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A few random thoughts, in no particular order - You will likely lose some muscle mass as you lose weight irrespective which procedure you get; the main emphasis in general for WLS is to minimize muscle loss as we lose. Some maintain that it is impossible to build muscle mass while in a caloric deficit (needed to lose that fat) and while I never like to say "never" on such things, I would say that it would be exceptionally rare for it to happen, Typically, we lose what we need to lose to a healthy weight and body composition, and then work on building additional muscle mass if we so desire. The bypass and VSG have very similar weight loss and regain characteristics - there isn't much to choose between them from that aspect. You may lose a bit quicker with the bypass owing to its malabsorption, but will ultimately end up in the same place. The caloric malabsorption of the bypass is a temporary thing - it dissipates after a year or two - so weight maintenance is similar for both; nutritional malabsorption is a long term affair, however. As long as one stays on top of supplements and lab tests, both are good for long term health. The bypass, however, is somewhat fussier in its supplement requirements - minerals are malabsorbed, so one usually needs to supplement iron and calcium more than with a sleeve (and that may not be enough, as the need for iron infusions is usually greater with the bypass than with the sleeve. Iron and calcium is somewhat fussy as they need to be spaced out during the day. it's mostly a matter of establishing the habit, but this will bother some more than others. The sleeve has a predisposition toward GERD or acid reflux, so if one already suffers from this, the bypass is often preferred unless there is a specific identifiable cause that can be corrected during surgery (such as a hiatal hernia.) In contrast, the bypass is predisposed to dumping, reactive hypoglycemia, and marginal ulcers (which precludes the use of NSAIDs such as ibuprofin or aspirin, which are better tolerated by the sleeve.) The sleeve is conceptually a more straightforward, or simpler, procedure. However, it still takes some time and practice for a surgeon to master, so it is well to ensure that a prospective surgeon has performed several hundred of them. In the US, that isn't a big problem these days as most have been doing them for several years, but in other countries where they have been slower to adopt it, this may be a consideration. Owing to their national health policies, Canada is running about five years behind the US on their learning curve, and other countries seem to be similar. There is a recent poster (from AU, IIRC) here who went through a quick revision from an initial sleeve to a bypass within the first week or two, that is likely an example of this. So, if your surgeon is recommending one over the other, it is well to pay attention to them - their recommendation may (or may not) the absolute best thing for you, but it is likely to be the best that they can do for you, or are most comfortable performing on you.

Revision

I have had my Slimband for 11 years and I am trying to offer my support to those that have been feeling abandoned now that the company is no longer doing the surgeries and do not have the support that they once had or promised. I am not involved in pursuing any legal action against Slimband. But I can offer guidance if you need support, fills or defills, or need/want to have it removed and are considering getting the revision from band to sleeve, bypass or duodenal switch. DM me to talk. I should disclose that I am a former Slimband employee, and worked there for about six years, and left on my own free will in 2016.

I was banded by Slimband 11 years ago and still have my band. However, I have helped others have their band removed and have the band-to-sleeve or band-to-bypass revision surgery done and they are soooo happy. I can also help ones that just need to have their band adjusted to a proper level of restriction. DM me if you want to talk about getting fills/defills or about revision to a more effective weight loss surgery.

I was sleeved in 2014 and now I’m looking into getting a revision due to GERD and a Hiatal Hernia. Has anyone had Medicaid approve revision surgery??

I am very happy with my bypass. My GERD is gone, which has relieved my asthma as well. I started exercising right away, gradually adding elements of cardio, weights, stretching. I have more muscle mass now than before surgery. I have also entered a triathon in Oct and a bicycle event in November. I have so much energy now and feel 20 years younger! My only issue with malabsorption is with fat. If I eat too much it will come out in my stools. All of my 6 month vitamin levels were great, but I do take my vitamins faithfully, which I think is a small price to pay in exchange for the life I have now. My only other issue is getting enough calories in now, to keep up with my training schedule. My pouch limits intake, so I am having to eat more frequently and starting to add more healthy carbs back into the menu. All in all, I couldn't ask for a better outcome. I respect anyone's decision about which surgery to have, but it seems quite a few folks with the sleeve end up getting revised to bypass. I was also fixed on the sleeve until I understood the advantages of bypass with helping GERD and since that was an issue for me, it became a no brainer. I also like the fact that dumping can occur with sugar intake, when bypass is chosen. That is a great detriment for me to avoid sugar. Sugar is poison. I want no part of it, and my tummy agrees! No brainer there. I am also commited to taking care of my pouch and all the connections as well as possible. I work in the GI department of our hospital and I have seen firsthand the damage that can be done to WLS sites - ulcers and erosions beyond horror. So no alcohol, coffee, or NSAIDs for me. Those are my personal choices - again, a small price to pay for the life I have now. Best wishes in your journey!

Hello, I had a revision from Lap-band to Mini-bypass exactly 1 year ago. It wasn't the greatest success. I lost about 47 pounds but still have 33 to go. My doc and dietitian are both happy as they said this is average for revision, age etc. I am not happy at all. I have seen several people have success with the injection Saxenda. I was wondering if anyone had any drug help to lose the last of the weight. I still have a hefty amount to go and its not moving. Yes I have some hurdles incl Thyroid and some other issues but really, really want to progress further. I was never happy with the revision. I wish I had done RNY. I NEVER had the full button. I can eat any amount without issue which I was so disappointed in. Obviously, I really don't try and take advantage of this but have a very good appetite. Did anyone go this route with success?

Why are you being revised??? Sent from my LM-Q710(FGN) using BariatricPal mobile app

How tall are you. More info please about the first surgery. Why do you think that eating cereal and milk is a recipe for anything other than regain (and then some) and hellah GERD? I had RNY and before and after surgery, if I ate a meal like that I have hellah GERD. Just asking cuz there are no magic surgeries. And typically revision surgery doesn't imbue the type of weight loss you see in virgin surgeries--especially if there are emotional food eating behaviors that have contributed to the regain. Regardless of which surgery you choose, the main question should really be--where can I find the best RD and best bariatric counselor to work with on my eating program? Welcome! And I wish you all the best.

So I had my sleeve done in 2014. Day of surgery I was 210 pounds. Lowest I dropped to was 174. I maintained my weight between 180-190 for a couple of years. With in the past year gained back all the weight I lost and then some. I’m currently at 212 pounds. I think I have some sort of hernia, and HELLA MEGA BAD reflux. I take Zantac everyday, like even cereal with milk gives me bad heartburn. So now here I am, thinking I should get some revision surgery. I already made an appt for a consult. But I’d also like y’alls opinions or suggestions. -What’s better post sleeve, Roux en Y or bypass? Also, what are some things y’all wish you would have known with revision???

Hoping that all goes well for you now. My revision is scheduled for tomorrow at 11am. The info that you have shared is invaluable to me. Thanks so much!

I will be having my gastric sleeve converted to the RNY hopefully, in December. I was told by my provider that they never had to get the authorization up front with Medicare. She said they submitted the letter of medical necessity with the claim when they filed and they never had any problems. I believe that Medicare has guidelines you must follow in order for them to cover my procedure. The problem is I'm not overweight, but I'm being revised due to spontaneous reflux. Everything I eat the majority of it comes back up. I definitely have the medical necessity. In my doctor's notes he states that I am malnourished and not receiving the nutrients I need to sustain life. So, basically if I don't have the procedure I'm not going to live a lot longer. My BC/BS of AL will not cover it because I had the original procedure out of the country and didn't follow insurance guidelines that are typical for WLS. I had other insurance at the time I had the surgery. The surgery was done probably 10 years before I became effective with BC/BS of AL. I've contacted Medicare to see if they would cover and was told yes if medically necessary. Since the self pay is a lot, I want to feel warm and cozy on the idea of the surgery being covered by Medicare. Has anyone had the revision due to complications only and Medicare cover? Thanks!

I assume you meant my original sleeve surgery, I managed to lose 45 lbs pre-op so I was at 375 on surgery date. As for my revision, I lost 30 lbs pre-op so was at 300 on 6/15/19.

I cannot answer your question as I haven't bought anything but socks and underwear from WM in many years, I have to buy FR (Fire Retardant) clothes for my work so I just wear those jeans for everyday clothes as well, shorts, sweats, shirts, etc...I buy online. BUT, I just wanted to give you a huge congrats!!!! I know the feeling as we have almost the exact same stats. I was up to 420 in 2015, am 5' 10''. I was up to a 54 waist also. I am currently in a loose 40 and saving pennies for some 38s. I had a bunch of stuff, down to 36 because I had lost down to 190 but when I gained a bunch back (up to 330) I got pissed/depressed/whatever, and gave all my smaller clothes away....again. I had my revision from sleeve to bypass in June and now having to keep buying all these clothes all over again. Anyway, congrats on the amazing weight loss, keep it up.

WTG! Sounds like a great plan! Be sure to contact them if your symptoms get worse!!! Make em document EVERY little thing. I've never ever ever heard of anyone being made to wait 6 months for a medically necessary revision. Especially one involving active GERD that could cause Barrett's or erosion or ulceration, etc...at any time. I'd be that darn squeaky wheel they want to move along in the process!!!! ((hugs))

Okay, I want my sleeve revised or maybe not? I have to go through a 6 month process. I am beeing seen by one of the top bariatric surgeons. So here are some positives: (1) I have not gain all my weight back. (2) Having another procedure does not guarantee my GERD will be completely eliminated. (3) I will work with a specialist for WLS patients with GERD. (4) Following this lifestyle, I can get healthier and lose more weight. (5) I am willing to do this for at least 6 months. (6) My hernia will continue to be monitored. (7) I will increase my exercise. Sent from my SAMSUNG-SM-G935A using BariatricPal mobile app

Not leaving the remnant stomach is an option (that is what is done when the surgery is for something like gastric cancer - you don't want it lying around in there, lol) but there are trade offs as usual. The main one that I can think of is that the stomach is no longer there producing acid to neutralize the bile being secreted just downstream of it, so there may be greater chances of bile reflux. AFAIK, there are ways to minimize that when the surgery is done, but these are things to discuss with the surgeon as to how best handle your individual problems. If I had revised my VSG ro an RNY a few years ago, that is how it would have been done - no remnant stomach.

Revising the RNY to anything is difficult, which is why we don't see many revisions done; typically the most that is done is applying a band over bypass, or tightening the stoma to try to restore some restriction, but neither has a particularly good track record. I have seen a few revisions to the "traditional" BPD/DS performed which is very complex, and there are only a half dozen or so surgeons around capable doing that one. As the SIPS/SADI/SA-DS is being promoted as a simpler, more "accessible" procedure on a par with the RNY on a complexity basis, I wouldn't expect to see many surgeons with the skills yet to do a revision between the two. One doc to check into, who is in your neck of the woods, is Dr. Mitchell Roslin in NYC, who has done some of the RNY to DS revisons, and is a big promoter of the SIPS/SADI - if anyone could do it, he would be it, or he could tell you why it isn't such a good idea, if that is the case. Another possible in your neighborhood (just over the border in NJ is Dr. David Greenbaum who also does a lot of these complex revisions.

AFTER my sleeve i was starving then i had a revision to the mini bypass which is 1000 times better for me, I am not hungry and food tastes gross anyway so im losing super fast

Hopefully some of those folks will see this thread. I am really desperate to hear stories about this revision.

HI I had a weight regain and I have seen doctors with all kinds of suggestions for revision surgery. Has anyone heard of RNY to Single anastomosis duodenal switch. Or had this? I know revision after gastric bypass is unusual. Just looking for information.

Prior to my VSG 2 years ago, my acid reflux was minimal, not everyday. I had experienced reflux when I gained weight. I was a yo-yo dieter for years getting low as 130lb to high of 310. At my pre op testing for surgery, my surgeon says I have mild gerd. He had recommended gastric bypass. I didn't want bypass and told him if I lose the weight the reflux should go away like it has done in previous years. I was reflux free for 1 1/2 years post VSG. By then, i was 100 pounds lighter. By Dec of last year, I started having reflux here and there but not everyday. The ppi medicine was working but fast forward to this year. I was still experiencing mild acid in my esophagus after eating even with taking a ppi using with nutrition dense foods. My surgeon again recommended gastric bypass to get rid of the acid reflux or stay on ppi forever. I was leaning towards staying on ppi medication and losing more weight. However, I am still reading those with gerd/VSG and have reached a healthy BMI under 25 still experienced gerd. I will be moving forward with revision surgery from VSG to Gastric Bypass on the 19th of Sept.

A couple of things. 1st check your policy. If what you are waiting on is an approval for the revision, most insurance companies stipulate a time frame. Generally about 14 days. One thing to remember is that they work on a business day schedule not a calendar day. So it’s about a 3 week time span. 2nd If you’ve already been submitted, it was denied and an appeal has been submitted, there should still be documentation in the policy regarding the maximum amount of time they have to let you know of their decision. 3rd. It may take a phone call to get all of the information from your insurance company. My revision was listed as a covered procedure, but it wasn’t plainly listed in my policy. I had to call and get them to email it to me. Best of luck!

Pretty sure the only revisions from sleeve are either RNY or DS @Dr-Patient