Sad and discouraged - now what? Experiences of a lap band on top of a RYN

Just got back from my Dr and I’m not sure what to do now.   

I had a RYN 9 years ago and lost about 160 lbs, however, in the last 2 ½ years, I’ve gained about 100 back. I went back to the Dr that performed my original surgery and after having an EDG, the results are that my stoma is really big, but he says that’s to be expected after about 2-3 years and my pouch is fine.  He suggested a medically supervised diet (something my insurance won't cover).   The only other alternative is to have a lap band on top of my RYN, but he thinks that would be an extreme measure with only 10-15 lbs loss result.  He said he'd do the paperwork for it anyway.  

I’m discouraged because I know having the restriction was a great help in my original weight loss – I need the restriction.  Can anyone tell me what they have typically experienced in terms of weight loss and complications with a lap band on top of a RYN?  And, I know terms differ, but any United Healthcare insight in regards to this type of revision would be great too.

Thanks everyone!!!

Don't give up hope. I had a band placed over my bypass and I have lost 70 pounds. I have less then 20 pounds to reach my goal. The loss has been slow but it is coming off. The key to success is in the follow up make sure that proper restriction is achieved. If you post on the lap band board you will see there are a few of us with the band over bypass or the "BOB" for short. Good luck. Cathy

Have you looked into a revision to a DS or ERNY? There are other options then just the band over bypass, but the band may be the only one your doctor does. Please get another opinion from a very experienced revision surgeon to explore all your options - there are not many surgeons that are scilled enough to do RNY to DS revisions safely, but they exist. You can ask at the DS board for a list of recommended surgeons.

I am impressed that your doc didn`t promise you that the band over bypass would be enough for you - the results are very mixed and the band over bypass isn`t even an option for everyone (not possible when the pouch is still very small). With 100 pounds to loose, the revsion to a full DS would give you the best chance of loosing all you want to loose and keeping it off in longterm. The band over bypass will "only" give you some restriction and carbs go right through, so it`s no help if your problems are carbs. Plus, just restriction alone is usually not enough for people who have a damaged, over-effective metabolism, and the big loss and then the big regain with the RNY has most likely damaged your metabolism even further. the DS would give you restriction back and a lot of malabsorbation, while the ERNY (making the bypass more distal) would just add a lot of malabsorbation. It`s less risky then a revision to a full DS, but also less effective, although weight loss is generally better then with the band over bypass.

Have you thought about having a DS for your revision.  It will have the restriction you need as they will remove the greater outer curvature of your stomach and the part that is left does not stretch as bad over time.  It also has the best long term outcome on weight loss and keeping it off.  Just an idea hope this helps a little.

If your surgeon doesn't perform the Duodenal Switch, he or she probably wouldn't have mentioned it as an option. If they *did* mention it, they might have given you outdated or inaccurate information. Please research all your options and make this very important decision as an informed patient.

Here are a couple of excellent Web sites to help with the DS part of the euqation:

dsfacts.com
duodenalswitch.com

Good luck with your research. Whatever you decide, all the best to you!

Kathy

10-15 lbs???  Crazy wrong...thank goodness.  I had my band-over-bypass on 5/28/09 and have lost 41 lbs (9 lbs away from goal).  It was the best thing I ever did to lose the weight I had regained. :)

Any questions, just let me know and I will be more than happy to answer them.  Good luck!!

I think they are often conservative with their estimates of weight loss because everyone reacts differently...did he indicate how they handle the adjustments to the band (how often or how much they start with)? Like others...I know people who have had good success with it...worst case senario, you could get a second opinion.