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Are your weight gains the fault of the band or your fault for not following the program? The band has been successful for some and there are people out there who swear by them (as opposed to swearing AT them). Fix whatever is broken so, if it's the band's fault, then go for the revision. If your eating habits are the problem, then why undergo surgery? Even with the VSG, you have to make it work... it won't do it all by itself. Best of luck on whatever you decide.

Is there a military hospital that you can go to and get the sleeve if that is the surgery you really want. I refused RNY/bypass when I had to revise from the band and I listed the reasons below. I've also included the basic information about both surgeries. There are many reasons why I chose VSG instead of RNY, and my VSG was covered at a military hospital 100%. I would recommend checking out the obesityhelp.com website, look under surgical forums, check out the Revision forum so you can see how many people are looking to revise from RNY because of weight regain or complications, and then check out the failed weight loss surgery forum just so you can get an idea of people that are further out. Here are my reasons for getting VSG instead of RNY: The Vertical Sleeve Gastrectomy procedure (also called Sleeve Gastrectomy, Vertical Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction, Logitudinal Gastrectomy and even Vertical Gastroplasty) is performed by approximately 20 surgeons worldwide. This forum is titled “VSG forum” to include the two most common terms for the procedure (vertical and sleeve). The earliest forms of this procedure were conceived of by Dr. Jamieson in Australia (Long Vertical Gastroplasty, Obesity Surgery 1993)- and by Dr. Johnston in England in 1996 (Magenstrasse and Mill operation- Obesity Surgery 2003). Dr Gagner in New York, refined the operation to include gastrectomy(removal of stomach) and offered it to high risk patients in 2001. Several surgeons worldwide have adopted the procedure and have offered it to low BMI and low risk patients as an alternative to laparoscopic banding of the stomach. It generates weight loss by restricting the amount of food (and therefore calories) that can be eaten by removing 85% or more of the stomach without bypassing the intestines or causing any gastrointestinal malabsorption. It is a purely restrictive operation. It is currently indicated as an alternative to the Lap-Band® procedure for low weight individuals and as a safe option for higher weight individuals. Anatomy This procedure generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from 1-5 ounces (30-150cc), depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded. The Roux-en-Y gastric bypass stomach can be reconnected (reversed) if necessary. Note that there is no intestinal bypass with this procedure, only stomach reduction. The lack of an intestinal bypass avoids potentially costly, long term complications such as marginal ulcers, vitamin deficiencies and intestinal obstructions. Comparison to prior Gastroplasties (stomach stapling of the 70-80s) The Vertical Gastrectomy is a significant improvement over prior gastroplasty procedures for a number of reasons: 1) Rather than creating a pouch with silastic rings or polypropylene mesh, the VG actually resects or removes the majority of the stomach. The portion of the stomach which is removed is responsible for secreting Ghrelin, which is a hormone that is responsible for appetite and hunger. By removing this portion of the stomach rather than leaving it in-place, the level of Ghrelin is reduced to near zero, actually causing loss of or a reduction in appetite (Obesity Surgery, 15, 1024-1029, 2005). Currently, it is not known if Ghrelin levels increase again after one to two years. Patients do report that some hunger and cravings do slowly return. An excellent study by Dr. Himpens in Belgium(Obesity Surgery 2006) demonstrated that the cravings in a VSG patient 3 years after surgery are much less than in LapBand patients and this probably accounts for the superior weight loss. 2) The removed section of the stomach is actually the portion that “stretches” the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food. Remember, resistance is greatest the smaller the diameter and the longer the channel. Not only is appetite reduced, but very small amounts of food generate early and lasting satiety(fullness). 3) Finally, by not having silastic rings or mesh wrapped around the stomach, the problems which are associated with these items are eliminated (infection, obstruction, erosion, and the need for synthetic materials). An additional discussion based on choice of procedures is below. Alternative to a Roux-en-Y Gastric Bypass The Vertical Gastrectomy is a reasonable alternative to a Roux en Y Gastric Bypass for a number of reasons Because there is no intestinal bypass, the risk of malabsorptive complications such as vitamin deficiency and Protein deficiency is minimal. There is no risk of marginal ulcer which occurs in over 2% of Roux en Y Gastric Bypass patients. The pylorus is preserved so dumping syndrome does not occur or is minimal. There is no intestinal obstruction since there is no intestinal bypass. It is relatively easy to modify to an alternative procedure should weight loss be inadequate or weight regain occur. The limited two year and 6 year weight loss data available to date is superior to current Banding and comparable to Gastric Bypass weight loss data(see Lee, Jossart, Cirangle Surgical Endoscopy 2007). First stage of a Duodenal Switch In 2001, Dr. Gagner performed the VSG laparoscopically in a group of very high BMI patients to try to reduce the overall risk of weight loss surgery. This was considered the ‘first stage’ of the Duodenal Switch procedure. Once a patient’s BMI goes above 60kg/m2, it is increasingly difficult to safely perform a Roux-en-Y gastric bypass or a Duodenal Switch using the laparoscopic approach. Morbidly obese patients who undergo the laparoscopic approach do better overall in their recovery, while minimizing pain and wound complications, when compared to patients who undergo large, open incisions for surgery (Annals of Surgery, 234 (3): pp 279-291, 2001). In addition, the Roux-en-Y gastric bypass tends to yield inadequate weight loss for patients with a BMI greater than 55kg/m2 (Annals of Surgery, 231(4): pp 524-528. The Duodenal Switch is very effective for high BMI patients but unfortunately it can also be quite risky and may be safer if done open in these patients. The solution was to ‘stage’ the procedure for the high BMI patients. The VSG is a reasonable solution to this problem. It can usually be done laparoscopically even in patients weighing over 500 pounds. The stomach restriction that occurs allows these patients to lose more than 100 pounds. This dramatic weight loss allows significant improvement in health and resolution of associated medical problems such as diabetes and sleep apnea, and therefore effectively “downstages” a patient to a lower risk group. Once the patients BMI is lower (35-40) they can return to the operating room for the “second stage” of the procedure, which can either be the Duodenal Switch, Roux–en-Y gastric bypass or even a Lap-Band®. Current, but limited, data for this ‘two stage’ approach indicate adequate weight loss and fewer complications. Vertical Gastrectomy as an only stage procedure for Low BMI patients(alternative to Lap-Band®and Gastric Bypass) The Vertical Gastrectomy has proven to be quite safe and quite effective for individuals with a BMI in lower ranges. The following points are based on review of existing reports: Dr. Johnston in England, 10% of his patients did fail to achieve a BMI below 35 at 5 years and these tended to be the heavier individuals. The same ones we would expect to go through a second stage as noted above. The lower BMI patients had good weight loss (Obesity Surgery 2003). In San Francisco, Dr Lee, Jossart and Cirangle initiated this procedure for high risk and high BMI patients in 2002. The results have been very impressive. In more than 700 patients, there were no deaths, no conversions to open and a leak rate of less than 1%. The two year weight loss results are similar to the Roux en Y Gastric Bypass and the Duodenal Switch (81-86% Excess Weight Loss). Results comparing the first 216 patients are published in Surgical Endoscopy.. Earlier results were also presented at the American College of Surgeons National Meeting at a Plenary Session in October 2004 and can be found here: www.facs.org/education/gs2004/gs33lee.pdf. Dr Himpens and colleagues in Brussels have published 3 year results comparing 40 Lap-Band® patients to 40 Laparoscopic VSG patients. The VSG patients had a superior excess weight loss of 57% compared to 41% for the Lap-Band® group (Obesity Surgery, 16, 1450-1456, 2006). Low BMI individuals who should consider this procedure include: Those who are concerned about the potential long term side effects of an intestinal bypass such as intestinal obstruction, ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency. Those who are considering a Lap-Band® but are concerned about a foreign body or worried about frequent adjustments or finding a band adjustment physician. Those who have other medical problems that prevent them from having weight loss surgery such as anemia, Crohn’s disease, extensive prior surgery, severe asthma requiring frequent steroid use, and other complex medical conditions. People who need to take anti-inflammatory medications may also want to consider the Vertical Gastrectomy. Unlike the gastric bypass where these medications are associated with a very high incidence of ulcer, the VSG does not seem to have the same issues. Also, Lap-Band ® patients are at higher risks for complications from NSAID use. All surgical weight loss procedures have certain risks, complications and benefits. The ultimate result from weight loss surgery is dependent on the patients risk, how much education they receive from their surgeon, commitment to diet, establishing an exercise routine and the surgeons experience. As Dr. Jamieson summarized in 1993, “Given good motivation, a good operation technique and good education, patients can achieve weight loss comparable to that from more invasive procedures.” Next: Advantages and Disadvantages of Vertical Sleeve Gastrectomy >> This information has been provided courtesy of Laparoscopic Associates of San Francisco (LAPSF). Please visit the Laparoscopic Associates of San Francisco. Advantages and Disadvantages of Vertical Sleeve Gastrectomy Vertical Sleeve Gastrectomy Advantages Reduces stomach capacity but tends to allow the stomach to function normally so most food items can be consumed, albeit in small amounts. Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin). Dumping syndrome is avoided or minimized because the pylorus is preserved. Minimizes the chance of an ulcer occurring. By avoiding the intestinal bypass, almost eliminates the chance of intestinal obstruction (blockage), marginal ulcers, anemia, osteoporosis, protein deficiency and vitamin deficiency. Very effective as a first stage procedure for high BMI patients (BMI > 55 kg/m2). Limited results appear promising as a single stage procedure for low BMI patients (BMI 30-50 kg/m2). Appealing option for people who are concerned about the complications of intestinal bypass procedures or who have existing anemia, Crohn’s disease and numerous other conditions that make them too high risk for intestinal bypass procedures. Appealing option for people who are concerned about the foreign body aspect of Banding procedures. Can be done laparoscopically in patients weighing over 500 pounds, thereby providing all the advantages of minimally invasive surgery: fewer wound and lung problems, less pain, and faster recovery. Vertical Sleeve Gastrectomy Disadvantages Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass. Higher BMI patients will most likely need to have a second stage procedure later to help lose the rest of the weight. Remember, two stages may ultimately be safer and more effective than one operation for high BMI patients. This is an active point of discussion for bariatric surgeons. Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss. This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur. Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure. Considered investigational by some surgeons and insurance companies. Next: >> Frequently Asked Questions About Vertical Sleeve Gastrectomy This information has been provided courtesy of Laparoscopic Associates of San Francisco (LAPSF). Please visit the Laparoscopic Associates of San Francisco. Bypass information

I know exactly where you're coming from. I was banded in Oct 2009 and originally lost 104 lbs (9 lbs from goal of 135) last year. Then my band had a minor slip and they took some fill out. I gained 18 lbs. Then, 2 months ago, I had a major slip and they took out ALL of my fill (awaiting revision to sleeve in late June) and I gained another 12 (8 of them on my 7 day Alaskan cruise last week). So I've gained a total of 30 lbs in about 18 mths. Wow. I also thought once I lost it, it would be easy to keep it off. I don't fit into many of my clothes anymore. I'm not trying to lose weight but I'm also trying not to gain weight before my revision surgery. I know that I'll lose what I have left after that. Good luck taking it off. It sucks to think you're a failure (you're not, btw) Marci

Well I am already three days post op. I continue to do well. I have no hunger. I am able to get in all my fluids and protein. I just set myself up a schedule and sip sip sip all day. I am still tired but not as much as yesterday. I have mild pain when changing position from laying to standing. My big problem is that I have developed an allergy to the surgical glue. My whole tummy is red and inflamed. Some spots are blistered. Ice packs help. I have to call in the am to see if I can take some Benedryl for the itch. Other than that it has been smooth sailing. I am so lucky. Because I was a band to sleeve revision, there was a greater chance for complications. I really thought it would be much worse.

I was banded in 08, self pay, its slipped and I was denied for Sleeve. Should I do peer-to-peer with docs/insurance and appeal. I was denied for "non-compliance" - I wasn't having problems and didn't see a surgeon due to proximity and cost. I have coverage now that hasn't paid anything out - help on what to do - appeal?

I am 100% for the sleeve. !! Sent from my SM-N910T using the BariatricPal App Get that band out before it ruins your stomach and you can't get any kind of revision surgery. I had my band out and got the sleeve in the same surgery, 7 years ago. i am 63 now. It was the best decision of my life. The sleeve works so well. I can still only eat small portions. Just like the sleeve though, candy is my biggest threat. The sleeve does not stop sweet cravings and unfortunately, most of them go down just fine. I'm still fighting a 10 lb regain but at 7 years, I am thrilled that's all it is. It's harder to lose weight the older we get. It could easily be 20 or more, if I didn't watch things so closely.

Ironically Irgau is the one who told me same as you .... RNY was not a good option for me. I am soooooooo glad I switched practices, the surgical group who did my revision is about an hour away in NJ but the differences in the practices are unbelievable. Love my new surgeon ... he and his partner both said I should have had RNY and they would have never given me a band, especially with me being diabetic for 15+ years. The RNY caused metabolic changes that put my diabetes into remission. That's is just one of the many benefits from RNY. I am glad you found a practice that sounds like it is really great and you got your revision done. Best of luck to you!

Only two days left for me..Friday is the big day! I'm a little nervous but more excited, I'm finishing up my last shopping and cleaning, I'm packing a bag tonight and everything is pretty much done. I've splurged a little and bought a NutriBullet and a FitBit for after surgery and I love them both, well worth the money my house is perfect, everything is organized and my family is up to speed and ready to help me when I need anything in the beginning. I'm a revision so I'll be in the hospital for a minimum of 2 nights and may be there a little longer depending on recovery, they are also a little worried that it will have to be open because of the damage to my esophagus but won't know until they get in there. Positive thoughts and prayers for laproscopic would be greatly appreciated on Friday, I have to start classes on August 22nd so hopefully my recovery will go smoothly! I'll keep everyone updated and let you guys know how I'm feeling so hopefully you will know what to expect when you have surgery!

My day is Aug 7th. I am a band to sleeve revision. So ready. Laura

I've actually been working on something like this with my own recipes.. but if you need help on actually making the book let me know (katie@griffonco.com) Maybe I can just convert my personal work in progress to the LBT book since its already started hehe im also including a lot of info related to eating and the band since i was plannign to give this to a couple girls in my support meetings. But basically will have stages, broken up to what stage your on from pre-surgery to years post op. I have made several cookbooks for family / friends that I've printed and bound with table of contents, pictures etc. I can even help with pricing. Laminating is VERY expensive, so i stopped doing that awhile ago... plus several of the books we did revisions about every year or so adding new recipes etc so they just got a new copy! My dad used to be a head chef and he had me make a book that was about 250 pages catagorized etc. anyways if you need help let me know.. i have all the software needed to make any type of professional looking designs (I'm a professional graphic designer btw) and if we set it up right we could very well make it a website out of it.. (professional web designer too) I actually also have a ton of ideas I've got a binding machine and can generally get the materials fairly cheap. Depending on the size of the book prices vary but the large book that i did for my dad came out about 20 bucks each (including ink, full of pictures, front back covers and the binding) but we didnt make very many of them (just for family) so obviously the more you do , the cheaper it will be. im also able to work out deals with print shops to get cheaper stuff like copies and cutting etc Anyways.. lemme know if you need help perhaps we could set something up to where we sell the books at cost, or perhaps slightly over and we give away prizes from the proceeds with contests nstuff (did i mention i know alot about marketing?) haha so yea email me if your looking for some help

I am 57 having revision from band to rny tomorrow. Hope to have some healthy years in this second half of my life.

Hello. This is my first post over here on RNY Talk- I've been a member on Vertical Sleeve Talk for a few months. I had the sleeve on August 6th and it is has been quite a terrible journey! My surgeon could not figure out why I was vomiting daily and having trouble staying hydrated. I have a new surgeon now and he believes that he will need to do a revision surgery to the RNY. I'm wondering if anyone else has had this type of revision an what it was like? I hear your pouch is super small compared to normal RNY patients... Just looking for any pointers....

After a year and 100 pounds down, I started gaining weight again and found out my band slipped. My doctor opted to do the revision surgery and my insurance covered it do to the risks of not getting it done. Come to find out that when most surgeons do the band they take part of the stomach up over the band and suture it on both sides. My doctor only did one side so the other slipped up. My new doctor was able to get it back in position and get it tied down. He also put 4cc's in at that time. I am on the liquid diet again till i heal but I am so happy they where able to fix it for me without removing it. The lap band saved my life and sets backs or not, I owe my life to the band.

Welcone sk8!!!! If you have any any questions about before during and after we are all here for you. Lapband is the safest and only reviseable surgery, like i wanted mine out cos it was placed wrong so no matter what fill i had i was always chucking. 18 months ago after i got it taken out i never thought i would want it again. But i no it works and at least melb has such a great parnrship and the docs let you know in advance what they expect from the start till the rest of your life which i never got in hobart or geelong. Were you given the blue book that also has a dvd 8 golden rules? Watch the dvd and a couple chapters of the book, my mums friend got stomach stapling and she lost tons of weight then over a couple years gained close to 50kg back. And last year her staples burts and she was very nearlly dead from all the gut juices going every were and she was in icu for a while. In my first visit with mr burton i told him a band would be good but i asked him is there a better one you think i should have? I know the sleeve stretches and after a while not good. We must all be 32 here!!!! Thats a long wait till january!!! I had just under 2 weeks to wait and that seemed like forever!! Ask us anything from basically never going to the loo to never being able to take part in burping compitions!!

LMAO Thanks BJean even though I never thought of myself as uppity or superior.I often find myself in a pickle because I come in and smack them old Bitches around for picky on the newbies,seriously I don't care how long you have been banded you just have one band or in rare instance you may have needed revision and had a two or three,my point is this your band and your weight loss experience means little to me and my journey the same as averages.We are all unique in our own way,and if you are having a moment and you come in here hungry and feeling let down by your band or your doctor we should not attack you with (how many carbs,Proteins ,calories or exercise did you do.)We should recognize this as what it is *venting* and say something encouraging and supportive and not beat you over the head because we lost weight and if you didn't then you must be doing something wrong.Well sorry didn't mean to rant but I think most will get my drift.If you don't then don't waste your time bashing me cause trust me I do not giva-sshit either way.

Band to sleeve revision. Surgery was June 26th. 2 days in hospital. Surgeon had me on puree's from day 1. Dairy has not agreed with me. My belly is far too irritated. I went to Clear liquids and I seem to be tolerating that pretty well. Mostly only having lactose free Protein shakes, broth, popcycles, and hot tea.

@hardwork&dedication It is nerve wracking to me as well. I have having the extra skin on my stomach removed on June 5th even though I am not at goal yet. It is very large already and giving me issues so insurance is covering it, I will have to pay for my revision when I get to goal out of pocket though. I also will want a thigh lift and as mentions a breast lift. I may or may not want my arms done too. They don't bother me as much as my thighs and breasts. My surgeon said he does not recommend the thigh surgery though and quotes a 90% complication rate.

I had a slipped lap band that had to come out and my surgeon said it was easier to revise to a RNY than a sleeve. Also I had GERD before my band, and the bypass is supposed to help alleviate GERD, where the sleeve sometimes causes it in some people. Also I had developed a "touch" of diabetes, and the bypass really helps with that. I went off metformin right before the surgery and now, only two months later, my hemoglobin A1C is normal!

Hi, Fort Jackson does the sleeve as well, pretty quick process if you are revising, did not have to go throug Tricare. Surgery is very soon.

Wheetsin....how many revisions has your surgeon done? I'm about 9 months out from band removal so my stomach should be healed well by now. I'm going to keep plugging away and get another opinion and also work on getting into the program at Fort Gordon...they have the fist info session in June. Thanks for your input!

Sorry for the late response, I lost track of this thread. Most of my surgeons revisions have been band -> RNY. I believe he has done about 1,300. Band -> sleeve was about 275. I'm not military so I didn't go through an MTF (just to clarify). If there's an upside to lots of scar tissue (I had gobs of it)... it's the restriction. Scar tissue can play a role in how much "flex" (calling it stretch isn't really accurate) you have. The more virgin tissue, the more natural flex. The more adhesions/scarring, the less... just like how our skin can stretch, but our stretchmarks are scars and we aren't getting any more stretch out of that spot. I'm about 3 mos out and often still get full on tablespoon portions. ^ I actually had a good conversation with my surgeon about that yesterday. We're told not to graze, but if it weren't for grazing I'd max out at about 300 calories. I was talking to him about the verbiage he uses... if you tell people not to graze they're going to think in terms of meals. I have three meals, but 2 - 3 "snacks" -- but since each meal/snack takes at least 30 - 45 mins to eat (except for Protein bars, they go down like nothing)... that's about 5 - 6 hours of the day I spend eating, and in my book that sounds a lot like grazing.

Me too! I'm down about 17lbs from my 2 day clear liquid diet. I can't help but worrying though since it has been so easy compared to the band. I keep wondering if I'll have adequate restriction as a revision patient. What does restriction feel like to you? I feel restriction finally...with sleeve. I never did with the band. This was the best decision ever! You may be worried because this feeling is all new...the band never did the job...like sleeve. You will have true restriction when u move to real foods...believe me! I can eat a couple ounces at a time...then I'm full abd I'm never hungry between my meals! That's helpful. Right now I can eat 3-4 oz of puréed and feel satisfied and full for long periods of time. In fact I don't really ever feel hungry I'm just wondering what the actual restriction feels like! Like what if I ate 5 ozs?! Guessing I don't want to find out but with the band we know what would happen

My weight remained around the same but I had a revision at my goal weight. Also my surgeon was modest with the length of my bypass (less than 150) because he was adamant that I shouldn’t lose more much weight (his preference from his experience- YMMV) For me, It is not the same restriction as the VSG. The VSG was a mid chest tightness like something was stuck. RNY feels like a lower abdomen fullness of eating way too much. I always try to stop before I get to that point. But I can eat pretty much the same amount with the RNY as with the VSG. I hope that helps ❤️

I am a bit of a hypochondriac so I was inspired to read this as well! I have hope that a revision won't be needed and that I can keep my weight maintained!

Stomaphyx is Bariatric revision for Gastric Bypass patients who are regaining weight. Not something that would be performed on a Gastric Sleeve Patient. People typically get this when they have stretched their pouch. Sleevers have less likelihood of doing so.