What would you do?

Oh boy - now we have to French kiss - you did it on purpose didn't you Grim?

Don't ask a question if you already know the answer.

I had a band for 7 yrs and it finally got to me with excess acid and next to zero weight loss because even empty it was tight I lost all of 20-30 lbs with it.

When I got it removed I could finally eat healthy food again and started losing. I didn't revise for several reasons but I'm glad I didn't because now they advise against a sleeve for bandsters who have esophageal damage.This is because the sleeve works with the same type system where the food is being resisted against going down by the band or sleeve while the esophagus is trying desperately to get the food down. So if your esophagus was already damaged the sleeve should never have been done. Now the experts are advising RNY only for esophageal damage and excess acid production.

Trust me excess acid does indeed mimic hunger and no I believe it isn't head hunger but I know from my own experience that it feels like hunger. I am on 2 different meds 4x a day and I still suffer from excess acid they don't even phase it. So trying to figure that out right now.

I can also say that I have lost 75lbs since band removal a year ago by weighing and measuring my food and eating little more than dense protein and non starchy vegetables I should have done that in the first place but my doctors kept telling me I needed surgery! Your diet is very carb heavy, beans are healthy but very high in carbs and carbs are killers for me. If I eat more than 20-30 carbs a day I will gain huge amounts of weight in no time.

So if I were you and had a little one who needs me I'd learn to eat low carb, high protein for a year before I ever even thought about another surgery. Surgeons will give you anything you want to pay for!!! Even with RNY you will lose the malabsorbtion of calories after 12-24 mos so there is still that honeymoon period.The more revisions you have the slower the weight loss will be.

There's my 2 cents but I have had far more success by strict eating and weighing and measuring. I have no choice because my I can't have surgery unless my life is at stake. Just few things to think about cause I got no dog in this fight.

Interesting, this is the first I've heard of not advising the sleeve for patients with damage.  I know my esophagus was very dilated at the time of my surgery.  While it doesn't fix my problems, there is some comfort in this, again it could be, even though no one on here seems to believe it that even though I'm truly working with my "tool"  it really isn't working for me due to the damage from the band.  I want to give you tons of kudos for being able to lose post band, most as you know struggle more than ever once it is removed and feel as if a hunger monster has been released that they can not satisfy, you may be the only case i've ever heard of being successful that way, so congrats! thats amazing and to be admired.  

I've read through the trail of responses.  You asked what I'd do.  Here's the answer, and keep in mind I'm preVSG:

I would not risk another surgery.  You've had two without complications as far as I can tell.  I know you say it's getting harder to maintain the loss, and you've gained some.  Still, you're much lighter than you were before the band.  If I were in your same position -- best I can say at this point-- I'd continue to exhaust my nonsurgical options and tell myself surgery is not an option.  You're clearly in good shape based on your crossfit comments, and you have an eight year old child.  A third procedure isn't worth the risk in my view, and the risks don't seem to outweigh the rewards.  Keep doing crossfit, and gain muscle to rev your metabolism. That's what I'd try.

Best of luck to you.

Thank you ! 

Hislady~

First congratulations on your excellent loss after the band.

My comment is in regards to your existing and severe acid reflux. As you know damage to the esophagus is nothing to mess around with. I have Barretts Esophagus, a pre curser to esophageal cancer which is among the most deadly cancers one can be diagnosed with.

That being said I am prohibited from getting the sleeve, which was my first choice, because of the damage to my esophagus from long term acid reflux. It will be interesting to see if the incidence of Barretts increases in sleeved patients who suffer from uncontrolled reflux as time goes on.

But I digress, my question to you is if you are aware that the RNY was originally performed on those with severe GERD??

The RNY is known to- in most cases stop acid reflux in it's tracks.

So, if you ever do decide you need to revisit weight loss surgery (and I sincerely hope you don't) RNY might be an option for you.

What would I do?  No way in the world would I have another surgery unless medically necessary and by that I mean life threatening.  I would make whatever tool I had work the best I could.  I haven't had surgery yet, but I'm very self aware of how much I dislike surgery and recovery and complications so a third surgery would not be in my arsenal.  Good luck with whatever decision you make.

Just another point to consider.  

I am a surgeon and therefore did a ridiculous amount of research before surgery and I had extensive questions for my surgeon.  In those discussions I have learned that several surgeons are compiling information about the rate of stomach emptying with the sleeve.  Early data appears to show that although some sleeves can stretch a bit over time, the larger factor in being able to eat more as time goes by is how rapidly the stomach empties.  The pylorus controls how quickly the stomach empties.  Eat dense protein and the pylorus remains closed longer to start the break down process before allowing it into the small intestines.  Eat carbs and the pylorus will open fairly quickly since it does not need to be processed as much before moving on.  Well it appears that the pylorus will adapt over time and begin to allow food to pass out of the stomach more quickly= which may be enhanced in people that chronically over eat their sleeve.  

Ultimately, the size of your sleeve may not matter over time.  Transit time may decrease (edit), and may have already decreased (edit), regardless of the size of a person's stomach.  This could mean, in patients that do feel hunger, that they would feel hungry more often and those looking for satiety could potentiate the problem.

Lots of speculation here, but again, just something to consider.  I look forward to some peer-reviewed results in this area.