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My doctor does sleeve-to-bypass revisions for those who have GERD or those who don't lose weight with the sleeve.

I don't know how many are "many" (there is something called "adverse selection" that is common in online forums, where negatives outnumber positives because everyone with a complaint will post about it, but those with nothing to complain about are largely silent, so things tend to seem worse than they are,) but it does happen for a few reasons. The sleeve is predisposed do reflux problems due to its geometry and physiology. The volume of the stomach is reduced much more than the acid producing potential, so it takes a while for the body to adapt, and sometimes it doesn't. Also, the sleeve is considered to be a "high pressure" system in that the stomach is often closed off by the pyloric valve at the bottom, so excess gas, fluids or solids have no place to go other than back up; the bypass is a "low pressure" system as there is no pyloric valve in the system, so excess gas can vent down into the intestines. In contrast, the RNY due to its geometry and physiology is predisposed to dumping, marginal ulcers, reactive hypoglycemia and bile reflux. With either procedure, this does not mean that everyone will experience these problems, just that this is the natural result of the anatomical changes that have been made. Another compounding factor with the sleeve is the relative experience level of the profession - in the US, the sleeve has been routinely approved by insurance for about the past 6-8 years, while the bypass has been routine for around 40 years. This means that there has been some revisions needed due to inexperience in some of those early sleeves - the surgeons may have been well experienced doing bypasses and bands, but a new procedure, even a straightforward one such as the sleeve, brings along its own subtleties and nuances that take practice to master. Resultant shaping issues can promote or exacerbate the reflux problem. In the US, most bariatric surgeons are now far enough up the learning curve that most are now making routinely making functionally competent sleeves (one should always seek out a surgeon who has several hundred of whatever procedure one is interested in under his belt.) However, now the problem is, as it has been since early on, is that many are not very experienced in correcting any problems that may crop up with a sleeve, so the natural inclination is to stick within their comfort zone and revise to a bypass when a problem occurs, rather than correct the sleeve. So yes, the OP is correct in some respects that there are some unnecessary revisions being done, though not necessarily just for the sake of charging for two procedures. As time marches on and the industry gets more experience with sleeves, I would expect that the revision rate will decline as both the sleeves will be made better overall, and the surgeons learn how to repair them when necessary rather than revise them, much as the bypass has matured over time and some of its predisposed problems are less common as they have learned how to mitigate them to the extent they can (bile reflux isn't too common anymore as they have worked out techniques to minimize its occurrence, for instance.) Another factor that may skew the impressions some is that the bypass is a difficult procedure to revise - it is something of a dead end surgically speaking. If poor weight loss performance or regain is experienced, there is little point in reversing it and revising it to a sleeve as they are both so similar in performance that there isn't much to be gained. There are minor tweaks that are offered - tightening of the stoma or intalling a band over the bypass - but overall results are generally pretty poor. Revising it to a DS, which can offer improved weight loss and regain resistance, as well as diabetes remission, is a very complex procedure that only a handful of surgeons are capable of performing. So, we don't see a lot of bypasses revised for that reason, though sometimes they are reversed if there are significant complications that can't otherwise be resolved, though that isn't a trivial option, either.

You might want to seek therapy, we all have our food issues. I know some people that cannot trust themselves and have revised their food choices to be less palatable - not untaste-y - but not hyper flavor saturated as this lead to overconsumption every time.

@Jodi1980 - Sorry I'm so confused... Can you clarify - you had initial VSG 2012 and "less than 2 weeks away from my revision and I'm not looking back." What does this mean? Did you re-gain all the weight you lost?

Revisions from restriction only to restriction and malabsorption are common. I'm a Band to Bypass revision myself. Reasons will cover a wide range of situations. Maybe someone ended up with GERD after the sleeve, or they lost some weight but plateaued out and couldn't lose more (like with a lot of folks with the band did), maybe the sleeve didn't "work" (IE the person didn't change their habits enough or figured out how to eat around the sleeve), maybe they had complications that required the revision. There are quite a few reasons. But all of them fall into one big category "something didn't work right the first time"

I met my goal at 1 month but I am a revision and had very little to lose...we knew that would happen. I’ll likely get a bit too low before I can fit in enough good calories to maintain a good stable weight. I refuse to eat garbage just to get calories in. Everything was in place ahead of surgery.

First I don't know the answer but I will guess. It seems like Sleeve surgery is trending right now. But many who have the sleeve encounter problems with severe acid reflux (Gerd). Sleeve only makes this condition worse. So therefore they have a revision to gastric bypass.

Thank you. I actually could have answered on the revision as that is the surgery that I had February of this year but it did not fix anything. The Dr. thought I might have something called Candy Cane Syndrome and so he did a bowel resection and as mentioned it was unsuccessful. I am actually a pretty strong person but going through this has even affected my poor husband. We have been married August 8th 31 years and I hate that he has to be so sad over watching the situation but he is my strength even though sad and a very strong advocate for telling others to really think twice before going under the knife.

@churchgirl You have the mindset and your new "tool" , make it a habit and your new way of eating and you will be fine. I had my initial VSG 10/2012 and years out. I too was a grazer. I say "was" because I am less than 2 weeks away from my revision and I'm not looking back. Something that was written in my hospital program and holds testament, "eat to live, don't live to eat". I just need to convince my brain to get happy neurons somewhere else

There are a couple of factors at play here. Yes, revisions typically show slower results than an original or virgin WLS. Think of it this way - when you had your first surgery, your stomach had a capacity of somewhere in the 32-64 oz neighborhood, depending upon how much you stretched it at a meal; after surgery and some months or years of adaptation and growth, your stomach would have a capacity of maybe 4-8 oz. that you had learned to live with, so there isn't nearly the difference in capacity with your revision surgery. There are also some metabolic and hormonal changes that come with the surgery that help you over your "normal" obese state, and that change is now less with a revision. Further, if you had a pre-op diet where you lost the initial 20ish lb, you have already lost most of that quick and easy water weight that we lose when we first start a major weight loss effort; those of us who never had a pre-op diet will experience that rapid water weight loss soon after surgery and will show those impressive numbers that you sometimes see in the forums.

@apositivelife4me I am the prime example of why not to drink carbonated beverages! That along with other factors (had my son and switched on different medication) contributed to my stretching out my sleeve and now here I am getting a revision in 2 weeks. I would not recommend it for the better part of a couple of years post op if ever. It's not worth it!

hi all! I had a revision from sleeve to bypass on May 30th, and 6 weeks in I only lost 17 pounds from surgery day so far. preop highest: 260, Surgery Day: 241, CW: 224 Is anyone else having issues? I am getting my 60 g of protein, 64 oz of water, and walking more (maybe 2-3 miles a day). I am getting SO frustrated when I see others at 6 weeks down 20-50 pounds. Any suggestions, or similar issues?

What was your starting weight? I had a revision from sleeve to bypass on May 30th, and I am only down 17 pounds, and getting extremely frustrated. Preop highest: 260 Surgery day: 241 Current weight: 224 I am 28, 5 ft 4

My lap band surgery was almost 12 years ago. It was nearly pain free. I was playing with my then 8 year old on the floor within a day or so. But, I always bounce back right away from all of my surgeries. I’m not a great benchmark. I’m very, very fortunate. My band was not over bypass. Just straight-up lap band on regular stomach. I actually just got it removed and was revised to a sleeve in May. I wish you the very best. Please consider seeing the local surgeon you didn’t choose, the one who worked with you before. I think they will be more concerned with making sure you are okay than some lost business. And update here. I’m concerned about your pain level.

It sure sounds like more than "sweet tooth" as others have said. Please be sure to mention to the doctor about GI bleeding/blood in poop. This is a serious and can be a potentially life-threatening situation. What color is the blood? Dark tarry black/brown? Or bright red? Also, the intense deep pain you describe that doubles you over is not normal. So please please bring these up. At the very least I'd ask for an EGD, and even more, maybe an upper and lower GI or MRI? I'd especially do all of this before doing another surgery. And the GERD symptoms being so bad after the VSG, that alone would merit a revise to bypass or DS. But I'd worry about having a DS being as light as you are going in. Hope you get it figured out soon! Hang in there and you might see if going back to low carb and ditching any wheat/sugar will help at least improve the GERD a little and also improve the insatiable hunger a little in the interim?

Yes I had a sleeve Feb 2016 and revised to bypass. And yes, I'm still having reflux 24/7. One may ask how that's possible but I assure them it is. It actually feels like I didn't even have bypass at all. In fact I complained about reflux before I even left the hospital!!!! When I had nothing to eat!! I am currently waiting on my bravo testing and manometry testing. I am on dexilant 60mg, carafate, and zantac. I just don't understand! 😥 It can't be my diet because I'm not eating anything. Still on stage 2

Not sure if you’ve had an endoscopy or not, but it’’ll show the damage, if any, caused by your band. If damage is found, the doctor can request treatment for the issues or request that insurance cover band removal. Docs usually want to remove with the intention of revising the patient to a different surgery. I literally had to threaten my doctor to finally get him to put in for only a band removal with no revision. He caused me much suffering over the years, and I was done. He was so afraid when I suggested that he call security, that he finally agreed. He worded it so that insurance approved it about 48 hours after the referral. Sometimes we have to fight for our health. Literally. Good luck.

I’m confused, did you have a revision from VSG to RNY and still have reflux or did you just have a VSG? I’m so sorry you’re still struggling with GERD. Are you working with a top notch Gastroenterologist to figure it out, have you had a recent EGD to see what may be the root cause, and are you taking any PPIs?

Had my sleeve to bypass revision today and in a lot of pain. I’ve had seven surgeries in the past for different issues and this by far is the worst for post-op. Hoping someone will tell me it gets better each day

I revised only three weeks ago due to severe acid reflux. Unfortunately it has not helped my reflux at all. I'm in pain 24/7. Literally. However this is NOT the norm apparently and I would encourage anyone to revise who has GERD.

Anyone have revision from sleeve to bypass? I would like to hear your story? Ups, downs, how it is working for you?....any information you are willing to share with me... Thank you

I was just revised to bypass from band last week. I only ever lost about 35 lbs with the band but would have stuck food constantly which made me eat sliders. So far so good. I waited 10 yrs too long to make the change. Good luck!

technically a 13 year vet, but the system only let me on the vets forum recently because of my revision date. almost a year in maintenance post revision, so only check in once in a while.

On and off since 2011. More on back in 2011/2012 and recently after my revision.

Curious you why didn't revise in the same surgery?