If someone had gastric bypass.....and they haven't lost as much as they'd like. (its been 10 years) Can they get the sleeve????

I've heard of it being done. It is not standard by any means. I think a DS would be the better option.

Wouldn't getting the sleeve be a backwards move from the bypass procedure? Isn't the bypass rerouting the digestion bypassing the stomach all together and going straight to the intestines? I just want to make sure I am understanding what the procedure is.

It's possible, but not too common - revising to a DS is much more common. When getting around to re-routing the intestines, it's just as much work to change them to the DS configuration as it would be to put them back to "normal". The tricky part is restoring the stomach to normal and sleeving it - there are only a half dozen or so surgeons in North America who are genuinely qualified to do RNY/DS revisions (or as noted, revising to the VSG is a similarly complex job) - check out dsfacts.com for more information on the DS and on RNY revisions and a list of qualified surgeons. Also check out the DS board on ObesityHelp.com. My big concern would be the viability of the remnant bypassed stomach after ten years - things in the body that aren't used tend to atrophy over time.

The other option is to stick with the RNY and have one of the more experienced RNY surgeons do one of the revisional surgeries that are used to correct some of the RNY problems, such as tightening or banding the pouch, tightening the stoma, or changing the intestines to a distal configuration. None of them work as well as the DS since they're simpy rejiggering the RNY configuration some, but they are more widely available procedures.

Wouldn't getting the sleeve be a backwards move from the bypass procedure? Isn't the bypass rerouting the digestion bypassing the stomach all together and going straight to the intestines? I just want to make sure I am understanding what the procedure is.

Not really a step backwards (many would consider it a step forward!) but more of a sideways step - the RNY and VSG overall provide very similar results, though the VSG does it more simply.

Yes, the RNY bypasses the majority of the stomach, (along with the duodenum and a small part of the small intestine,) with a small portion of the original stomach being formed into a small pouch between the esophagus and small intestine. There are a number of problems created by the RNY configuration that are avoided with the VSG while offering similar performance, which is why we are seeing a growing use of the sleeve, and many RNY surgeons learning how to do sleeves.

Not really a step backwards (many would consider it a step forward!) but more of a sideways step - the RNY and VSG overall provide very similar results, though the VSG does it more simply.

Yes, the RNY bypasses the majority of the stomach, (along with the duodenum and a small part of the small intestine,) with a small portion of the original stomach being formed into a small pouch between the esophagus and small intestine. There are a number of problems created by the RNY configuration that are avoided with the VSG while offering similar performance, which is why we are seeing a growing use of the sleeve, and many RNY surgeons learning how to do sleeves.

Okay. I understand. Thank you very much.

Dr. Aceves, who is a very expereienced sleeve surgeon, said he would never even consider doing a sleeve on someone who had gastric bypass . He said that with the pouch that they make when you have the gastric bypass operation there is not enough stomach tissue left to do a sleeve.