This is interesting for those considering the sleeve....

[505dardar 0]

Thanks Mac,

LAPSF is one of the places I'm looking into. I've been lurking around these boards for a few months now and its amazing how much I have learned. Thanks again!!

[MacMadame 81]

Cool! If you contact them, say "Hi" to Dr. Cirangle from me. He really is an awesome surgeon.

[WASaBubbleButt 41]

I think a VBG to VSG is a pretty natural operation. You would just be taking out the band and finishing the transection of the stomach. I'd think you could probably revise to a bypass as well, but I'm not sure about the band. That might be trickier because your stomach has a hole in it now.

Both of the surgeons at LapSF (where I went) have done VBG to sleeve revisions including at least one I know about that was VERY HAIRY because the band was so embedded into the stomach. But this person was on a liquid diet for over a year beforehand due to problems with her VBG. So it was totally worth it for her. In fact, it probably saved her life.

But if you aren't having big problems, I would guess your operation wouldn't be as hairy as hers was. You would still want to go to someone very experienced with revisions, even if you have to travel to find them. Revisions have higher risks so experience is even more important than it is when your stomach is a "virgin."

If you do get a VBG to sleeve revision, the aftercare can be handled by your PCP so that shouldn't be an issue.

Not really, Mac. In the procedures used from the 70s - 90s they used the mesh around the VBG and after the mesh you really can't revise to anything except a band safely, there is a 50/50 chance of a leak. That's just too dangerous.

~~~Edit, changed "sleeve" to band.

Edited December 31, 2008 by WASaBubbleButt

[505dardar 0]

Hey Wasa,

Did I hear you right. I might be able to get a sleeve?

[WASaBubbleButt 41]

Hey Wasa,

Did I hear you right. I might be able to get a sleeve?

No, actually I was disagreeing with Mac. They used a mesh around the stomach at that time and you can't safely sleeve a person because of that crappy mesh they used way back when on stomachs. The staple line can't be secured where the mesh was. Bypass might be an option if they didn't have to staple along the mesh portion, I don't know for sure one way or another. I'm guessing not.

If you think of your stomach like a big piece of cow liver (sorry, best I can compare it to off the top of my head) and you put that crappy mesh stuff all the way around the slice of cow liver... there is no way you can staple from the bottom to the top of that liver without catching some of the mesh and that is where you'd have a strong chance for a leak.

I wonder if you couldn't do bypass, I wonder if they could use the portion of stomach that has the mesh, cut that away and suture the intestine there? I still don't see how you could avoid the mesh though but I'm not surgeon. I'm just kinda thinking it through as I type.

[505dardar 0]

Thanks Wasa,

Since I've been investigating different procedures I've followed that band/sleeve diet for the most part and have lost about 15#s. By the time I figure out what is best for me I'll be at goal (wish, wish). I've pretty much ruled out the band. Too many trips to doc. and I'm far from any bariatric doc. Soooooo, looks like a longer more invasive surgery. Not a good option either but don't like the maintenance on a band. Any suggestions other than sewing my mouth shut??????

[WASaBubbleButt 41]

Thanks Wasa,

Since I've been investigating different procedures I've followed that band/sleeve diet for the most part and have lost about 15#s. By the time I figure out what is best for me I'll be at goal (wish, wish). I've pretty much ruled out the band. Too many trips to doc. and I'm far from any bariatric doc. Soooooo, looks like a longer more invasive surgery. Not a good option either but don't like the maintenance on a band. Any suggestions other than sewing my mouth shut??????

Yours is a difficult one because of the timing of your surgery. Meaning, unless I'm mixing you up with another, didn't you have your original surgery in the 90s?

You know, you might do well with a band. Even unfilled it is going to give you some restriction. Or a very small fill. I guess I'm thinking a band with little restriction is better than nothing at all. I spent the majority of my banded life underfilled or unfilled and lost 100% of my excess weight. So I know it is possible.

If you go to have a band the surgeon can SEE if there is the mesh. I'm betting there is but on the off chance there isn't he could sleeve you. If there is mesh he could band you.

I'd have to research bypass after your procedure to see if that is even an option. I'm guessing it isn't as I think through it but I'm not a surgeon so I don't know.

Either way, especially in your case you'd have to go to the best of the best REVISION surgeons and there aren't many of them out there. There are plenty who do them, but that doesn't mean they are any good.

I know of Pleatman but I just read an email he wrote to someone and it confirmed what I already knew. He has a 2.5% leak stat (global stats are less than 1%), he's had a death, very little experience in revisions, not much experience in bariatrics, and as someone else explained.... he came right out at his seminar and told them that people don't go to him because he's good, they go to him because he's cheap. His testimonials are some of the worst I have read. His patients plain don't like him.

Just goes to show, people shop by price and not skill. Finding a good revision surgeon is hard.

[505dardar 0]

I talked to Pleatman and decided he was not the one I wanted to go with. I did talk to Aceves assistant. Can't remember his name, about the band. If I just had a doc. that was around me if I had a complication. I've talked to a few docs here in town (ABQ) and none of them wanted to help at all. Maybe I'm thinking I'll need a doc more than I will. Just like the no maintenance thing but maybe not in the cards.

[WASaBubbleButt 41]

I talked to Pleatman and decided he was not the one I wanted to go with. I did talk to Aceves assistant. Can't remember his name, about the band. If I just had a doc. that was around me if I had a complication. I've talked to a few docs here in town (ABQ) and none of them wanted to help at all. Maybe I'm thinking I'll need a doc more than I will. Just like the no maintenance thing but maybe not in the cards.

There is a fill person in AZ that wouldn't be too far away from you but I have to say, I don't like her. But the distance from ABQ to her isn't bad. Not great, but not impossible. Some do fly back to their surgeon for fills.

I really feel for you, you are in a situation that isn't great. Due to that crappy mesh - a sleeve or bypass would be soooo risky. Bands do require aftercare unless you want to go with minimal restriction which would be better than nothing at all. It would make the weight loss a bit easier.

I know me and I know that I can't lose and maintain by myself, I can't do it. I am a person that has to have WLS to lose/maintain. Most of us are in the boat, if we weren't we wouldn't need WLS.

If I were you I would rather have a band than nothing. Even minimal restriction is better than none at all. I can only tell you what I would do in your shoes. *I* cannot tolerate bands, I'm one that does have band intolerance. But if I were in your shoes you already know you can do it with a form of a band... the old procedure you had. I'd go for it. I'd have the surgeon look for the mesh, if it isn't there I'd get a sleeve, if it is there then I'd get a band. He won't be able to tell you until after surgery what he found, but something is better than nothing. At least then you'll know about that crappy mesh stuff they used. What if by chance they didn't use it? You can have your sleeve. If they did, you get a band and at least have some help losing weight.

My opinion only.

[505dardar 0]

Thanks for you help. I'll rethink the band. Have a happy new year and lets hope 09 is a great one!!!

[WASaBubbleButt 41]

Thanks for you help. I'll rethink the band. Have a happy new year and lets hope 09 is a great one!!!

I wish I had better suggestions for you but I just don't. With that mesh around your stomach it makes your choices for revision verrrry limited.

When I see people that are still looking at that procedure (the one you had) I cringe. If banding does not work they are amazingly limited in what they can do.

I'm not concerned about my sleeve, if something happens I could do bypass (and I wouldn't) or I could do DS (damn sure wouldn't) but at least I have options. I could have more of my sleeve shaved off too. That, I would do. But when people get that damned mesh they just can't revise to anything but a band.

But you know, banding does work for some people. Seems to me your choices are to do it on your own or revise to an adjustable band.

Can you do it on your own? And maintain?

[MacMadame 81]

Well, my surgeons do VBG revisions so they can be done, whether to sleeve or bypass, I don't know.

But at least one was revised to a sleeve, because she told our LapSF Yahoo! group about it. But this VBG was done with a mesh band around the top, not mesh all over the stomach like WASa is describing. So the rest of the stomach was virgin. It was just top part that had the hole and the mesh band.

Dr. J (who did the surgery) took hours, though, because it was such a delicate operation and the first surgeon she contacted said there was nothing that could be done for her so it's not something just anyone can do.

But, as I said, she was very close to dying from complications from her VBG, so I think it was worth it to her to take a chance on a leak.

This is one reason why people come to the VSG board and say their surgeon is going the sleeve this "new and improved" way where they put a band around the top like a VBG, I say :Yawn: I just can't see why someone would willing do that, given what we know about the VBG and what happens when you push mesh around the stomach.

[WASaBubbleButt 41]

Well, my surgeons do VBG revisions so they can be done, whether to sleeve or bypass, I don't know.

But at least one was revised to a sleeve, because she told our LapSF Yahoo! group about it. But this VBG was done with a mesh band around the top, not mesh all over the stomach like WASa is describing. So the rest of the stomach was virgin. It was just top part that had the hole and the mesh band.

Dr. J (who did the surgery) took hours, though, because it was such a delicate operation and the first surgeon she contacted said there was nothing that could be done for her so it's not something just anyone can do.

But, as I said, she was very close to dying from complications from her VBG, so I think it was worth it to her to take a chance on a leak.

This is one reason why people come to the VSG board and say their surgeon is going the sleeve this "new and improved" way where they put a band around the top like a VBG, I say :Yawn: I just can't see why someone would willing do that, given what we know about the VBG and what happens when you push mesh around the stomach.

If someone is dying from complications of a VBG then obviously they have to do something, there is no choice. Technically any sleeve surgeon can do the surgery but the risk is the same regardless of who is doing it. None of the better doctors are going to sleeve someone with the mesh unless it is an extreme case such as you are suggesting.

There is a person that was posting on OH revision boards that she had the mesh band and she had an inexperienced surgeon do a sleeve and she was quite ill for several months with a leak they could not fix. She was down for about 8 months. They never told her that the mesh meant she stood a good chance of a leak. Had she known, she wouldn't have done it. I have a hunch she is going to deal with that one through a lawsuit. :thumbup:( She almost died from that leak and due to the mesh it took a very long time to heal.