Thinking about revision from band to RNY
I had my Lapband amost a year and a half now, I think, I'd have to check my profile---I did very good initially, even though I had issues with vomiting, and I lost down to what my ticker is now......I was vomiting about once a day from being stuck. Then I had a week where I eventually couldn't get down water, so I had to go to the emerg. room and get a emerg. unfill because I evidently had something obstructing it. I eventually was filled back up to where I was, and I have had this amount for about 9 months now, and have gained BACK all but 30 lbs. I recently have had trouble again with getting stuck, even water is giving me trouble at times. I am sooooooo sick of this game...I would get a revision if I qualified in a heartbeat, but my BMI is only 36.8 currently. I do still have high blood pressure but that's about it. My Lapband dr. knows nothing of all the vomiting I've had to do, so that's not in the records. I'm really in a bad mental place.....I don't want another fill....I'm sick and tired of having to vomit and get stuck. My Dr. is 5 hours away too. Any words?Also, I'm wondering, should I go to my original band Dr., or see someone totally different? I'm learing towards different......
Nancy
Nancy
It sounds like you can do well with only restriction. It isn't your fault that the band is a plastic piece of junk that has failed you. Before doing an RNY, research the VSG. It is purely restrictive (which you know you can do) without the foreign body that requires fills, unfills, ports, 5 hour drives, etc.
Sorry to hear of your troubles. But, do check out the VSG board if you haven't.
Sorry to hear of your troubles. But, do check out the VSG board if you haven't.
I agree with the above poster. I also chose a completely different surgeon to perform my revision because my initial surgeon would not do anything about the band complications I complained to him about for months.
In 5 months, with the sleeve I've lost 80% of my excess weight. I knew that restrictive only procedure would work for me, and did not want to deal with the malabsorption, dumping, or rerouting issues of RNY.
In 5 months, with the sleeve I've lost 80% of my excess weight. I knew that restrictive only procedure would work for me, and did not want to deal with the malabsorption, dumping, or rerouting issues of RNY.
Band to VSG revision: June 3, 2009
SW 270lbs GW 150lbs CW Losing Pregancy Weight Maintenance goal W 125-130lbs
SW 270lbs GW 150lbs CW Losing Pregancy Weight Maintenance goal W 125-130lbs
ive been banded since 2007. initially i lost almost 50 lbs. i quit smoking on easter, and gained back 25. now my band ISNT WORKING ANYMORE...ive been checked, nothing is wrong...i'm at 3.75 cc's in a 4cc band...i can eat breads, meats...i get stuc****asionally but in 2 years i think ive vomited only 5 times...and 4 of those was on the same stuck episode. i really want the rny revision but i doubt my insurance will cover it...sooooooo, i just wanted to say good luck to you...i fell your pain. please keep me posted on your progress with this...hopefully we will get through it.
jamie
jamie
Hello,
More recently I have had a number of patients that have inquired about similar situation.
I would hope that this helps.
The symptoms that you are describing are encountered after adjustable gastric banding much more frequently that most patients appreciate. All one has to do is look at the insert that is available in the box that the Lap Bands come in and you will be impressed by he high incidence of symptoms similar to yours.
The Lap band being a purely restrictive procedure relies on limiting food intake. So does the RNY and the Sleeve gastrectomy. All of these procedures rely on limiting food intake. A sleeve gastrectomy can cause worsening of the reflux, since it needs to be very small and narrow pouch. Similarly, in the RNY, the opening between the stomach pouch and the small bowel acts as a gate to control flow of the food in the the small bowel.
Whoever gets to think about revising your surgery, will have to make sure that you do not have a dilated esophagus as a result of the persistent vomiting.
Clearly I am biased in favor of duodenal switch operation being the best procedure for revision of ALL other procedures. I will strongly recommend that you do your research before proceeding. Research should include seeking many opinions from different surgeons and asking to see the science behind their recommendations.
As a surgeon that does many revisions, the best revisions (if there is such a thing ) to do are the first ones. Yet I very frequently see patients in the office that have had a RNY revised to another RNY, or RNY with a band placed on top of it, or Lap band that was revised to RNY or Sleeve gastrectomy. Having both the first and second procedure not work for them, they come to use for a third operation.
Hope this helps
Ara Keshishian, MD, FACS, FASMBS
www.dssurgery.com
More recently I have had a number of patients that have inquired about similar situation.
I would hope that this helps.
The symptoms that you are describing are encountered after adjustable gastric banding much more frequently that most patients appreciate. All one has to do is look at the insert that is available in the box that the Lap Bands come in and you will be impressed by he high incidence of symptoms similar to yours.
The Lap band being a purely restrictive procedure relies on limiting food intake. So does the RNY and the Sleeve gastrectomy. All of these procedures rely on limiting food intake. A sleeve gastrectomy can cause worsening of the reflux, since it needs to be very small and narrow pouch. Similarly, in the RNY, the opening between the stomach pouch and the small bowel acts as a gate to control flow of the food in the the small bowel.
Whoever gets to think about revising your surgery, will have to make sure that you do not have a dilated esophagus as a result of the persistent vomiting.
Clearly I am biased in favor of duodenal switch operation being the best procedure for revision of ALL other procedures. I will strongly recommend that you do your research before proceeding. Research should include seeking many opinions from different surgeons and asking to see the science behind their recommendations.
As a surgeon that does many revisions, the best revisions (if there is such a thing ) to do are the first ones. Yet I very frequently see patients in the office that have had a RNY revised to another RNY, or RNY with a band placed on top of it, or Lap band that was revised to RNY or Sleeve gastrectomy. Having both the first and second procedure not work for them, they come to use for a third operation.
Hope this helps
Ara Keshishian, MD, FACS, FASMBS
www.dssurgery.com
In general I am not in favor of any of the distal bypass operation. In the RNY you can change the RNY limb or the common channel, by lengthening either one you reduce the absorptive capacity (as you do with the duodenal switch) yet the problem with the RNY is that having a very small stomach most patients are unable to eat any significant amount. This results in small food volume consumption and reduced absorption. It is my opinion that the distal RNY and/or the extended RNY has the worst of the surgeries in many fronts. It had the complications of the RNY (dumping, marginal ulcer, Iron def. anemia, protein malnutrition) it also does not allow normal dietary life after surgery.
I am acutely aware that more people are recommending this. Most surgeons who perform the RNY have this as a back up procedure for revision of large percentage of patients that will have to have something done. I have also been told by others that it is an easier revision to do that RNY to Duodenal switch. I completely agree with that, however easier is definitely not the best in this case.
Hope this clarifies it.
I am acutely aware that more people are recommending this. Most surgeons who perform the RNY have this as a back up procedure for revision of large percentage of patients that will have to have something done. I have also been told by others that it is an easier revision to do that RNY to Duodenal switch. I completely agree with that, however easier is definitely not the best in this case.
Hope this clarifies it.
Insurance companies have not started covering the sleeve on a regular basis. I have only read about a very few that actually had their surgery paid for. Most are self pay.
The Rny is most commonly done, but that does not mean it is the best.
http://www.dsfacts.com/Comparison-of-DS-and-RNY.html
I am so convinced that the RnY is an inferrior surgery to the DS, I have my revision surgery scheduled for 7:30 tomorrow morning. I too have a lap band and wish I would have known about the DS back in 2006 when I had my band put in.
You will see alot of people revise from lapband, vsg, and rny to the DS. Many insurances are covering it now, and where as the Rny is considered the "gold standard" the DS is the "platnum standard".
I suggest you convert, but hope you convert to something with a great long term success rate and a higher quality of life.
Good luck!
The Rny is most commonly done, but that does not mean it is the best.
http://www.dsfacts.com/Comparison-of-DS-and-RNY.html
I am so convinced that the RnY is an inferrior surgery to the DS, I have my revision surgery scheduled for 7:30 tomorrow morning. I too have a lap band and wish I would have known about the DS back in 2006 when I had my band put in.
You will see alot of people revise from lapband, vsg, and rny to the DS. Many insurances are covering it now, and where as the Rny is considered the "gold standard" the DS is the "platnum standard".
I suggest you convert, but hope you convert to something with a great long term success rate and a higher quality of life.
Good luck!
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