Possible band to bypass revision...questions and concerns

[William 2010 5]

Hi all, I having been lurking through these forums for some time, but now have a few questions. I will try to give a quick recap of my history and then get to my questions. I will post this in a few different areas of the forum so you may see it in other places.

I got the lap band about 4 years ago at 375lbs. Lost maybe 35lbs from the band and another 50lbs from hard work, dedication, and about 1 ½ hours in the gym daily bringing me to 290. A lady in my doctor’s office (she is no longer working there) was giving me blind fills (they normally place us under the xray to see how we swallow and if we are too tight). Obviously I was too tight, had bad acid reflux one night, some went into my lungs. My doctor unfilled me a bit, I then went to NY for a month (I live in NC). Stomach was irritated and band slipped, went to ER in NY where they took all Fluid out. Went back home to my doctor, they had me unfilled for 4 months. Ravenous hunger and a little depression ensued and I gained weight back and plateaued at 324. Had a few other issues similar to the above where the band would get irritated causing pain/discomfort. The take away is that the band stopped working, I am still at 324 and about to have my info submitted to insurance for a revision to the sleeve.

A more recent complication is where I said enough was enough with the band. The band can often cause pressure in the stomach/esophagus area causing acid reflux. I never have heartburn, but one night it appears I had “silent” acid reflux which cause swelling in the back of my tongue and voice box. The swelling was very weird, at times I would be sleeping and how I was breathing would irritate it and I would wake up with that area quivering/shaking (this has since gone away). I get the lump in my throat feeling ever so often. Doctor put me on protonix temporarily to reduce acid and allow stomach irritation to go down. I went to a throat doctor who looked at the swelling in my throat and said to stay on the protonix and allow about three months for the swelling in my throat to go down (it takes some time for it to heal I guess), but the swelling was consistent with acid reflux flare up’s that get into the throat. So here are some questions and concerns:

1.If I didn’t lose much with band, is the sleeve the best option? I would feel like all hope is lost if I went through with the sleeve surgery and lost 30lbs and nothing more. I would be heart broken. I am very active and very dedicated, not lazy by any means, but to go through this again and not have the surgery meet me half way would be difficult to deal with. I eat healthy and exercise, people in the weight loss office can’t even believe I weigh 324lb because I don’t look it. I have a high muscle mass, but none of that helps when it’s hiding under fat.

2.I’m concerned that if I have acid issues now (never have in the past other than a couple instances of late eating and band being too tight as stated above) is the sleeve the best option? The gastric bypass literally bypasses any acid reflux issues, but the doctor has not said I have acid reflux issues. Could the protonix be masking any symptoms that could come back post-surgery? Doctor also said I could go either way, sleeve or bypass. He said that because I was “successful” with the band that the sleeve would be a good option, but it was up to me. He supports me in whatever I decide.

3.Will the lump in my throat go away? I attribute this to the band as I have heard similar stuff from those who have been banded. One woman said anytime food passed through the band into the stomach it would spasm. It could also be from the swelling in my throat. Just curious is anyone ever had a “lump in throat” that went away after having the band removed.

4.For a while I thought I had anxiety. I had tightness in my chest, lump in my throat, tightness in my throat, etc… I started getting anxious thinking I had anxiety; I’ve never been that type of person. Then I had this idea that it might be the band. As soon as he took out the fill from the band the tightness in my chest went away. I still get tightness in my throat/lump in my throat which I know can be attributed to anxiety, but the throat doctor also said that I have the swelling in my voice box/throat/back of tongue. So I’m thinking that is the reason for the tightness. Anyone ever deal with this or something similar? Here is a good explanation of this: http://www.doctoroz....-lump-my-throat . As a side note, the doctor wanted to fill the band to check for a port leak and when he did, almost immediately, the tightness in my chest and throat came back. So if anyone who reads this is dealing with a similar thing, do not worry. Talk to your doctor.

5.Because it is common for those with band-to-sleeve surgery to not experience the weight loss as those who get the sleeve first, might the bypass be a wiser choice for me? I’m not asking you to predict my future, just your thoughts on the matter. Why would you choose sleeve over bypass? Etc…

This will be it for now, but as we discuss I will definitely have more questions. Thank you all for your help. I do appreciate any feedback and input you might have. I have twins coming in July, will have surgery before and I want to get the best option for me. Just worried I might have the same results with the sleeve as I did with the band. The band did not meet me half way.

[DLCoggin 1,788]

Doctors usually don't recommend the sleeve for patients that have a history of acid reflux. There are posts on the forum by folks who are having a sleeve to bypass revision because of acid reflux. But...from reading your post, it seems that the reflux you have experienced is attributed to the band as opposed to a previous history of reflux from other causes. If that is the case, reflux may not be a consideration in your sleeve vs. bypass decision. I had a history of reflux prior to surgery. I can tell you that since I had the bypass (two and a half years ago) I have not had a single instance of reflux. There are exceptions to every rule but it is rare for a bypass patient to experience reflux.

BMI is a poor measure of body fat for folks who are very muscular. But obviously your doctor believes that you are a good candidate for sleeve or bypass. Again, there are always exceptions to every rule but statistically speaking, it is highly unlikely that you will not lose considerably more than 30 pounds following either surgery. About 50% of excess body weight is often cited as an average. And losing considerably more than that is common. I started at 285 with a BMI of 35. This morning I'm 153 with a BMI of 22.9.

Both surgeries are safe and effective. Bypass is more invasive and has a slightly higher complication rate. Sleeve is less invasive and has a slightly lower average weight loss. Bypass is a little more effective at resolving type 2 diabetes but results in some degree of malabsorption increasing the importance of Vitamin supplements for life. Both surgeries can result in dumping syndrome but it is more common following bypass than it is with sleeve. Hospital stays and recovery times are a little shorter for sleeve vs. bypass. If for some reason the sleeve fails, revision to bypass is usually an option. Revisions following bypass are pretty rare.

I can't answer your other questions but I'm sure other folks will weigh in based on their experience. This is a great place with tons of very knowledgeable people. Welcome to the forum!

Edited March 27, 2014 by DLCoggin

[LilMissDiva Irene 3,281]

Hello @@William 2010 - I would advise you to please discuss the GERD issue in depth with your bariatric surgeon before making a final decision on which surgery to have. I was revised from Lap Band to VSG in Sept. 2010, which at that time it wasn't as recognized as it is today that prior GERD issues and the Sleeve are usually not a good mix.

I had incredible success with my Sleeve where I didn't so much with my Lap Band, but now I'm dealing with some really awful GERD, worse than ever and yes I did have it prior to my revision. However I did not have acid reflux problems before I was Lap Banded in Feb. of 2008. I am now faced with the situation that I must have a revision again to go from VSG to the Rny GB to relieve me of the acid problems I'm having. I wish I had been told this prior to revision, but hindsight is 20/20. Only you know the full scope of what's going on in your life and health and only you and your surgeon should make the decision with certainty that everything will work out fine. I can tell you this though I love my Sleeve and it is a wonderful tool! I also hope I will love my new pouch just as much.

All the best in your new journey!!

Edited March 27, 2014 by LilMissDiva

[iamsoworthit 430]

I had lapband for 5 years and rekate to your story so much. Mine was a little different in that the gerd and reflux ended up doing serious damage and last year I was diagnosed with intestinal metaplasia, a precursor to stomach cancer. It was then that I decided to revise to rny or at a minimum take the band out. My highest weight was 267. With the band I got down to 185 and the first two years were great. Then the reflux, heartburn and port pain started. I ignored a lot of the symptoms, like a fool, but wanted to succeed and was afraid to admit I had a problem. The last three years of my band were pure hell. I didn't eat, I played what I call food games where I would eat nothing all day until my band ' warmed up' and ate slider food due to pain and starvation. When I decided in february 2013 to take it out due to the diagnosis I decided on rny because I never wanted gerd or reflux again. My surgeon was at mayo clinic for both so I had the best of best. My revision was in june 2013 and I am now 144, no reflux or gerd and my intestinal metaplasia gone! Rny was the best decision in my life. Good luck with your choice and yoy can send me a personal message if I can help in any way.