going through process now for approval of conversion from lap band to VSG.  I havd had lap band almost 3 years - very little success. lots of discomfort. what little weight i managed to lose the first year ( 40#) has just about all come back. I want this dang band out but don't want to fail again. I think RNY woudl be best but just can't get comfortable with  the side effects of it so will probably get the VSG,. Has anyone else not had luck with lap band btu succeeded with VSG? if so - what was different?

Try posting this on the sleeve forum, they are lots and lots of folks over there that are band to sleeve revisions and I think the majority are successful.

Have you also researched the DS? The DS has the same stomach as the VSG, so it avoids RNY 'side effects' like dumping, reactive hypoglycemia, getting food 'stuck', marginal ulcers, etc. The DS also has an intestinal bypass to provide malabsorption, and this seems to be the reason the DS has the very BEST long-term, maintained weight loss stats. It also has the best stats for resolving or preventing co-morbs like diabetes and high cholesterol.

You need to look at WHY you failed with the Band, and WHY you failed with the ol' "diet and exercise" routine. If you've yo-yo dieted for years (like most of us here), your metabolism is probably waaaay too efficient. Only malabsorption can fix THAT.

I'm a band to VSG revision success, and have every plan on continuing down that path.

My band failed me, I had complications that required I get the band out. BUT, I can tell you that with the sleeve I've had success. Malabsorption was not an option for me. I am not too proud to admit that I am not the type of patient that would be compliant with (what I consider) a very strenuous vitamin/supplement regimen that RNY or DS require for life. I had to choose a surgery type that I could live with for the next how many ever years I'm blessed to live.

I have had great success not only with weight loss, but changing my relationship with food to give me long term success. Come over to the VSG board, and read around for all the revision patients. Most of us don't frequent the revision board too often.

this is MY opeion only..... and success or failures are very difficult to decide on since there are so many factors...the VSG is a great surgery and doesn't come with some of the band complications and in the next few years that will replace the band completly, it also doesn't come iwth the RNY problems or the DS malabsorption issues,   RNY is a surgery I would not get, again personal.  it comes down to you as a person, of course you can be successful with the VSG, and you wont feel like you have a choke chain inside you when you attempt to eat.  will it be "enough" that is up to you.  would you be compliant with the vit/nut aspect of the DS, if not then stay away from that, wishing you the best......

Hi!

Checking VSG board for others' experiences in the band to VSG revision is a great idea, since i know there are several people who have done that.

It's a totally personal decision and a tough one, but for me the VSG made the most sense in terms of normal stomach absorption for the most part and normal connection between the stomach and the intestines and digestive tract that helped me make my choice.  but, you know, i work with someone who had the RNY and he was thrilled and got great results.  again, it's just a load of research and thinking about what makes the most sense for you.

good luck while you're deciding and as you get toward whatever surgery you decide on.  hope i didn't sound too soap-box-y!

I believe that long term, this is NOT going to work well.  You've already failed one restriction-only procedure, and ****** up your metabolism with what was in effect another crash/starvation diet.  Your body will be trying to hold on to your weight even harder than it did before, and with only restriction, it is not going to work well.  This time around, you need malabsorption too.  How many revisions do you think you're going to get?  It's like cutting the puppy's tail off a little at a time.

Here are some papers to give you something to think about - note that these lousy results are from not very far out - the results ARE NOT going to get better, they're going to get worse with the passage of time and inevitable regain:

http://www.ncbi.nlm.nih.gov/pubmed/19889585

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.

Source

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.

HOW WOULD YOU FEEL ABOUT YOUR BMI GOING FROM 45 TO 39 AFTER TWO YEARS, AFTER A FAIRLY RISKY REVISIONAL PROCEDURE??  WOULD THAT FEEL LIKE SUCCESS TO YOU??  

In the following paper, they don't give the ending BMI, but the starting BMI was 49.9 (compare to 45.7 in the paper above) and they lost 42.7% of EWL at 13.4 months (compare to 41% above) - so these poor people on average STILL HAD A BMI >40 and were STILL MORBIDLY OBESE!

Obes Surg. 2009 Sep;19(9):1216-20. Epub 2009 Jun 27.

Laparoscopic sleeve gastrectomy as revisional procedure for failed gastric banding and vertical banded gastroplasty.

Iannelli A, Schneck AS, Ragot E, Liagre A, Anduze Y, Msika S, Gugenheim J.

Source

Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, 151 Route Saint Antoine de Ginestiere, BP 3079, 06202 Nice, France. [email protected]

Abstract

BACKGROUND:

The problem of revision of failed gastric banding (GB) and vertical banded gastroplasty (VBG) procedures has become a common situation in bariatric surgery. Laparoscopic sleeve gastrectomy (LSG) has been recently used to revise failed restrictive procedures. The objective of this study is to evaluate the results of LSG as revisional procedure for failed GB and VBG.

METHODS:

A prospective held database was questioned regarding patients' demographic, indication for revision, conversion to open surgery, morbidity, percentage of excess weight loss (%EWL), evolution of comorbidities, and need for a second procedure after LSG.

RESULTS:

Forty-one patients, 34 women and seven men with a mean age of 42 years (range 19 to 63 years) and a mean body mass index at 49.9 kg/m(2) (range 35.9-63 kg/m(2)), underwent laparoscopic conversion of GB (36 patients) and VBG (five patients) into LSG. Indication for revisional surgery was insufficient weight loss in all the cases. All procedures were completed laparoscopically. There was no mortality and five patients (12.2%) developed complications (high leak, one patient; intra-abdominal abscess, three patients; and complicated incisional hernia, one patient). At a mean follow-up of 13.4 months, %EWL is on average 42.7% (range 4-76.1%). Six patients had a second procedure (four had laparoscopic duodenal switch, one had laparoscopic Roux-en-Y gastric bypass, and one had laparoscopic biliopancreatic diversion).

CONCLUSION:

Conversion of GB and VBG into LSG is feasible and safe. LSG is effective in the short term with a mean %EWL of 42.7% at 13.4 months. Long-term results of LSG as revisional procedure are awaited to establi****s efficacy in the long term
 

In my not-so-humble opinion, restrictive-only revisional surgery is a waste of time, money, heartache and surgical risk.