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Remember that the sleeve can always be revised to the bypass but not the other way around. I had the sleeve 2 years ago eliminated 100lbs and think was the best decision I made.

Let me try and recap. You had Lap Band surgery in 2014. You had a revision to Gastric Bypass Surgery around 8 July 2018. The three most important elements after RNY gastric bypass surgery are to meet your daily protein, fluid and vitamin requirements. Food is secondary because your body is converting your stored fat into the energy that drives your body. Thus you lose weight. Weight loss is achieved after surgery through meal volume control. You begin at 2 ounces (1/4 cup) per meal and gradually over the next year and a half increase the volume to 1 cup per meal. With this minuscule amount of food, it is next to impossible to meet your protein daily requirements by food alone, so therefore you need to rely on supplements such as protein shakes. Without sufficient protein, your body will scavenge protein from other areas of your body, such as your muscles. Protein is extremely important after surgery as its job in the body is to build and maintain tissues including your body's major organs and skeletal muscles. Protein deficiency, when continued over a long period of time can cause a disease known as protein caloric malnutrition. Common symptoms are poor healing, fatigue, hair loss and muscle wasting. Immediate post op, protein promotes healing of the staple line and incisions. Right after surgery, I was probably consuming around 500 calories per day. But I was drinking 3 protein shakes per day in order to get in the protein I needed. Why is your doctor recommending that you not drink protein shakes? Is there some medical reason for it? If so, you might have to seek an alternative which is drinking a lot of milk. So you have an option of drinking fortified milk. 32 ounces of 1% milk fortified by adding 1 cup of dried milk provides 56 grams of protein. It also takes a dent out of meeting the fluid requirements. Mix up a pitcher and drink a little throughout the day. I found it difficult to drink protein shakes because I could not find any that tasted good. But I am not sure you have that problem. In the end I experimented and found one that I could tolerate. As my meal volume increased, and I was able to meet my protein requirement by consuming high protein meals, I was able to offload my shakes. But you are at the beginning of the process. So my words of advice is to MEET YOUR DAILY PROTEIN REQUIREMENTS - PERIOD. Find a way. I totally do not understand the logic of your doctor about not utilizing protein shakes. Is this your surgeon's office making that request or is it your family general practicioner?

I had a band to SIPS revision with Aetna. The time from submission to approval was super fast, I think like 2 or 3 days. I can’t exactly remember but I do recall it being so fast that I had to question if they really said approved.

This is interesting. Is this why we are having so many,sleeve to bypass revisions recently?😨

I had the sleeve, lost a little bit of weight, lost restriction, gained weight back, developed GERD & then had a revision to RNY. wish I had the bypass to begin with. I definitely need the malabsorption & restriction. I feel like there’s a lot of leeway with the sleeve in terms of foods that one can eat. But that’s my opinion and it doesn’t happen for every sleever. Good luck in your journey

Thank you! My doctor has me back on full liquids for two more weeks. He then wants me to do one teaspoon of food when I try again, since my pouch is smaller due to it being a revision. If that doesn’t work, I will have an endoscopy and he will use the balloon to open up the pathway a bit.

Personally, the Bypass is my choice. I had the band installed in 2011, long story short, I was revised to the bypass this past march. There are a decent number of folks that end up having their sleeves converted to bypass as well. The Sleeve has issues with GERD and acid reflux that the bypass doesn't have, Not sure why he even offered the band, even 2 of the largest band manufacturers have given up on it at this point. Good luck in your progress forwards!

@hayr995 I was all over the place for the first few weeks: Happy that I finally had the procedure done (I was a revision from a lap band so I was happy the band was out too) Depressed on and off over the foods that I couldn't eat that I would see on TV or smell as my family was cooking their meals. I just would take a second to remind myself of how much better life in general is going to be once I shed the extra weight. Excited over the weight loss. Frustrated over all the things I couldn't do. Even had a few moments of being totally unsure of what I did, not feeling like it was the best decision. This occurred while I was on my second night still in recovery. Just felt scared and nervous and upset that I screwed up and made the wrong choice again. But, I just kept moving forwards and eventually all that went away. I still get moments here and there where I go "sigh, I'll never be able to eat that without some serious issues" usually that happens when I'm watching TV and a commercial for some new food product comes on, I just make sure that when that does happen, I remember what that food did to me, how it made me feel *after* I would eat it and how much happier and more energetic I am now. It's normal to be scared, to have emotions that fall all over the place at the drop of a hat for no reason with these surgeries, but it's very important to just keep reminding yourself that, the journey might be hard but the reward is well worth it!

For those of you that need or have had revision surgery, what do you think was the gateway to the weight gain? What do those undergoing WLS really need to be careful about?

Thanks for sharing! I feel the same way about eating right and exercising. It feels as though I don’t lose a lot of weight even when I am eating and exercising right. Even Day 10 on the liquid diet, I only lost 10 lbs. I feel like people lose way more than that!!!! Good luck on your revision! I hope you get to your goal weight.

You have to let me know how you are doing after you have it done. I am also a revision from band to sleeve but mine will be on the 17. I am so scared for some reason.

It sounds like you are doing the right thing to wean off of them, but that your body isn't ready to, as if whatever underlying problem has not been resolved. This certainly isn't normal. Typically we hear of VSG patients having problems with acid reflux and heartburn that sometimes can't be resolved, so an RNY revision is sometimes done, though reflux can hit the bypass too sometimes, though fairly rarely. The asnastomis between the pouch and intestine is sensitive and the typical location for ulcer problems - the intestine where the pouch joins isn't resistant to stomach acid like the duodenum is, hence the sensitivity. I would think that the endoscopy would have shown any problems there. That leaves the remnant stomach and upper bypassed limb as a possible problem area. The remnant stomach is where most of your acid production typically occurs, but that is usually neutralized by bile that's introduced into the duodenum. so perhaps there is something wrong there that is creating an imbalance. Unfortunately, that doesn't show up in an endoscopy with your bypass anatomy. You mention that you are following your surgeon's instructions on taper off the PPI, so I assume that he is in the loop on this problem and should be able to suggest the next step. Does the omeprazole resolve the problem when you are on it, and this is just a problem when trying to taper off of it, or is this a continuing problem even with the omeprazole? Perhaps whatever quirk there is in your body isn't ready to give it up, as desirable as it may be to do so. If you haven't found her already, maybe you can reach out to this gal who is having significant ulcer problems with her bypass - there may be some insight from her problem that can shed some light onto yours. This is a puzzle, and as my PCP likes to say, you don't want to be an "interesting" patient - great for the MD's to have an interesting problem to solve, not so great for the patient. Perhaps this is your turn. Been there, done that myself on the interesting patient thing, with a different problem. Good luck in getting this resolved.

Has a GI doctor ever assessed you for and recommended a Nissen fundoplication, which is a surgical procedure to treat GERD disease and hiatal hernia? PPIs just take mask symptoms but don’t resolve root cause, so you may need to address the underlying issues in order to correct painful GERD symptoms. GERD is no joke and needs to be managed by clinicians with extensive experience with it in bariatric patients. Your RNY surgeon may not be the best person for this. I speak from experience with this myself. I recently had a hiatal hernia repaired, which appeared small on imaging, but was much larger in the operating room. A new revision surgeon fixed the HH and added the fundoplication. I’ve been dealing with this issue for years and am finally optimistic I may be on the mend for good.

@beautifulmess @atlantared hey! May I ask why a “revision”? I wish I saw this yesterday when I was at my surgeons for an appt, I asked him why sleeve was a better option. He didn’t say specifically that sleeve is better he said that it’s safer. But now seeing that you are both having revisions. What would be the reason for a revision?

Hi. I’m going to answer as many of your questions as possible, lol. Yes Dr. Ponce does actually perform the surgery but rarely meets the patients, a few others on this forum have also stated this. However, his reputation in Tijuana is very good if not probably the best if that is any consolation. He gets called by other docs to handle difficult cases. I did make a complaint to Dr. Frayre and to Lana (the driver who picked me up and sent me to the airport— she checked up on me not Ana) Ana coincidentally had the sleeve done the day after I had mine. My bad luck I suppose but otherwise I think things would have gone smoother. I had surgery the same day I flew in even though my flight was delayed and I did not arrive at INT hospital until 3-4 PM. (I should have arrived at 10:30AM and had the surgery late afternoon. I wanted to get it over with to be honest with you and needed the following two days to recover before my trek home. So I insisted they still operate and I think the docs wanted to have the weekend off (I arrived Thursday—surgery Thursday night at 10PM, hospital Friday and Saturday, hotel Saturday to Sunday, went home Sunday morning.) My BMI was 33 when I started preop and 32 when I actually had the surgery. I was charged $6000 total which originally should have been $6500. Now the reason I was charged that was b/c originally I was considered a revision because I had an ESG (similar to gastric plication but they go through the mouth so no incisions) but that was a complete failure because I lost no weight and began to gradually gain. When the surgeons went in they said my stomach looked completely normal as if nothing had been done so they took off the $500. (That showed their honesty in my opinion b/c I had no clue). I still had to be charged the extra $1000 for the SILS because they used the special equipment required and they did discuss with me beforehand that one extra incision may be necessary but once the special SILS apparatus is used they charge. I didn’t mind the extra amount because otherwise I’d have four to six incisions instead of just one and a minute one from the drain. I had 2 c-sections and they were still able to do the SILS but I don’t know about a tummy tuck. Just ask Ana she is very helpful and answers you super fast. The only advice I can give you is download google translate if your Spanish is as bad as mine, walk ALOT after surgery—it’s the only thing that will get rid of the awful gas you’ll have, which honestly by day 2 was so much better. I have not vomited at all since the surgery. I felt really nauseous the first ten minutes after I woke up from surgery and dry heaved but no vomit yet 🤞🏻🤞🏻Thankfully! I did not experience much pain at all just soreness where the incision was (I felt no pain at all at my belly button) and the drain is uncomfortable but they take it out by 2nd day and you’re good to go. No worries the staff and everyone there take really good care of you and your surgeons are top notch. Just be prepared for slower weight loss like me because we have less to lose. The restriction however is fabulous. Once again best of luck and please let me know how you made out!!

New here! I was lap banded years and years ago and had success. But alas, the band slipped. I year without the band now and very much in need of a revision. Surgery scheduled for 8/22. Preop diets starts in 8 days. Looking forward to getting to know you.

At the end of the day I think your post illustrates the best in a bariatric patient. The intense thought process considering all of the possible complications for getting, revising, or removal of the surgery. Going into this blind after watching a few "My 600# life" shows is about the worst thing one can do (And yes, I watch the show myself). It sounds to me that your mind is in the right place - considering what is going to improve your life the most, and yet doing lots of research on it. I applaud you for your research and I am very sorry for what seems like an awful number of years. I'm only 3 weeks out from my revision from a band to a RNY, but there were a number of reasons I went with a RNY over the sleeve. One of which is the possibility to do a reversal. Yes, it is not without complications, and no, it is not a complete reversal, but yes, it is still possible. With the sleeve? not so much. I would imagine that something as complex as a reversal would be quite variable between patients - what reason for each reversal is probably drastically different. So while I do think it is really good to see how outcomes were, I would postulate that your surgeon is probably going to be the best to trust. I was told that my surgeon was very "conservative" when it came to revisions. I was told he would go in and remove the band, and if things were really bad from scarring, he would not do the revision, and instead allow me to heal for 3 months before coming in and doing the revision. Maybe have a frank talk with your surgeon and make the same request. Maybe when he goes in, there is an obvious problem that can be fixed without actually reversing the procedure? Just throwing out another idea, if there is someone in your life that you trust your life with, consider filling out a medical power of attorney, and have a long conversation with them about your desires. Then, if doing the surgery the doctor would have a person to turn to and present both options...Your medical power of attorney, knowing your intents, could make the decision instead of a doctor who has spent an insignificant amount of time with you determining your interests. For my revision surgery, I did the above with a family member, so I'm not recommending something I didn't do myself. I will be praying for you and I wish you the best outcome, no matter what needs to be done to improve it!

My doctor wants to perform a sleeve. I would prefer a bypass due to my eating history and desire to succeed and make it last. I dont want to go back later and have to have the bypass if I have already done a sleeve. Please advice me, not really sure what to say or do at this point. I want surgery even if it's just the sleeve. Will it work? Is it a ploy to get revision money later? [emoji15] Sent from my SM-G930P using BariatricPal mobile app

I'm August 6th, sleeve to bypass revision too.

i am about to have a conversion from a sleeve to a bypass - next month. Can you tell me what the changes were after you had this revision done? thanks

My band ended up giving me Grade 3 Esophagitis, I had no idea either, it wasn't until I had the upper endoscopy to make sure there was no erosion with the band before my revision that I found out I had a moderate to severe esophagial damage... Now, heartburn and other burning issues are totally gone!

Thanks mate that's what I have been told by a lot people including my friends I'm so glad to hear that you are very happy about the revision cant wait for mine in November i have an almost empty band still suffering from food getting stuck due to the inflammation and the constant heart burn nexium 40 is becoming my only help atm Sent from my SM-N950F using BariatricPal mobile app

I'm a band to bypass revision myself. Had the band installed in 2011, and whereas I didn't have any severe issues, the band just didn't work out well for me, I got stuck constantly, leafy greens hurt to eat... it was just not how it should have gone. I spent years feeling like a failure. I finally went back to my surgeon after years of not checking in and we discussed my options and on March 21st, I had my band removed and was revised to the bypass. And I haven't been happier about a decision in a very long time. I really do wish I had the bypass back in 2011 and didn't get sucked into the promises of the band. The Bypass surgery has come a long way since it showed up. Do people have problems, they sure do, but seems you are already dealing with some pretty intense issues with the band, not sure what potentials with the bypass are scaring you away from it... I'm so very happy with my revision.

OP: I’m so sorry you’re going through this. It sounds complicated and confusing. I would get a second opinion from another bariatric practice that has extensive revision experience. They’re the best ones to guide you and provide accurate medical assessment, not us random folks on the Internet. Good luck.

It is best to consider it to be irreversible as one typically needs some form of WLS to get or keep the weight off, so revisions are the norm in that case, but in the rare cases where something is drastically wrong as I believe is the case with the OP, it can certainly be put back to semi-normal again. When the bypass is revised to a DS, that is the first step before the reunited stomach is sleeved and the intestines are reconfigured.