distal/proximal RNY you have reduced capacity, but still have to watch what things you eat; low fat for example. With extended RNY and DS you have malabsorbtion too, which gives you more leeway with food choices - I can eat high fat and high protein but like everyone I still have to watch the carbs.
- if you have to take NSAIDs for pain relief for anything - RNYers can't take these, sleevies and DSers can
- if you mind taking vitamins. The other side of the eRNY and DS scale is that you have to replace the vitamins you aren't absorbing and get tested regularly. Sleevies don't have to do this.
- how much weight you have to lose. DS has the best stats for overall pounds lost and being able to keep it off long-term (that old malabsorbtion again) but it is the most complex of the surgeries so you have to balance that too.
So your first step is to lurk on all the boards, see what issues people talk about, see what information you can find. Then just allow it all to sink in and feel what you might be comfortable with. Everyone will try and 'sell' you their surgeries (me included, can't help it!) but in the end only you can decide.
Second time round is scary, but there are a lot of people on all the boards who have had two surgeries and been successful. Then find a good revision surgeon who can do what you want. Best of luck!
DS revision from failed lapband
The best data on results with LapBand are not very far off from the typical data for gastric bypass: about a 25% failure rate versus a 20% failure rate. RNY can be reversed, which is something I do laparoscopically when I convert a failed RNY to a BPD/DS or to a vertical/sleeve gastrectomy. My preferred revision procedure from failed LapBand is either Vertical/ Sleeve Gastrectomy ( for those patients unwilling to have a malabsorptive procedure) or BPD/DS ( for those up for having their intestines re-routed). Also note that a vetical/sleeve is one component of a BPD/DS, so a vertical/sleeve can be converted to a DS very straightforwardly.
John D Husted, MD
Forum Contributor
John D Husted, MD
Forum Contributor
Dr. John Husted
DISCLAIMER: I am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!
DISCLAIMER: I am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!
On March 25, 2009 at 7:17 AM Pacific Time, DrHusted wrote:
The best data on results with LapBand are not very far off from the typical data for gastric bypass: about a 25% failure rate versus a 20% failure rate. RNY can be reversed, which is something I do laparoscopically when I convert a failed RNY to a BPD/DS or to a vertical/sleeve gastrectomy. My preferred revision procedure from failed LapBand is either Vertical/ Sleeve Gastrectomy ( for those patients unwilling to have a malabsorptive procedure) or BPD/DS ( for those up for having their intestines re-routed). Also note that a vetical/sleeve is one component of a BPD/DS, so a vertical/sleeve can be converted to a DS very straightforwardly. John D Husted, MD
Forum Contributor
Dr. H...
Where can I obtain the studies showing the 25% failure rate with the lap band?
Thanks!
I had the same situation of you. Banded 3/21/07, and my port flipped twice. In the 1.5 years I had the band I had only lost about 20lbs, but then gained it all back since I couldn't exercise without excruciating pain. I had my band removed 1/5/09, and then revised to RNY on 2/23/09.
So far I've lost 23lbs in just over a month! Which is more than I lost in the 1.5 years I was banded.
So no regrets for the revision. Already I have less pain than I did with the band.
So far I've lost 23lbs in just over a month! Which is more than I lost in the 1.5 years I was banded.
So no regrets for the revision. Already I have less pain than I did with the band.
I was banded August 2007 and lost only thirty pounds, but gained 10 back. I was so disappointed. My band will be removed April 6th and then be revised to RNY. I had no problems with the band, but didn't lose much weight. How did you feel after the surgery and how long did you stay home from work? Congratulations on your weight loss. I know you feel good. 
StacysMom
on 3/25/09 3:07 pm
on 3/25/09 3:07 pm
I hate to be the "killjoy" here, but I've read where people who were unsuccessful with weight loss with the lapband, can be more successful with the RNY, but for it was only for a short term period. Some were even told to put a lapband BACK ON over their RNY. The stats did not include people who experienced mechanical band failure. I wish I would find the info, so I could post a link to it, but it was some time ago. Maybe someone else has the time to find it and post it.
Quite a few failed lapbanders are finding success with the Gastric Sleeve (aka VSG - vertical sleeve gastrectomy) which has the same long term success as the RNY. The benefit of having the sleeve is that they remove the greater curvature of the stomach where Grehlin (the hunger hormone) is produced as well as leaving your pyloric valve intact so your stomach is still a normally functioning organ (no RNY pouch).
Additionally, if the sleeve procedure is not a strong enough tool to affect all the weight loss someone needs It is easily revisable to the DS. While the patient loses the synergistic effect of having a "fresh" sleeve plus malabsorption at the exact same time, they can add the intestinal aspect of the DS later, as the sleeve is the first half of the DS, The RNY is difficult to revise successfully, as you can see from the research I have linked to below. While there aren't a lot of weight loss centers that offer the DS surgery, more and more surgeons are adding the Sleeve procedure to the repertoire of procedures that they do.
The only two articles I have at my fingertips are these two, which go into the revision options for RNY failure and the successes and failures of each type - maybe reading this will give you some other ideas for your lapband revisions?:
www.obesityhelp.com/forums/revision/3886215/Everyone-should- read-this-Revision-Procedures-for-Failed/
and
www.obesityhelp.com/forums/revision/3886208/Great-article-on -RNY-revisions-from-Bariatric-Journal/
Quite a few failed lapbanders are finding success with the Gastric Sleeve (aka VSG - vertical sleeve gastrectomy) which has the same long term success as the RNY. The benefit of having the sleeve is that they remove the greater curvature of the stomach where Grehlin (the hunger hormone) is produced as well as leaving your pyloric valve intact so your stomach is still a normally functioning organ (no RNY pouch).
Additionally, if the sleeve procedure is not a strong enough tool to affect all the weight loss someone needs It is easily revisable to the DS. While the patient loses the synergistic effect of having a "fresh" sleeve plus malabsorption at the exact same time, they can add the intestinal aspect of the DS later, as the sleeve is the first half of the DS, The RNY is difficult to revise successfully, as you can see from the research I have linked to below. While there aren't a lot of weight loss centers that offer the DS surgery, more and more surgeons are adding the Sleeve procedure to the repertoire of procedures that they do.
The only two articles I have at my fingertips are these two, which go into the revision options for RNY failure and the successes and failures of each type - maybe reading this will give you some other ideas for your lapband revisions?:
www.obesityhelp.com/forums/revision/3886215/Everyone-should- read-this-Revision-Procedures-for-Failed/
and
www.obesityhelp.com/forums/revision/3886208/Great-article-on -RNY-revisions-from-Bariatric-Journal/
The 25% failure rate - I believe, off the top of my head - came from Dr. Ren's data. This was in a group that had very good follow-up.
John D Husted, MD
John D Husted, MD
Dr. John Husted
DISCLAIMER: I am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!
DISCLAIMER: I am not your surgeon, any comments made by me are not meant to be taken as medical advice, just general guidelines. Contact your surgeon about your specific problem!
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