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I wanted to preface this post with this optimistic fact. My husband had the surgery with amazing results and no problems whatsoever 15 years ago - it saved his life. He lost over 150 pounds and kept if off. He's gained and lost the same 25 pounds like your typical middle aged person, but it's been nothing but a blessing for him. We had different surgeons. My experience wasn't so awesome, and I feel it's so important to share a few facts so you choose the RIGHT surgeon and ask the RIGHT questions. I hope I can help people avoid the avoidable. I'm a big believer in the surgery - but I want you to not suffer. Let me help:) What's the problem? The sleeve has a common and serious side effect that I suffer with, and that many surgeons downplay. GERD. But this isn't the GERD you think you know - I'll jump into that later. GERD has up to a 30% rate of occurrence after VSG - that's a lot higher then what my doc told me. https://nyaspubs.onlinelibrary.wiley.com/doi/10.1111/nyas.14467. Not only did my doctor gloss over it, and convey that it was "really rare", but he didn't really explain what this type of GERD is. I'm going to explain what this type of GERD is, and then I'm going to arm you with the right questions and research to do before you pick a surgeon. Because once it goes bad, your surgeon will pawn you off on a GERD doctor and that's that. Let me help you get proactive and avoid a bad result! What is VSG GERD? Gastroesophageal reflux disease, or chronic acid reflux is when acid shoots into your esophagus and throat. VSG GERD is different - that's why I'm giving it its own name. I never had GERD before the surgery. Now I get VSG GERD after drinking 4 oz. of water. It's NOT triggered by food. This isn't occasional, it's constant without dangerous meds. I now weigh 115 pounds, so it's not triggered by overindulgence or weight gain brought on by binging. Now you might think you already know GERD. Who hasn't had to pop a tums here and there? Not a bad trade off for a morbid obesity cure, right? THIS IS NOT THAT!!!! VSG GERD is an unrelenting tidal wave of persistent, burning acid that causes chest pain (and emergency room visits) that can only be somewhat managed by daily, longterm use of a class of drugs called PPI's. These PPI's lead to malabsorption and a host of side effects. I sit in my local cancer center to have my bi-annual 4-hour iron infusion with chemo patients to name just one. https://journals.lww.com/ajg/Fulltext/2018/10001/Effect_of_Long_Term_Proton_Pump_Inhibitor_Use_on.1227.aspx PPI's are a class of drugs that are only intended for 2 weeks of use because of their fairly horrific side effects. PPI's are linked to depression, blindness, cancer, and early death, (and this is the short list). There are several law firms dedicated to compensation for PPI victims. PPI's makes me feel like I've just downed a bottle of Mayo. I've been nauseous for years. I alternate between taking a bottle of tums a day so that I can take breaks from the PPI - but I always revert back to them after a short break to alleviate the pain. I am seriously at risk for a ton of really serious diseases, and my liver tests are really bad. PPI's are deadly. I'm in the process of finding a surgeon who can help. https://www.nature.com/articles/s41598-019-53622-3 The amount of VSG patients converting to the bypass/Linx system/etc. to rid themself of GERD and get off PPI's is exploding. Common sense would tell you that this isn't a" tums" sort of reflux! Hope for post VSG GERD As someone with no energy, horrible anemia, and low final weight - the bypass conversion sounds like a disaster because of the increased risk of malabsorption, but one surgeon told me it might be my only option. Some surgeons are discovering that a revision surgery to treat a hiatal hernial (HH) is the key to relief. I've had several scopes over the years, and they can never find a HH, but according to my husband's VSG surgeon, that isn't uncommon. He feels there is a possibility that my past the doctors missing it. I'm waiting on my barium swallow results. This gives me hope - that's why I wanted to share it. Hope is everything. I'm also going to talk with the doctor who wrote this article. "Laparoscopic Ligamentum Teres cardiopexy to the rescue; an old procedure with a new use in managing reflux after sleeve gastrectomy". Follow me and I'll keep you updated. https://www.americanjournalofsurgery.com/article/S0002-9610(20)30814-X/fulltext#gr2 Future VSG patients - ASK QUESTIONS! A few surgeons are now doing the sleeve with hiatal hernia repair at the same time, and some understand how important it is to consider GERD while doing the surgery. Different surgeons have different techniques. Some doctors "get it", and are being proactive because they've seen the pain that GERD causes. Some downplay it. I would suggest that ALL sleeve pre op patients have this discussion with their surgeon before moving forward. If he downplays it, RUN. ASK!!!! Ask your surgeon how many patients has he had who've had GERD. How does/or will he address it if you are unlucky? Ask about his follow up - does he even know what's going on with his past patients? How does he keep track? Has he sent any patients to a GERD specialist? If he says, "oh, only a few of my patients had that" - ask him how he handled it. (My surgeon sent me to the GERD doc and then cut off ties. He was not curious about my results - he did not want to know. He probably still tells patients that it is rare. He has no idea I've been suffering for 14 years.) Bariatric surgeons who've done the surgery and are on the forefront of GERD repair are a good bet. These doctors are rare and you need to really hunt for them. If your doctor does the whole "very rare", etc. (my doctor did), he's either: not reading recent studies, not listening to his patients, not following up on them, minimizing this horrific side effect, or all of the above. Don't settle for a doctor who acts like it's "super rare" or "no big deal". THIS IS A BIG DEAL. Find one that is proactive and discusses HOW they avoid it. I'm rooting for all of you! Let's get the surgery, but let's get it from the right people. Don't pick the guy in Mexico just because he's cheap. Don't pick the guy because he takes your insurance. Spend the money for a few consults to discuss the surgery with different surgeons. Come here and reach out to people who've gone to him/her. I went with a blind recommendation and didn't ask enough questions - and the price is really expensive - I'm still paying.

I had an endoscopy yesterday as part of the pre-surgery process for me. I've had GERD issues for a while, and my nurse wanted to make sure there wasn't something more there going on before getting a sleeve (which was the surgeon's recommendation based on my weight). Turns out I have a medium-sized hiatal hernia of the paraoesophageal type. Based on this we're actually going to go with bypass. According to the nurse, while it's possible the GERD would go away with the sleeve if the hernia was fixed, it's also not entirely uncommon for sleeve users to get another hernia later on due to the reduced size of the stomach, and then we'd be back to square 1 with the GERD issues (with them possibly being worse due to the new stomach). Where I am self-pay and a revision would not be covered by insurance, we have decided to go with bypass instead as I essentially have one chance to get this right. That is just for me though, and everyone is so different with multiple other factors at play that it may not be the right choice for others. Either way, I'd say an endoscopy will likely be beneficial. Doesn't hurt to have more information going into such a big decision, and the results may help you decide what type of surgery would work best for you.

Hi! I had the lap-band 12 years ago. I lost 80 pounds, but have gained back 40. I have band issues (vomiting, liquid in my throat when I wake up, reflux, etc.). I’m meeting with Dr. Houston to consult about a revision. Any one on here use him? Any positives or negatives? I’m self-pay. Thanks!

I was just revised from the sleeve to the bypass on the 23rd and my pain is minimal. Doing my best to get fluids in. I gained 10 pounds during my hospital stay so hoping that will come off pretty fast. I haven't had any incidences of reflux so I'm super happy about that.

I was finally able to get some clarification regarding my coverage. Knowing what to expect puts me at ease. Gastric Bypass Surgery (Bariatric Surgery) is covered only if specific medical criteria are met:  Bariatric surgery may be indicated for patients 18 to 60 years of age. Requests for bariatric surgery for patients less than 18 years of age should include documentation that the primary care physician has addressed the risk of surgery on future growth, the patient's maturity level and the patient’s ability to understand the procedure and comply with postoperative instructions, as well as the adequacy of family support. Patients above 60 years of age may be considered if it is documented in the medical record that the patient’s physiologic age and co-morbid condition(s) result in a positive risk/benefit ratio. • The patient has been clinically evaluated by an MD or DO. The physician has documented failure of non-surgical management including a structured, professionally supervised (physician or non-physician) weight loss program for a minimum of six consecutive months within the last four years prior to the recommendation for bariatric surgery. The six consecutive month weight loss program listed above is waived for super morbidly obese individuals who have a BMI ≥50. Documentation should include periodic weights, dietary therapy and physical exercise, as well as behavioral therapy, counseling and pharmacotherapy, as indicated. • Documentation that the PCP and the patient have a good understanding of the risks involved and reasonable expectations that the patient will be compliant with all postsurgical requirements. • A psychological evaluation must be performed as a pre-surgical assessment by a contracted mental health professional in order to establish the patient’s emotional stability, ability to comprehend the risk of surgery and to give informed consent, and ability to cope with expected post-surgical lifestyle changes and limitations. Such psychological consultations may include one unit total of psychological testing for purposes of personality assessment (e.g., the MMPI-2 or adolescent version, the MMPI-A). • The physician needs to be aware and follow-up with individuals who have had gastric surgery for any long-term complications. • In cases where a revision of the original procedure is planned, documentation of all of the following is required: - Date and type of previous procedure - The factor(s) that precipitated failure - Any complications from the previous procedure that mandate (necessitate) the takedown - If the indication for the revision is a failure of the patient to lose a desired amount of 51 weight then the patient must meet all of the initial preoperative criteria. Note: The following surgical procedures are considered experimental/investigational because their safety and/or effectiveness have not been proven: • Loop gastric bypass gastroplasty - also known as mini-gastric bypass • Stomach stapling Endoscopic procedures to treat weight gain after bariatric surgery to remedy large gastric stoma or large gastric pouches are considered experimental/investigational.

I also had the revision for GERD, Gastritis and Esophagitis and I'm very happy that all that has been resolved. But I'm also very happy with the weight loss. As you can see below, I gained almost all my initial weight that I had lost after the sleeve. I felt like a complete failure and a fool for having thrown away my chance at a normal weight. I know this revision is my second chance to do it right and learn from my mistakes. Here are my stats over my 6 year journey. Highest weight May 2012 - 222 lbs. Gastric sleeve surgery weight November 2014 - 212 lbs. Lowest weight post sleeve May 2015 - 151 post op 6 months (61 lbs. lost) Highest weight prior to revision surgery January 2019 - 205 lbs. (54 lbs. gained) Weight day of revision surgery October 2020 - 185 lbs. Current weight March 2021 (5 months post op) - 138 lbs. (47 lbs. lost) I hope that I never have to add a line that says I've gained weight back again!!!! Good luck on your journey!!!!

@Paradigm Star I didn't feel much restriction immediately following RNY either. At least not like I did after VSG. But as time has gone by, it's not really restriction that I feel as much as just feeling full. And yes, I do feel hungry at time. I had a ZOOM meeting with my support group yesterday and the dietician even commented that revision surgery patients don't always feel like the "virgin" RNY patients - maybe because we've "been there, done that", we know what is going on and what to expect and there isn't that huge jump from a normal stomach to 1/4 stomach like we had with the VSG. So we went from 1/4 stomach to 1/8.....not as drastic of a change. But I know I feel great and have a ton of energy at almost 5 months post op. I feel like I'm fully healed inside. I'm glad you had the surgery. It should help, or eliminate, the gastric issues you were dealing with.......and you'll get to lose some weight in the process!!!

Pain after revision was significantly worse than any of my other previous abdominal surgeries (myomectomy, sleeve, hysterectomy, colostomy reversal). I expected it based on the amount of scar tissue I have but it still shocked me upon waking up. Each day it gets easier. This group has really helped me this week. Any suggestions on how to get all my protein in since I’m going home soon?!

I had a Vsg revision to bypass on 03/23 I’m feeling okay there’s more pain this time around. I am able to sip liquids okay but the purée are not sitting to well. They’re waiting on signs that my bowels are active again then I should be discharged.Good luck and speedy recovery to all March Surgeries 😊😊

If you don’t mind me asking, what is the reason for the revision? I am a rny patient. 6 yrs out. I had lost 170 pounds and now have regain 50. This puts me 100 from my goal weight. I am hoping a revision would jumpstart my weight loss again and help me reach my goal weight.

Unfortunately a lot of people are in the same boat after a revision. No restriction really stinks and is quite a shock when it is all said and done. We pretty much have a funnel where the food goes straight into the intestines, so the food just slides right on through is my understanding. What are you eating and how often ? I find I get more of a fullness feeling when I eat solid protein like steak or salmon. It really comes down to making the best choices you can in what you are eating and eating every 3 to 4 hours and make sure you dont drink until 30 min after a meal or you are just washing it out.

So here is my story and already I know your being able to help me is a long shot. I had my stomach stapled in 1999. I lost 100 pounds but the metal ring that was placed at the bottom of my stomach eroded through. Later I learned this is why they do not do this procedure anymore. I then had a conversion surgery to a gastric bypass in 2012. This was following the death of my daughter. I lost 30 pounds but that was from no appetite due to depression. I never had restriction from the surgery. I had a revision in 2020 (October)) again I have no restriction and am not losing weight. I have done everything I was told and it did not work again. Have you ever heard of this? My pouch is an appropriate size, but I can still eat? Why doesn’t it work for me? Why can I still eat? Do I need a ring or device to truly have restriction? I need some help and answers.

So, I am almost 2 weeks out. My sleeve never healed correctly, and my surgeon reccomended revision to rny. I was like you. Sleeve, no problem, I can still eat, just less, but rny terrified me because of dumping. Recovery has been harder for me with this, but, weigh in last Friday, I was told to move ahead to purees, because I've lost so much already. It's getting easier everyday. I know I will be thankful I did this. I'm right ahead of you, so message me if you need any support. You've got this!

Greetings to everyone, On May 2, 2016, I received my VSG from my Bariatric Surgeon. Fast forward to February 2019, I start getting experiencing abdominal pain, nausea and vomiting that my general GI specialist couldn’t figure out what was wrong with me. Diagnostic testing revealed a raw sore in my esophagus, a hiatal hernia, and the medical professionals couldn’t diagnose why I was experiencing abdominal pain in my gut. As time moved on, my aforementioned symptoms got worse and worse where I couldn’t keep down my food and medications. Now jump to March 10, 2021, I have my first surgical consultation with the Bariatric Surgeon that had put in my VSG in 2016. My Bariatric Surgeon recommended a revision from the VSG to RYGB to fix my hiatal hernia and the rest of my digestive symptoms. Dr. Chen has fast tracked my RYGB surgery to Monday, March 22, 2021. I have to admit to everyone that in 2016 when I the VSG, I was fine with it. However, now with the RYGB surgery within 48 hours of this posting in the BariatricPal forum, I’m getting nervous to having this surgery. One of the main reasons why I’m nervous is about having the RYGB surgery is the possibility of complications and after having surgery, and the dumping syndrome that seems to be common with a lot of individuals who get the RYGB surgery. Fortunately for me, while I was recovering from the VSG, I was not subjected to dumping syndrome. Can anybody share with me about your own experiences with getting the RYGB surgery? How was your recovery period? How was it going from a clear liquid diet to a full liquid diet to purée foods, etc. Share your thoughts and feedback. I would greatly appreciate that very much.

Revision is such an interesting topic! I'm hoping I can get the rest of my weight off on my own, but my Surgeon and Endo are talking about some sort of revision that might help my reactive hypoglycemia. I hope everyone does well with their revision and appointments! I would also love to hear how everyone is doing after!

I had the sleeve in 2017, and revised to bypass in December 2020 due to GERD and weight regain. Since the bypass in December I have lost 25kg (55 lbs). - current weight 187 lb. Weight loss for me now seems to be slower then the first time around, however I am ok with that. Since my revision I also have had NO more symptoms of GERD. Am so happy I was able to ge this revision, weight is steadily coming off. Hope this helps a bit

This is helpful. I was sleeved in 2018 and never had adequate weight loss no matter what I did. My insurance approved my revision after having 6 nutrition visits and my Dr stating it was medically necessary. My revision is scheduled for this upcoming Monday

I was sleeved before my revision. It took a little bit, but I enjoyed everything you listed. It's why I wanted bypass in the beginning because I needed something to really help me with that. I'm not typical. Wasn't a big eater before sleeve or after. A regular day for me was 700 calories, but I drank my calories, lol. Mostly in coffee. I could drink coffee all day & be fine, then maybe a little bit of steak w/ veggies for dinner. But if we were on vacation, forget it, I would eat ALL the things. I could still eat everything I did pre sleeve, after the sleeve. It was just that waiting period waiting for my sleeve to heal. I LOVE sparkling water, and I keep picking up a can and staring at it, lol. My sleeve recovery was super easy. You'll do great!

I wouldn't do the lapband at all, and I'm surprised your surgeon still does them. Few surgeons do those anymore and lots of people have had theirs removed because of complications. if you have GERD, just know that it gets worse for about 30% of sleeve patients. You may be OK with that amount of risk - I was not, so I went with bypass. Bypass usually (but not always) improves if not outright cures GERD. Having GERD won't prohibit you from getting the sleeve, though - but just know your risk if you do have it and you decide to proceed with the sleeve. Sometimes it can be medically managed, but we do see a fair amount of revisions to bypass on here if the GERD gets really severe (and again, that doesn't happen to most people - but it does happen to some..) P.S. Malabsorption issues aren't common with bypass AS LONG AS people are consistent about taking their vitamins. There are some people who can't absorb iron very well from oral supplements, so they need to go in for occasional infusions, but most of us absorb iron from pills just fine. As far as other nutrients, again, as long as you keep on top of your vitamin regimen, problems are rare.

My story started in 2012 my moms doctor told me if I lost weight we could work on me being her living donor. So I went to my doctor said I need this to save her life help me. We got me set up for the sleeve. At almost 300 pounds I would have done anything to help her. I had the sleeve done March 2014 and after getting to 190 her doctor told me I couldn't be her donor she wouldn't survive the surgery. So fast forward to 2019 I have major heart burn so bad even water gives me heart burn. By 2020 i was over the heart burn and the miserable life I met with my new doctor he informed me due to my sleeve it will be constant and just get worse so we did a revision and basically went to the bypass. Its been a very long and exhausting road. I wouldn't change it for anything but I would reconsider the original surgery.

those must be your particular surgeon's requirements, because I don't think that's universal - except maybe in the early weeks or months. I have a virgin RNY (not a revision), but I didn't have any restrictions at all once I get a ways out. I don't drink a lot (maybe three or four times a year), but I eat tacos every time we go to a Mexican restaurant. There's literally nothing I can't eat (although I watch my portion size)

A couple of comments to fill things in here. It's not really a matter of steroids vs. non-steroids, but rather what a drug or class of drugs does to the stomach as a side effect, NSAIDs are merely the most common that are sited as being problematic for bypass patients. The issue is that the part of the intestine where where the stomach pouch is connected is not resistant to the stomach acid, so that anastomosis there is quite vulnerable to ulcers, so any med that can cause some stomach distress is generally to be avoided. Some of the osteoporosis drugs are avoided for this reason, too. This presumably applies to the MGB as well, as it uses a similar connection. The duodenum, the part of intestine immediately downstream of the stomach and is resistant to the acid, is bypassed along with the remnant stomach. These various meds can sometimes be used in limited times under certain circumstances under medical supervision, but it's a risk/reward trade off between doctor and patient. The sleeve based procedures are generally more tolerant as they don't have that marginal ulcer issue, but many docs still restrict them owing to their bypass experience, (and the sleeve is probably less tolerant than a normal person, while being more tolerant than a bypasser.) Your bypass can be reversed, (that is sometimes one of its "selling points" but it's not commonly done as it's a pretty complex job; not all surgeons will do it. It is usually reserved for times when there is no other option in treating some problem, rather than just buyers remorse. I have seen it done a couple of times in cases of intransigent ulcers, where no other treatment worked. It can also be revised to a duodenal switch, but that's even more complex than a reversal (they have to reverse it first, then sleeve it, and redo the intestinal rerouting. It is usually done when weight loss was inadequate or with excessive regain, or for other RNY complications such as the intransigent ulcers or bile reflux. You weren't offered the MGB as it doesn't fit the "standard of care" for WLS in the US - insurance doesn't normally cover it and the ASMBS hasn't approved it, though it has been further developed and used more commonly elsewhere. The next procedure that's likely to gain approval here is the SIPS/SADI/Loop DS

Hi! I am in the same boat as you! I had surgery in August 2014, got to goal (8 pounds below at 142) and maintained 150-160 for 5 years. Then a neck injury, cancer diagnosis, and the year 2020 hit and I’m up to 188 at this point. It’s so damn depressing having to buy new clothes because nothing fits anymore. My doctor has put me on a BED medication called Vyvanse for the time being, and it’s really helped suppress my appetite. I’m back to exercising at least 3 days a week, and tracking what I eat. Trying to keep it protein and fiber rich foods. We will see. I feel like I’m back on the diet roller coaster/fat brain thinking from before. Seriously thinking about a revision to bypass since I have reflux anyway, but have been through so much medical crap, I don’t know if I want to deal with another surgery again. You’re not alone, friend!

For those of you sleeved, then revised to by-pass, did you feel depressed at all? Like with the sleeve, I could eat or drink what I wanted. I'm only a week post op, but the thought of not having hot spiced wine or a mojito ever again is depressing. I'm DREAMING of a taco. With the sleeve, I couldn't eat a whole one, but a tortilla with guac, beef, pico, and cheese!! The fear of never being able to eat or drink normally again just keeps flooding my mind. Tell me I'm not alone please, lol

Hello, Just wanted someone’s input on my situation. I was banded back in 2014. I lost about 85 lbs and was doing great. Until all of a sudden it caused me grief. A lot of pain, throwing up and reflux. After6+ years I’ve since gained about 40lbs and with all the problems I’ve incurred over the years my doc and I decided on a revision to the sleeve. Well, my insurance company, BCBSIL approved removal only. So, my doc is submitting a request for the revision to the sleeve. Has anyone had this happened to them? What are the odds of them not approving the sleeve? My worry is that I do not meet the BMI requirements to get the sleeve. If anyone can shed some light on this, it will be greatly appreciated. Thanks!