Are revisions REALLY necessary?

[Babbs 14,680]

I found myself at a WLS regain support group site someone had recommend in another thread just to check it out, and read this comment the founder of the regain program said about revisions:

"If I had a dime for everyone who asks about ‘a Revision’, I would not have to work. Even if you need a revision due to a mechanical band failure, you still ate your way through the first surgery. If do not change the way you eat and have more surgery, you will eat your way through that one as well. More surgery is not the answer. Bariatric surgery is not a dam that is built to hold back the deluge FOREVER, it’s meant to hold back our eating and remove the bulk of the weight burden while we get our act together!"

I know this is going to be a touchy subject for some, but what are your thoughts about the above statement? I have always agreed with her sentiment, but also don't like to paint everyone with the same broad brush because just like with anything, there are always special circumstances.

What say you?

[Hammer_Down 631]

I read about many of the issues with the lap band while I was intially researching WLS.

It seems that some bands were made of substandard materials, prone to corrosion or improperly fitted to begin with.

In those cases, i can understand not wanting to have something literally rusting or corroding on my insides.

As for the rest of it, I'm inclined to agree. I saw a post from a lap band to sleeve revision patient who has regained the weight and is now trying to qualify for a bypass. Personally, I think it would be malpractice to continue to operate on someone who obviously has an underlying issue that surgery will not address.

It might not be the answer that is popular, but all of the procedures work. Not following the diet is the part that doesnt work.

Huat eaeloer today there was someone inquiring about revision, and asking about eating mashed potatoes on liquids.

[Who'sThere 331]

I agree to an extent. I didn't lose a lot to begin with (65lbs) but I lost enough that I considered my surgery a success. I certainly felt better and was healthier than before. I feel like I never did solidify great eating habits completely. I did well enough to keep the weight off for 3 years, but if my eating had been better, I would have likely lost more.

Then, I got pregnant....and everything changed. My entire body feels foreign now, even my hair. I used to have very naturally curly hair, and now it's stick straight. I feel like that's an outward illustration of all the changes to my body. I had to have my band unfilled and never got correct restriction back. We had a very sick child for a while, and it was sooo easy to go back to my poor eating habits and I had no restriction to help me.

I take 75% of the blame for my regain. I lay the other 25% on my endocrine system and a persnickety band that has me vomiting 3-4 days a week until late in the day.

I am hoping this time to make my changes permanent. I can't afford to keep this weight on. I have a child I didn't have before and she is the best motivation I have to take care of my health and model good eating habits.

I do feel I'll be successful because I have already, prerevision, made some very good changes to my habits. It's all different to me this time.

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[Dairymary 533]

I saw more than just a handful of revisions in my support group. A LOT of band revisions due to complications, and some sleeve to bypass due to GERD or regain. The former banders were generally more successful the second time around. But bottom line with any of them was if the patient didn't drastically change their lifestyle, the revision was just as much of a failure as the first time around. It was very frustrating for me to watch so many make the same mistakes and come to group with all the same complaints, never really holding themselves accountable for the failures. Or worse yet, knowing what the problem was but not taking the steps to correct it.

There was one surgeon in my area that refused to do revisions unless the patient first went through six months of psychiatric therapy to address their food addictions and/or eating disorders. The psych had to give two thumbs up before surgery was approved. A lot of patients were pissed and looked for another surgeon. But for those that didn't, they were very happy with the help they got and were quite successful the second time around.

[summerset 5,261]

If only I had a dime for everytime I have to deal with ignorant statements...

"If I had a dime for everyone who asks about ‘a Revision’, I would not have to work. Even if you need a revision due to a mechanical band failure, you still ate your way through the first surgery.

Huh? So there is a failure of the material and it's the patient's fault and "ate his way through first surgery"? Yeah, right...

I know this is going to be a touchy subject for some, but what are your thoughts about the above statement?

I think that statement is quite ignorant because it ignores the fact that there is revision out of very different reasons, even though weight regain or losing not enough weight might be the more common one.

Many revisions are taking place because of severe GERD after GB or sleeve or because of bands eroding into the stomach.

[Aggiemae 739]

Revisions are only necessary if the surgery fails, which does happen with the lap band but how can removing most or all of your stomach "fail"???

Some people like to believe that if they gained back all their weight the surgery "didn't work" for them or it "failed" .Making bad choices caused the weight gain. Why they believe that ANOTHER surgery is the (magical) solution is beyond me. And expecting insurance to pay twice? Please. If the surgery they already had still works (it probably does) the patient needs to TAKE RESPONSIBILITY and do their part.

The thing about this that is craziest is how often people post that there new surgeon is trying to get them approved. This seems to validate the belief that the previous surgery was somehow flawed. Sure the surgeons staff is trying to get as many pt as possible approved. That's how they make their $$$. I think a competent surgeon would have the integrity to say no.

[Djmohr 6,965]

My personal opinion is that some surgeries fail due to equipment, mostly lapband patients.

Many others fail because they dont do enough research and choose the wrong surgery and their "lazy" surgeons allow it because it is easier for them. Sometimes i actually wonder if this is because they can get two surgeries in the end. $$$ dont know this for sure but i certainly wonder sometimes when it is clear that someone likely should choose a different option yet their surgeon tells them it may be ok.

But mostly......people simply dont educate themselves enough about what they need to do or they simply choose to keep the same habits. It is definitaely easy to do because the first year "honeymoon" pretty much allows you to eat whatever you want and still lose weight. However, when the honeymoon wears off you are screwed if you have not changed your behaviors.

Again....simply my opinion but I tend to agree...I have seen people on this website actually say, if this doesnt work i guess i can always have a revision to bypass. Ugh.....what?????? How ridiculous!

[shedo82773 1,236]

Well SHOOT!! I typed all of my stuff and lost it!! I have heard people say that my WLS didn't work. I don't totally agree with this. But like was said it is the choices that we make. Now the Lap Band failing I have 1st hand in knowing about. As you see my hubby had his for 13 years. He lost 100#'s with it but never met his goal. Yes, he did eat around it but it also was damaged during a fill, more surgery. Then in 2013 he went in for a revision to a RNY. It had eroded into his liver. Failed surgery. Then he got abscesses. Was deathly sick for 9 months 3 of which he doesn't remember. His Surgeon dropped him in the middle of his treatment, told him to go to his PCP or the ER. But hubby was so desperate he went back to this Dr again. Then he told him that he was a PROBLEM CHILD and he wouldn't do the surgery. He referred him to Portland, Oregon OHSU one of the best Bariatric Centers. They said they would try to do the RNY but he needed to lose 25#'s and get his A1C down to a 7 or 8. Which doesn't sound to hard right. He couldn't do both, if his Blood Sugar was good his weight went up and the same for his weight down BS up. In the mean time we find out he has Kidney Cancer but there is nothing they can do until he loses 150#. So down to Mexico self paid surgery. When they get in there he couldn't do the Rny because his whole right side is solid scar tissue so he gets the SLEEVE. This was June 3, 2016 to this day he has lost 60#'s. So pardon me when I say it isn't always easy to get another WLS. It makes me so mad when I hear someone say well, I'll jus ge a revision if it doesn't work out. We don't always get what we want. Now I'm not saying he did everything he could to lose his weight but darn the problems his weight has caused us!!! So I guess I'm saying in some cases yes a revsion is in order but if it is just because THE WLS didn't work, then they do need to go thru more counseling to make sure that their mind is on what needs to be done!!

[shedo82773 1,236]

Djmohr

What you said about the DR's is exactly how I feel. If they made it a little harder and with more education about the surgery then maybe it wouldn't be so abused!! It is so much the MONEY FACTOR!!! Just like my PS did with me. Well, I will give you a good price for Lipo and a breast lift!! HELL to the no!! I feel like he was drumming up more business!! MONEY MONEY is the evil product of greed!! Sorry I just get so involved!! LOL

[Aggiemae 739]

Yes She do, pre operative education and counseling is an important part of post operative success.

http://journals.lww.com/orthopaedicnursing/Abstract/2011/11000/Effects_of_Preoperative_Education_on_Patient.12.aspx

https://www.ncbi.nlm.nih.gov/pubmed/22124192

http://www.nursinglibrary.org/vhl/handle/10755/154102?mode=full

[LipstickLady 25,682]

Great question, @@Babbs !

I understand the revision when it's medically necessary. Band to sleeve because it eroded or sleeve to bypass because of GERD issues, but the idea of revising because "it didn't work"?

It's confusing. No judgement because it's not my journey, but confusing.

[woo woo 872]

I sort of hate the tone of many of these replies.

So, if surgery 1 didn't work for a person, they need to just be unhealthy because that's what they deserve? I'm not sure about that one. At least they keep trying. JMO.

Not referring to the OP btw.

I'm not a revision patient, but really if things were different I would absolutely explore all options.

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[LipstickLady 25,682]

So to piggy back on the question.

What are your thoughts on WLS on folks who swear they were not addicted to food, rarely over ate, only consumed 1500 calories or less daily. etc?

How does reducing their stomach size really help? I get that malabsorbtion might, but the sleeve or band? Again, no judgement, just confused.

[Babbs 14,680]

I sort of hate the tone of many of these replies.

So, if surgery 1 didn't work for a person, they need to just be unhealthy because that's what they deserve? I'm not sure about that one. At least they keep trying. JMO.

Not referring to the OP btw.

I'm not a revision patient, but really if things were different I would absolutely explore all options.

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I think the more important question is WHY didn't the surgery work?

If it's a medical issue, completely understandable.

If it's a case of the patient not being compliant, then why would another surgery be any different?

[woo woo 872]

I guess the answer is, maybe it will and maybe it won't?

Some people can learn from one mistake, some it takes a couple times.

And then there's those that never learn! That group is more tricky.

But even then,who am I to say they shouldn't be allowed to try? Or "oh please they want insurance to pay"?

I also think there is non-compliance, and then there is ridiculousness.

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