I've read some posts that band to sleeve revision patients sometimes lose slower than "virgins" .   Has that been the normal experience?  Please share your thoughts/experinences.

I'm posting on the VSG forum as well.

Thanks,

Crystal 

Not only slower, but probably not enough.  Revision from a failed restrictive surgery to another restrictive only surgery is more likely to be poorer outcome than virgin restrictive surgeries (which aren't that good in the first place).

Surg Obes Relat Dis. 2010 Mar 4;6(2):146-51. Epub 2009 Sep 15.

Sleeve gastrectomy as revisional procedure for failed gastric banding or gastroplasty.

Foletto M, Prevedello L, Bernante P, Luca B, Vettor R, Francini-Pesenti F, Scarda A, Brocadello F, Motter M, Famengo S, Nitti D.

Bariatric Unit, Azienda Ospedaliera Universita' di Padova, Padova, Italy. [email protected]

Abstract

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is considered an effective multipurpose operation for morbid obesity, although long-term results are still lacking. Also, the best procedure to be offered in the case of failed restrictive procedures is still debated. We here reported our results of LSG as a revisional procedure for inadequate weight loss and/or complications after adjustable gastric banding or gastroplasty.

METHODS: Since April 2005, 57 patients (20 men and 37 women), with a mean age of 49.9 +/- 11.9 years, underwent revisional LSG, 52 after laparoscopic adjustable gastric banding/adjustable gastric banding and 5 after vertical banded gastroplasty at our institution. The mean interval from the primary procedure to LSG was 7.54 +/- 4.8 years. The LSG was created using a 34F bougie with an endostapler, after removing the laparoscopic adjustable gastric band or the anterior portion of the band in those who had undergone vertical banded gastroplasty. An upper gastrointestinal contrast study was performed within 3 days after surgery and, if the findings were negative, a soft diet was promptly started.

RESULTS: A total of 41 patients had undergone concurrent band removal and LSG and 16 had undergone band removal followed by an interval LSG. Three cases required conversion to open surgery because of a large incisional hernia. The mean operative time was 120 minutes (range 90-180). One patient died of multiple organ failure from septic shock. Three patients (5.7%) developed a perigastric hematoma, 3 (5.7%) had leaks, and 1 had mid-gastric short stenosis. The median hospital stay was 5 days. The mean body mass index at revisional LSG was 45.7 +/- 10.8 kg/m(2) and had decreased to 39 +/- 8.5 kg/m(2) after 2 years, with a mean percentage of the estimated excess body mass index lost of 41.6% +/- 24.4%. Two patients required a duodenal switch for insufficient weight loss.

CONCLUSION: LSG seems to be effective as revisional procedure for failed LAGB/vertical banded gastroplasty, although with greater complication rates than the primary procedures. Larger series and longer follow-up are needed to confirm these promising results.

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41% EWL is considered a failure by the bariatric surgeons.  These poor people on average went from a BMI of 45 to 39.  Hardly worth undergoing surgery, if you ask me.

Well, I think all the revisioners on this board can prove that revision surgery from the band to sleeve works.  If you have an experience revision doctor, you should not have issues with leaks.  The sleeve is an amazing tool.  It works and I am so glad I decided to have my revision.   I have lost more in a month with my sleeve than I did with my band.

Works?  Yes, to some extent - at first.  And losing more with the sleeve than the band is faint praise indeed.

Works long-term?  There's no data.  And the mid-term data for VIRGIN VSGs doesn't look that promising to me, especially not for someone who has a BMI over the low 40s - since revisions work less well than virgin surgeries, a VSG for someone who is again MO sounds like either a lifetime of strict dieting and excessive exercise, or a failure more likely than not:

Here is some more recent, SHORT-TERM data on virgin VSG.  Note the BMI limitations for their conditional recommendation - note that the 24 and 36 month numbers are flat and starting to decline -- and remember these are VIRGIN VSGers -- revisions will without question do less well:

Obes Surg. 2010 Dec 3. [Epub ahead of print]

Laparoscopic Sleeve Gastrectomy is a Safe and Effective Bariatric Procedure for the Lower BMI (35.0-43.0 kg/m(2)) Population.

Gluck B, Movitz B, Jansma S, Gluck J, Laskowski K.

Mercy Health Partners, 1325 E. Sherman Boulevard, Muskegon, MI, 49444, USA, [email protected].

Abstract

BACKGROUND: The laparoscopic vertical sleeve gastrectomy (LSG) is derived from the biliopancreatic diversion with duodenal switch operation (Marceau et al., Obes Surg 3:29-35, 1993; Hess and Hess, Obes Surg 8:267-82, 1998; Chu et al., Surg Endosc 16:S069, 2002). Later, LSG was advocated as the first step of a two-stage procedure for super-obese patients (Regan et al., Obes Surg 13:861-4, 2003; Cottam et al., Surg Endosc 20:859-63, 2006). However, recent support is mounting that continues to establish LSG as the definitive procedure for surgical treatment of morbid obesity. We will report our experience with the LSG as a primary bariatric procedure and evaluate if this operation is suitable as a stand-alone procedure.

METHODS: The study is a nonrandomized retrospective analysis of 204 patients from a single surgeon operated between July 2006 and April 2010. The study comprises of 155 women and 49 men with a mean age of 45 years (range, 19-70 years), a mean preoperative weight of 126.6 kg, and body mass index (BMI) of 45.7 kg/m(2).

RESULTS: The mean percent excess weight loss (%EWL) was 49.9% (n = 159), 64.2% (n = 138), 67.9% (n = 77), 62.4% (n = 34), and 62.2% (n = 9) at 3, 6, 12, 24, and 36 months, respectively. For patients with BMI ≤43.0, the mean postoperative %EWL was 58.9% (n = 72), 74.1% (n = 67), 75.8% (n = 39), 72.1% (n = 17), and 78.7% (n = 5) at 3, 6, 12, 24, and 36 months, respectively. Operative complications include leak (0.0%), abscess (0.5%), hemorrhage (1.0%), sleeve stricture (1.0%), and severe gastroesphogeal reflux disease with need to convert to laparoscopic Roux-en-Y gastric bypass (0.5%).

CONCLUSIONS: LSG yields excellent outcomes with low complication rates for morbidly obese patients. We advocate LSG as a safe and effective stand-alone procedure, especially with the lower BMI population (BMI 35.0-43.0 kg/m(2)).

Who was your recovery time after the revision from band to sleeve?