8 yrs post op from Gastric Bypass: Considering a Lap Band?

Im glad everything went well. Roslin is a gem and Lenox Hill is a FABULOUS hospital. I live 5 blcks away. 

I am 99% sure my stoma is enlarged.  I get hungry very soon after I eat.  I havent had any diagnostics done but I did call Roslin's office last week and I'm going to get an appt in the coming weeks. 

I'm going to add you so that I can check in on your progress. 

Good luck to you.

Heather

have you had diagnostics to determine why you are gaining? is it diet related? how large is your stoma today? your pouch? you need an upper gi to determine why it is necessary to begin with.

No.
Yes/No.
Large
Large
I know

I do have an enlarged stoma bc I have always been very hungry immediately after eating.  From the beginning. The only difference is, backin the day, I worked out 7 days a week for 1.5 hrs a day and was extremely diligent. While I have ate badly the last 6 mos, the amount/volume I have been eating for the last 5 yr concerns me.

Im going in for an appt ina few wks.

I am going this week to have it done. At this point I dont have time, money or emotional energy to recover from a DS.   The research supports it.  I am pasting a couple of studies I have been able to dig up. I think it depends on the individual, these boards give color to some of the complications mentioned in the studies. 

1. Surg Obes Relat Dis. 2010 Jan-Feb;6(1):31-5. Epub 2009 Oct 9.

Adjustable gastric banding as revisional bariatric procedure after failed gastric
bypass--intermediate results.

Bessler M, Daud A, DiGiorgi MF, Inabnet WB, Schrope B, Olivero-Rivera L, Davis D.

Center for Obesity Surgery, Columbia University, New York-Presbyterian Hospital
and Lawrence Hospital, New York, NY 10032, USA. [email protected]

BACKGROUND: Although gastric bypass is the most common bariatric procedure in the
United States, it is has been associated with a failure rate of 15% (range
5-40%). The addition of an adjustable gastric band to Roux-en-Y gastric bypass
has been reported to be a useful revision strategy in a small series of patients
with inadequate weight loss after proximal gastric bypass. METHODS: We report on
22 patients who presented with inadequate weight loss or significant weight
regain after proximal gastric bypass. All patients underwent revision with the
placement of an adjustable silicone gastric band around the proximal gastric
pouch. The bands were adjusted at 6 weeks postoperatively and beyond, as needed.
Complications and weight loss at the most recent follow-up visit were evaluated.
RESULTS: The mean age and body mass index at revision was 41.27 years (range
25-58) and 44.8 +/- 6.34 kg/m(2), respectively. Patients had experienced a loss
of 19%, 27%, 47.3%, 42.3%, 43%, and 47% of their excess weight at 6, 12, 24, 36,
48, and 60 months after the revisional procedure, respectively. Three major
complications occurred requiring reoperation. No band erosions have been
documented. CONCLUSION: The results from this larger series of patients have also
indicated that the addition of the adjustable silicone gastric band causes
significant weight loss in patients with poor weight loss outcomes after gastric
bypass. That no anastomosis or change in absorption is required makes this an
attractive revisional strategy. As with all revisional procedures, the
complication rates appear to be increased compared with a similar primary
operation. 2010 American Society for Metabolic and Bariatric Surgery. Published
by Elsevier Inc. All rights reserved.

PMID: 19914147 [PubMed - indexed for MEDLINE]


1. Surg Obes Relat Dis. 2009 Jan-Feb;5(1):38-42. Epub 2008 Aug 22.

Adjustable gastric band placed around gastric bypass pouch as revision operation
for failed gastric bypass.

Chin PL, Ali M, Francis K, LePort PC.

Smart Dimensions and Lite Dimensions Surgical Weight Loss, Fountain Valley,
California, USA. [email protected]

BACKGROUND: The failure rate after gastric bypass surgery for weight loss has
been reported at 10-20%. To date, no reliably safe and effective salvage
operation is available. This pilot study was conducted to determine whether
restriction of the Roux-en-Y gastric bypass (RYGB) pouch using the adjustable
gastric band (AGB) is an effective revision operation. METHODS: A prospectively
accrued group of patients who underwent revisional surgery using the AGB placed
around the RYGB pouch by our bariatric surgical group from October 2004 to
October 2006 was analyzed. RESULTS: Of the 10 patients accrued during this
period, 2 were lost to follow-up, leaving 8 patients for analysis. Of the 8
patients, 1 was a man and 7 were women. The mean prerevision weight was 135.75 kg
(range 105-165), and the body mass index was 48.42 kg/m(2) (range 38.92-55). The
mean weight loss at 1 year of follow-up was 17.03 kg (range 0.2-42), with a mean
percentage of excess weight loss of 24.29% (range 0.2-49.2%). The mean weight
loss of the 5 patients with 2 years of follow-up was 36.4 kg (range 20-58), with
a mean percentage of excess weight loss of 48.7% (range 21.8-98.1%). One patient
with 3 years of follow-up had a weight loss of 56 kg and a percentage of excess
weight loss of 66.2%. Three minor complications developed: 2 AGB port-related
complications requiring port revision and 1 postoperative wound hematoma
requiring evacuation. No band erosions or band slippages occurred, and no major
complications developed. CONCLUSION: In our study, an AGB placed around the RYGB
pouch was a safe and effective revision operation for a failed RYGB operation.

PMID: 18996754 [PubMed - indexed for MEDLINE]

1. Obes Surg. 2009 Oct;19(10):1439-41. Epub 2008 Dec 13.

Laparoscopic insertion of a gastric band for weight gain following laparoscopic
Roux-en-Y Gastric bypass: description of the technique.

Heath D, Leff D, Sufi P.

North London Obesity Surgery Service, The Whittington Hospital, Magdala Avenue,
London, N19 5NF, UK. [email protected]

BACKGROUND: A recently published prospective series has demonstrated that weight
loss ceases 18 to 24 months following Laparoscopic Roux-en-Y gastric bypass
(RYGB) and that, by 48 months, there is significant weight regain in 50% of
patients. METHODS: We report the case of a 38-year-old male patient who developed
significant weight regain 42 months following laparoscopic (RYGB) and underwent
laparoscopic placement of a Swedish ajustable gastric band (SAGB) around the
gastric pouch. RESULTS: In previous reports, the gastric band was placed around
the upper part of the stomach. This paper provides the first report of the
placement of a gastric band around the lower gastric pouch, just above the
gastrojejunal anastomosis, in the management of weight regain following
laparoscopic RYGB. Prior to revision surgery, the patient's weight was 95 kg
[body mass index (BMI) 31 kg/m(2), excess weight loss 65%]. CONCLUSION: Four
months following the procedure this had reduced to 82.1 kg (BMI 26 kg/m(2),
excess weight loss 90%).

PMID: 19083072 [PubMed - indexed for MEDLINE]

1. Surg Endosc. 2008 Apr;22(4):1019-22. Epub 2007 Oct 18.

Gastric banding as a salvage procedure for patients with weight loss failure
after Roux-en-Y gastric bypass.

Gobble RM, Parikh MS, Greives MR, Ren CJ, Fielding GA.

Department of Surgery, New York University School of Medicine, New Bellevue 15
North 1, 550 First Avenue, New York, New York, 10016, USA [email protected]

BACKGROUND: This study reviews outcomes after laparoscopic adjustable gastric
band (LAGB) placement in patients with weight loss failure after Roux-en-Y
gastric bypass (RYGBP). METHODS: All data was prospectively collected and entered
into an electronic registry. Characteristics evaluated for this study included
pre-operative age and body mass index (BMI), gender, conversion rate, operative
(OR) time, length of stay (LOS), percentage excess weight loss (EWL), and
postoperative complications. RESULTS: 11 patients (seven females, four males)
were referred to our program for weight loss failure after RYGBP (six open, five
laparoscopic). Mean age and BMI pre-RYGBP were 39.5 years (24-58 years) and 53.2
kg/m(2) (41.2-71 kg/m(2)), respectively. Mean EWL after RYGBP was 38% (19-49%).
All patients were referred to us for persistent morbid obesity due to weight loss
failure or weight regain. The average time between RYGBP and LAGB was 5.5 years
(1.8-20 years). Mean age and BMI pre-LAGB were 46.1 years (29-61 years) and 43.4
kg/m(2) (36-57 kg/m(2)), respectively. Vanguard (VG) bands were placed
laparoscopically in most patients. There was one conversion to open. Mean OR time
and LOS were 76 minutes and 29 hours, respectively. The 30-day complication rate
was 0% and mortality was 0%. There were no band slips or erosions; however, one
patient required reoperation for a flipped port. The average follow-up after LAGB
was 13 months (2-32 months) with a mean BMI of 37.1 kg/m(2 )(22.7-54.5 kg/m(2))
and an overall mean EWL of 59% (7-96%). Patients undergoing LAGB after failed
RYGBP lost an additional 20.8% EWL (6-58%). CONCLUSION: Our experience shows that
LAGB is a safe and effective solution to failed RYGBP.

PMID: 17943353 [PubMed - indexed for MEDLINE]

Good luck!

 

 

Thank you for saving me the time to look those up
Im just starting my research but this is something I think I really want done. My RNY dtr doesnt do Lap Band, but, I trust him immensely and trust him with the recommendation.

Hi Heather! I am having my band over bypass next week. I'll be sure to keep you posted on how it goes

Awesome. Please let me know.  You can either email me on here (and as you can see Im not on here much) or send me an email [email protected]

Thanks so much.

Goodluck!

For me personally I had the lapband done a year ago. I hate it I lost a total of 10lbs and am back at my presurgery weight. The port is painful I could never get a fill to the right amount. Everytime after my 3rd fill I would have a hard time getting liquids down and any thing I ate I threw up. I haven't had a fill in three months and tried to eat some eggs today which I eat normally and they have came up twice so no food so far today. The only things I can eat are the bad foods. Mashed potatoes any thing soft any kind of meat is a hit and miss and that isn't to often. I am considering rny or ds. Just can't decide. I understand about your concern about the surgery for ds but in the long run you have a better quaility of life with your eating I am told. Good luck and let us know how you do. I would never have the lapband again. And the reason I am worried about rny  is because of the weight gain.

In a way I agree. I don't think I would want a lap-band to start but for us with the BOB it is like a second wedding where we know what to expect to a certain extent. It is not a magical happening.  All the throwing up fun is the same with an RNY so I am not worried about all that, I am an old pro.  I had my RNY in 2004 and I still cannot eat certain things, my stoma has stretched. 

Now though, the quickest and dirtiest way to deal with my weight gain in the band.  I really think WLS is part of an overall management plan.  I don't think these surgeries last forever and I am hoping they get the stomaphyx and these other fix-its worked out so all we have to do is go in for a tune up every once in awhile. 

The next step in a few years may be the DS but I think the band will give me the edge I need for the time being.   I am so willing to eat right and exercise when there is a positive reward at the end but this yo-yo biz makes me very angry. I am willing to take responsibility to a certain point but I am done with the blame and thinking I am lazy and useless because I cannot do it on my own.

My sentiments exactly. Amen!