Considering Revision from Lap Band to Bypass. Need Advice

Hi,

I had the lap band in 2008. I don't think I need to go into why that didn't work. I never lost more than 30 pounds, starting at 220. Then I had terrible burning in my chest and had to have it unfilled. Gained it all back plus 20. Now I'm considering the bypass, mostly because of the GERD that could come with the sleeve. However, the bypass scares me to death. Also, I'm concerned about nutritional deficiencies in the long term.

If you are someone who has had a revision from lab band to RNY (preferably in one surgery as that's how my surgeon does it), I would like to hear how it went for you and why you chose that surgery and not the sleeve.

I would also love to hear from long term bypass people about their long term complications particularly related to nutritional deficiencies. Is there a way to avoid these?

Thanks so much everyone!

What in particular scares you about the bypass?

It's quite easy to avoid nutritional deficiencies with the RNY as long as you follow ASMBS supplementation guidelines. I posted about them a while back, you may find it helpful:

http://www.obesityhelp.com/forums/amos/6032156/Helpful-vitam in-info/

Well my fears started in 2002 when my sister in law was one of the rare cases of a leak and ended up with sepsis and three more surgeries to clear up the infection all while in an induced coma in intensive care. She did survive though. It didn't help when my surgeon stated that leaks are more common in revision surgeries albeit rare. Any thoughts on this?

I'm no expert, but I found some statistics here that said one-third of revision patients experience complications. BUT, it's worth noting that they don't break down what counts as a complication, nor do they elaborate on how bad those complications were. For all we know, they could include "stitches came loose and had to be re-tied" as a revision!

From the same source, they conclude:

"Although revisional bariatric surgery is associated with higher risk of perioperative complications compared with the primary procedures, it appears to be safe and effective when performed in experienced centers...

"New concepts and improved techniques by well-trained surgeons in properly organized institutions coupled with cautious patient selection represent the cornerstone for achieving favorable results and for extending patients' longevity."

If you really want to dig deep, I found this review of research on revision complications. Look at page 7 of the PDF. Between several studies, the authors looked at hundreds of cases of band-to-RNY revisions and noted a variety of complications-- mostly hernias and abscesses. In all of these hundreds of surgeries, I see 6 leaks... well under 10%!

Overall, I get the impression that while there are certainly possibilities for complications, I don't know that it's any more risky than having a complication from another surgery like a knee replacement.

I would suggest finding a surgeon with a lot of experience doing revisions, and ask him/her for statistics. How many surgeries have they performed? How many leaks? How many other complications? That will give you more information for making a decision.

Thank you for the comprehensive response, Julie.

I am going with a very experienced surgeon. He said he does 250 total surgeries per year and about 1/5 revisions. He has even done double revisions from a a band to a sleeve to a bypass. I'll have to ask him about whether he has had leaks.

Sounds like he's got some good experience! Good luck :)

I always tell people - hope for the best, be prepared for the worst.

The complications are most likely less than 1%. But they do happen.

Hopefully not to you. But if they do - most of them can be deal with.

I had the RNY when I decided that I rather deal with side effects, than with my weight.

I am still dealing with the side effects. But since I am considering to be a "normal" size, I get better treatments from my docs. Suddenly no one is telling me I "need to lose weight".

I still deal with low energy (finally I was diagnosed with adrenal Insufficiency - 5 years ago) plus I get treated for back and SI joints pains.

There is the "Fat person" stigma when you have health issues. When I was MO most were blamed on my weight. Now they can't. So we look for diagnosis plus treatment.

I am 57 years young. About time someone take me seriously. No?

Yeah it's a shame there is fat discrimination even with the medical profession. I guess I'd also rather be normal size and have a treatable nutritional deficiency than not able to move very well like now.

I think the frustrating thing for me is that when I have a non-life threatening medical complaint now they no longer say "lose weight", they just tend to shrug and say "it's hard to say". I don't really feel I get a lot more answers. I think there is just a whole lot they don't know.

I had to find doctors who wilk not "shrug" and ignore my issues. Sometimes I had to waiting a long waiting list for a specialist. But it was worth the wait.