Being re-sleeved - anyone else?

In general I think revisions are useless unless the first surgery involved medical malpractice or a failed band.

You can't out train or out surgery a bad diet. So if how you eat doesn't change then it shouldn't matter. It really shouldn't matter the size of your stomach if you are eating the proper portions of dense protein.

All of that aside, you really need the hiatal hernia repaired. So since they are going to do that, might as well tighten up the sleeve.

The issue that you are not going to have is all the great metabolic changes that come with surgery on your 3rd go at it. That seems to be a one time shot. So after your revision is it all going to be on your diet.

https://youtu.be/aiWd9stWnu0

I agree, i will talk with the surgeon before i rule it out. I really just hate going under and having surgery....some people like it....i cant stand it....

A 60 bougie is a common size for sleeves done with the DS, which adds a malabsorptive component to the sleeve's restriction, allowing for the larger sleeve's lower restriction. At times, the DS was done in two steps for larger or less healthy patients with the sleeve done first followed by the intestinal rerouting later after sufficient weight had been lost for the patient to tolerate the longer second phase surgery. Occasionally, some patients lost enough weight on the sleeve alone to forego the second surgery, which was the start of using the sleeve as a stand alone procedure that we have today, with the sleeve size optimized to a somewhat smaller size, typically using a 32-40 size bougie.

So, if the primary defect of your sleeve is its larger size, it is possible for some to work it successfully. My wife has a sleeve in that size range with her DS (I don't know what specific size bougie was used, if indeed the surgeon used one at all) as her original stomach size after surgery was close to double the size of mine (4 oz vs 2.5 oz). Yet, her overall meal capacity now, some 12 years post op is little different than mine; capacity is much more sensitive to meal composition (lots of chips and twinkies can be consumed, along with fruits and veg, but still lots of restriction on meats and the like.) Tighter sleeves done poorly can yield much greater capacity problems than a well crafted sleeve of a smaller nominal size.

Working your diet for a while while you decide on surgery is a reasonable approach - test the sleeve that you have and see if it is workable as it is. It would not be unreasonable to put things on hold for a few months to see how things go. Look into other dietary approaches that emphasize long term sustainability rather than quickie weight loss. Check with the RDs at Cedars to see if they can put something together for your particular situation (when I talked to them, they were just promoting the basic "cookbook" WLS pre/post-op program diet, but they should be able to tailor something for your specific needs.) If you haven't run across them yet, take a look at some of the Dr. Matthew Weiner videos on youtube - he advocates more a veg-first approach to WLS and non-WLS diets, using the high bulk/low calorie character of vegetables as a means of accommodating the increasing capacity that we typically experience over the years after surgery - a compatible approach to your problem of a less restrictive than expected sleeve.

On the thought of putting off the hiatal hernia repair, that can be done with some caution as indicated by others. There can be damage from reflux that doesn't manifest itself in noticeable symptoms, so it might be wise to have a periodic EGD to ensure that no damage is being done by leaving it there, or at least as long as it takes to convince yourself that you can handle this problem with diet alone rather than surgery. Did the upper GI show any signs of reflux damage?

Good luck in wherever this leads....

Hi I'm actually in the same boat as you are but cancelled my scheduled gastric bypass surgery today I want to do the gastric sleeve with haital hernia repair so I hope dr.koreman is good

A 60f bougie sleeve is huge for a stand alone VSG.

Don't ever let anyone tell you that sleeve size does not matter, after all the VSG is a restrictive type WLS as a major component.

That pen photo that gets posted every so often is only accurate for a starting point "scale". Eventual capacity is what counts.

A 60f bougie can commonly have an eventual capacity of well over 16oz.

Reason being is that larger sleeves retain more of the stretchy tissue. A proper 32f sleeve that starts out about 2-3oz. capacity will eventually mature to around 5oz. It is very common that 36f-38f sleeves mature to about 8-12oz.

Some people will say that sleeve size does not matter and that the difference is minuscule. Eventual capacity with the VSG ranges from about 3oz. to well over 16oz. is that minuscule????

The VSG is a NON STANDARDIZED procedure and lots of bariatric programs deem 50% EWL a goal and successful.

Sure, it's ultimately about what you put in your mouth and you can be successful with a large capacity sleeve, just like you can be successful in losing all your EW without surgery.

For an example purposes, the other day I ate at In&Out and had a cheeseburger without the bun. The burger patty, slice of tomato and lettuce was just a little to much for me and I left a little. (this meal is well within my nutritional range)

I am almost 8 years post-op with a 32f sleeve and I can tell you for sure that sleeve size matters. It's the bumper, the electric fence. I have mealed with other sleevers that have had larger sleeves and we have compared our capacities. Even if we all ate proper foods, who is going to have it harder, the person that can eat 5oz. or the person who eats 10oz. ???? Even with my capacity and restriction I have to watch what I eat and stay close to plan most the time.

I think you should continue the research on modifying your sleeve size and definitely get the hernia fixed. The VSG is a whole system that starts at your throat and ends at the pyloric valve.

Hope this helps,

frisco

I have both a larger sleeve and after the vsg had to go back in to repair a very large hiatel hernia. My sleeve size is in the 40s, so not quite as large. I do think that I can eat a little more than a typical poster here, but not significantly so. I am 6'2'' and with my larger frame that alone could contribute to being able to eat more. If I have a 6-ounce steak, salad, and some type of side at a restaurant no way can I finish everything. However, the type of food matters as everyone says- slider foods I can do a whole lot of.

Regarding the hernia. I made it to goal in 8 months with no trouble maintaining. About two years ago I started having acid issues. Mine was the silent type- I didn't feel the burning like I did preop. During the vsg I had a hernia repaired. I started noticing I was hungry all the time (or so it seemed). Acid mimics hunger. I felt better after eating for brief periods. Calories went up. I started to regain. By around 6 months of this I had put on enough to be above my goal weight. I also reached a point where I could not keep solid foods down and would have to go several days at a time on a liquid-only diet to rest the digestive system. Turned out I needed the gallbladder removed and hernia repaired. Once that was done, my weight went right back down to my typical maintenance range.

In short, the hernia could have a lot to do with your weight. A constant acid issue for me was a direct contributor to my eating patterns. Now if I notice feeling "hungry" when I shouldn't (30-60 minutes after eating) that is my cue that acid is the problem. I don't have to take prescription PPIs all the time, but do need them every so often.

My surgeon who did the gallbladder and hernia removal was the same one who did the original sleeve. He warned me going in that my sleeve was "stretched" out and that he likely would revise. Turned out once he put the stomach back in the proper position it resumed a fairly normal sleeve shape. Due to revision being a high-risk procedure (as is getting the hernia repaired a second time) he left it alone. If I have another hernia issue down the road, my only option now would be to revise to a Rny to release the pressure... the revision would not be for further weight loss.

So in short. If it were me I would monitor very closely the impact your hernia may be having on your eating. Keep a journal and document everything, including when you notice you start to get "hungry" again or that urge to graze. Like you have started, stick to a proper vsg food plan. If you take or don't take a ppi record that. After a few weeks you should see some patterns. Even if you don't think you need a ppi if it is Ok with the doc I would try it anyway- if your acid is the silent type you may not even know that is an issue. Others are correct about acid causing damage. It can lead to Barrots and cancer. If the hernia is not repaired you need to monitor for damage.

You may very well need a hernia repair. If it were me, if it was a hernia that was not problematic then I would leave it alone nor do a revision. The high-risk surgery is not worth it. In my case, I was unable to eat, had constant nausea and vomiting, etc. so I had little choice. That weight I had gained started coming off prior to the surgery due to not being able to keep food down as the condition worsened.

It is a lot to think about. If you do go in for surgery it might make sense to revise that sleeve to a smaller one. The research I read indicates that 60 and under has comparable results, but over that it is not as effective. You are right on the edge of that. Personally, I would not go into the thirtys due to the higher risk and greater likelihood of acid problems. Even with my 40ish sleeve that proved to be an issue. I can only imagine what might have happened if the sleeve was smaller.

Some months after successful vsg my DH started having a lot of vomiting and gerd. Our surgeon looked at him and discovered a hiatal hernia. He checks for these and repairs them during surgeries but says he is seeing more and more of these develop after some weight loss. His theory is that all the abdominal fat hold stuff in place and when it is lost, things can slide around more. (I knew of mine and it was repaired during vsg). So anyway DH had a second surgery to repair that hernia and surgeon discovered upper part of sleeve was sort of stretched out so he tightened it up. All this helped a great deal. He does not have the gerd so much anymore. He has regained some weight but its because he eats goldfish crackers and doesn't stick to the plan. Our surgeon, Dr. Cirangle, uses a 32 bougie for everyone. After 7 years I still have pretty good restriction. GL. Diane S

How long did you have to wait to get the sleeve after having band taken out ? I'm considering going to sleeve I was banded 10 years ago was doing great but the last year I've had acid reflux which has caused ulcers in my esophagus and stomach thid is my late night stressed troy g to make a section to get the sleeve or not