Considering revision, besides the well known DS, RNY, and LB what other options exist?

I've noticed from reading different posts on here, that there are different, not as popular surgeries. I had the VSG and due to minimal weight loss, I'm reconsidering a revision. Most people would suggest the DS but I wanted to know if other options existed?  I have seen a placating mentioned. 

 

Is there a way for me to do my own pouch test to see if there was serious stretching? I can't remember the original size of my sleeve but this July makes two years. I'm in NYC and William Inabnet at Mt Sonai takes my insurance. I'm going to arrange an appointment just to get some info. I'm not in a hurry as this is a major decision.  As of now I am wondering if I should tighten if it's stretched, LB, and DS In that order. 

I would never put a LB on your sleeve.  I wouldn't put a lap band on anything though after living with one 4 years.  The placation is said to be a safer sizing surgery than when the "redo" the sleeve to make it smaller.  Than the DS is the no brainer as the sleeve is part of a DS.  Lap band would be last resort but, I wouldn't even do it than.  You do realized the manufacture have finally came out and admitted they are NOT a life time product.  They are NOT reversible as promoted they are only removable.

Thanks for the response. I decided to contact Dr Inabnet. I have to forward my info from my first surgeon and wait and see if I can be revised depending on the medical, surgical notes. 

Well, nothing else that will actually work. The other thing that gest mentioned are usually by surgeons that can't do the revisions, so they sell the janky choices they can. Read studies. Read from people that have had and LIVED with different revisions. It will become clear fairly quickly that their choices are few, and the success and problems of surgeries are what are pointing so many to so few surgeries.

I have to wonder though, if you already have the sleeve, which is the first half the what is the most successful WLS available (the DS) why on earth you are looking at all the janky options? And LB??? Have you looked at it's lousy track record and high reoperation rate?

Here's the thing.  The sleeve will stretch in time.  It shouldn't be a surprise.  It will never get anywhere near the original size, but expect it to triple or even quadruple in size.

That is nowhere near football sized stomach I started with.   My stomach started at 2oz and I can now eat a 5oz steak with a little potato and veggies.  I don't clean my plate, but I finish my steak.  I can probably pack in 8-9oz today 8 years after my DS.  Your sleeve is the same, but without the malabsorption I have.  

You have simple restriction, the rest is you choosing what to eat.  A re-sleeve is an option.  I wouldn't recommend LB on anything or anyone, and haven't seen any good reports on the plication procedure.  Resleeve, DS or RNY are your big options here....or work the sleeve a little harder, realizing that it's a malfunction.

I decided to get the DS. Thanks. 

 

I would like to offer my opinion.  One of the important things to consider is that not all sleeves are the same. The techniques used are different from surgeon to surgeon which  means that sleeve sizes and shapes differ greatly too.   My recommendation would be to  first check and see if you are  following proper nutritional guidelines to work with your sleeve and make any adjustments to your food intake if necessary.  If you are working with your sleeve I would recommend you find out if you have a technical problem with your sleeve.   Your dr can do a barium swallow x ray to check your sleeve and he will know if the sleeve is  too big, has a lot of fundus, has a lot of antrum, etc.   If there is a technical problem he can then decide how to make it smaller depending on what he finds, he will decide what is best to tighten it.   If you have a technical problem that would be, in my opinion,  the first option for a revision which most likely will  be enough to help you lose weight and keep it off.      If your sleeve is fine, no technical problem,   my suggestion would be to revise to the DS, which is the natural  progression after the sleeve.  A bypass is also a possibility but having the sleeve already the DS is the first natural option.   I would not recommend placing a band over the sleeve.    Best of luck to you!  

Thanks. I'm going to do some tests to see if my sleeve is okay. Once I find that out I will know the next steps 

Dr. Aceves,

I have a lot of adhesions or scar tissue from previous surgeries and from an automobile accident and resulting spleenectomy.  IS it still possible to do a DS after a failed sleeve with that kind of issue?

Yes!  You may still have the DS done. Certainly it is technically more difficult and  your surgeon needs to have the experience with revision surgeries to do it.  It will be a longer surgery too   but it can be done and it can be done laparoscopically in my exprience.  I m happy to read you are having the sleeve checked out. 

Good Luck,

Alberto Aceves