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I’m in the waiting room waiting for surgery today. The doc was talking about hernia repair, adhesion removal and scar revision from an old battle wound. No longer excited, more like terrified.

I had revision surgery from sleeve to bypass on 1/10. The revision was needed to address my out of control GERD that was not responding to medications. I have unfortunately hit the “trifecta” of weight loss surgeries. Banded in 2007, sleeved in 2015 after the band began leaking, and now in the process of recovering from bypass. I never had GERD until I had the sleeve. Wish I had skipped the sleeve and gone to bypass directly. To top it off, I was self pay all the way! BUT - I have no regrets. Good luck with your decision making journey and I wish you the best❤️

I copied this post from an old post I found on the site from 2013. What do you think? I kind of a long read, but I has a lot of good information I thought. I was most interested about the parts that talk about the importance of making the most in the first 6 months and not to take them for granted. I am 4 1/2 month out, so It has given me a renewed sense of urgency to make the most of my "honeymoon" period. As my weight loss starts to slow more, the more worried I get about actually meeting my goal. Pouch Rules for Dummies INTRODUCTION: A common misunderstanding of gastric bypass surgery is that the pouch causes weight loss because it is so small, the patient eats less. Although that is true for the first six months, that is not how it works. Some doctors have assumed that poor weight loss in some patients is because they aren’t really trying to lose weight. The truth is it may be because they haven’t learned how to get the satisfied feeling of being full to last long enough. HYPOTHESIS OF POUCH FUNCTION: We have four educated guesses as to how the pouch works: 1. Weight loss occurs by actually slightly stretching the pouch with food at each meal or; 2. Weight loss occurs by keeping the pouch tiny through never ever overstuffing or; 3. Weight loss occurs until the pouch gets worn out and regular eating begins or; 4 Weight loss occurs with education on the use of the pouch. PUBLISHED DATA: How does the pouch make you feel full? The nerves tell the brain the pouch is distended and that cuts off hunger with a feeling of fullness. What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is overstuffing themselves, or does the pouch actually re-grow in a healing attempt to get back to normal? For ten years, I had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave me an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 oz., with some as large at 9-10 ozs. We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible. OBSERVATIONAL BASED MEDICINE: The information here is taken from surgeon’s “observations” as opposed to “blind” or “double blind” studies, but it IS based on 33 years of physician observation. Due to lack of insurance coverage for WLS, what originally seemed like a serious lack of patients to observe, turned into an advantage as I was able to follow my patients closely. The following are what I found to effect how the pouch works: 1. Getting a sense of fullness is the basis of successful WLS. 2. Success requires that a small pouch is created with a small outlet. 3. Regular meals larger than 1 � cups will result in eventual weight gain. 4. Using the thick, hard to stretch part of the stomach in making the pouch is important. 5. By lightly stretching the pouch with each meal, the pouch send signals to the brain that you need no more food. 6. Maintaining that feeling of fullness requires keeping the pouch stretched for awhile. 7. Almost all patients always feel full 24/7 for the first months, then that feeling disappears. 8. Incredible hunger will develop if there is no food or drink for eight hours. 9. After 1 year, heavier food makes the feeling of fullness last longer. 10. By drinking Water as much as possible as fast as possible (“water loading”), the patient will get a feeling of fullness that lasts 15-25 minutes. 11. By eating “soft foods” patients will get hungry too soon and be hungry before their next meal, which can cause snacking, thus poor weight loss or weight gain. 12. The patients that follow “the rules of the pouch” lose their extra weight and keep it off. 13. The patients that lose too much weight can maintain their weight by doing the reverse of the “rules of the pouch.” HOW DO WE INTERPRET THESE OBSERVATIONS? POUCH SIZE: By following the “rules of the pouch”, it doesn’t matter what size the pouch ends up. The feeling of fullness with 1 � cups of food can be achieved. OUTLET SIZE: Regardless of the outlet size, liquidy foods empty faster than solid foods. High calorie liquids will create weight gain. EARLY PROFOUND SATIETY: Before six months, patients much sip water constantly to get in enough water each day, which causes them to always feel full. After six months, about 2/3 of the pouch has grown larger due to the natural healing process. At this time, the patient can drink 1 cup of water at a time. OPTIMUM MATURE POUCH: The pouch works best when the outlet is not too small or too large and the pouch itself holds about 1 � cups at a time. IDEAL MEAL PROCESS (rules of the pouch): 1. The patient must time meals five hours apart or the patient will get too hungry in between. 2. The patient needs to eat finely cut meat and raw or slightly cooked veggies with each meal. 3. The patient must eat the entire meal in 5-15 minutes. A 30-45 minute meal will cause failure. 4. No liquids for 1 � hours to 2 hours after each meal. 5. After 1 � to 2 hours, begin sipping water and over the next three hours slowly increase water intake. 6. 3 hours after last meal, begin drinking LOTS of water/fluids. 7. 15 minutes before the next meal, drink as much as possible as fast as possible. This is called “water loading.” IF YOU HAVEN’T BEEN DRINKING OVER THE LAST FEW HOURS, THIS ‘WATER LOADING’ WILL NOT WORK. 8. You can water load at any time 2-3 hours before your next meal if you get hungry, which will cause a strong feeling of fullness. THE MANAGEMENT OF PATIENT TEACHING AND TRAINING: You must provide information to the patient pre-operatively regarding the fact that the pouch is only a tool: a tool is something that is used to perform a task but is useless if left on a shelf unused. Practice working with a tool makes the tool more effective. NECESSITY FOR LONG TERM FOLLOW-UP: Trying to practice the “rules of the pouch” before six to 12 months is a waste. Learning how to delay hunger if the patient is never hungry just doesn’t work. The real work of learning the “rules of the pouch” begins after healing has caused hunger to return. PREVENTION OF VOMITING: Vomiting should be prevented as much as possible. Right after surgery, the patient should sip out of 1 oz cups and only 1/3 of that cup at a time until the patient learns the size of his/her pouch to avoid being sick. It is extremely difficult to learn to deal with a small pouch. For the first 6 months, the patient’s mouth will literally be bigger than his/her stomach, which does not exist in any living animal on earth. In the first six weeks the patient should slowly transfer from a liquid diet to a blenderized or soft food diet only, to reduce the chance of vomiting. Vomiting will occur only after eating of solid foods begins. Rice, Pasta, granola, etc. will swell in time and overload the pouch, which will cause vomiting. If the patient is having trouble with vomiting, he/she needs to get 1 oz cups and literally eat 1 oz of food at a time and wait a few minutes before eating another 1 oz of food. Stop when “comfortably satisfied,” until the patient learns the size of his/her pouch. SIX WEEKS After six weeks, the patient can move from soft foods to heavy solids. At this time, they should use three or more different types of foods at each sitting. Each bite should be no larger than the size of a pinkie fingernail bed. The patient should choose a different food with each bite to prevent the same solids from lumping together. No liquids 15 minutes before or 1 � hours after meals. REASSURANCE OF ADEQUATE NUTRITION By taking Vitamins everyday, the patient has no reason to worry about getting enough nutrition. Focus should be on Proteins and vegetables at each meal. MEAL SKIPPING Regardless of lack of hunger, patient should eat three meals a day. In the beginning, one half or more of each meal should be Protein, until the patient can eat at least two oz of protein at each meal. ARTIFICIAL SWEETENERS In our study, we noticed some patients had intense hunger cravings which stopped when they eliminated artificial sweeteners from their diets. AVOIDING ABSOLUTES Rules are made to be broken. No biggie if the patient drinks with one meal – as long as the patient knows he/she is breaking a rule and will get hungry early. Also if the patient pigs out at a party – that’s OK because before surgery, the patient would have pigged on 3000 to 5000 calories and with the pouch, the patient can only pig on 600-1000 calories max. The patient needs to just get back to the rules and not beat him/herself up. THREE MONTHS At three months, the patient needs to become aware of the calories per gram of different foods to be aware of “the cost” of each gram. (cheddar cheese is 16 cal/gram; Peanut Butter is 24 cals/gram). As soon as hunger returns between three to six months, begin water loading procedures. THREE PRINCIPLES FOR GAINING AND MAINTAINING SATIETY 1. Fill pouch full quickly at each meal. 2. Stay full by slowing the emptying of the pouch. (Eat solids. No liquids 15 minutes before and none until 1 � hours after the meal). A scientific test showed that a meal of egg/toast/milk had almost all emptied out of the pouch after 45 minutes. Without milk, just egg and toast, more than � of the meal still remained in the pouch after 1 � hours. 3. Protein, protein, protein. Three meals a day. No high calorie liquids. Fluid LOADING Fluid loading is drinking water/liquids as quickly as possible to fill the pouch which provides the feeling of fullness for about 15 to 25 minutes. The patient needs to gulp about 80% of his/her maximum amount of liquid in 15 to 30 SECONDS. Then just take swallows until fullness is reached. The patient will quickly learn his/her maximum tolerance, which is usually between 8-12 oz. Fluid loading works because the roux limb of the intestine swells up, contracting and backing up any future food to come into the pouch. The pouch is very sensitive to this and the feeling of fullness will last much longer than the reality of how long the pouch was actually full. Fluid load before each meal to prevent thirst after the meal as well as to create that feeling of fullness whenever suddenly hungry before meal time. POST PRANDIAL THIRST It is important that the patient be filled with water before his/her next meal as the meal will come with salt and will cause thirst afterwards. Being too thirsty, just like being too hungry will make a patient nauseous. While the pouch is still real small, it won’t make sense to the patient to do this because salt intake will be low, but it is a good habit to get into because it will make all the difference once the pouch begins to regrow. URGENCY The first six months is the fastest, easiest time to lose weight. By the end of the six months, 2/3 of the regrowth of the pouch will have been done. That means that each present day, after surgery you will be satisfied with less calories than you will the very next day. Another way to put it is that every day that you are healing, you will be able to eat more. So exercise as much as you can during that first six months as you will never be able to lose weight as fast as you can during this time. SIX MONTHS Around this time, our patients begin to get hungry between meals. THEY NEED TO BATTLE THE EXTRA SALT INTAKE WITH DRINKING LOTS OF FLUIDS IN THE TWO TO THREE HOURS BEFORE THEIR NEXT MEAL. Their pouch needs to be well watered before they do the last gulping of water as fast as possible to fill the pouch 15 minutes before they eat. INTAKE INFORMATION SHEET AS A TEACHING TOOL I have found that having the patients fill out a quiz every time they visit reminds them of the rules of the pouch and helps to get them “back on track.” Most patients have no problems with the rules, some patients really struggle to follow them and need a lot of support to “get it”, and a small percentage never quite understand these rules, even though they are quite intelligent people. HONEYMOON SYNDROME The lack of hunger and quick weight loss patients have in the first six months sometimes leads them to think they don’t need to exercise as much and can eat treats and extra calories as they still lose weight anyway. We call this the “honeymoon syndrome” and they need to be counseled that this is the only time they will lose this much weight this fast and this easy and not to waste it by losing less than they actually could. If the patient’s weight loss slows in the first six months, remind them of the rules of water intake and encourage them to increase their exercise and drink more water. You can compare their weight loss to a graph showing the average drop of weight if it will help them to get back on track. EXERCISE In addition to exercise helping to increase the weight loss, it is important for the patient to understand that exercise is a natural antidepressant and will help them from falling into a depression cycle. In addition, exercise jacks up their metabolic rate during a time when their metabolism after the shock of surgery tends to want to slow down. THE IDEAL MEAL FOR WEIGHT LOSS The ideal meal is one that is made up of the following: � of your meal to be low fat protein, � of your meal low starch vegetables and � of your meal solid fruits. This type of meal will stay in your pouch a long time and is good for your health. VOLUME VS. CALORIES The gastric bypass patient needs to be aware of the length of time it takes to digest different foods and to focus on those that take up the most space and take time to digest so as to stay in the pouch the longest, don’t worry about calories. This is the easiest way to “count your calories.” For example, a regular stomach person could gag down two whole sticks of butter at one sitting and be starved all day long, although they more than have enough calories for the day. But you take the same amount of calories in vegetables, and that same person simply would not be able to eat that much food at three sittings – it would stuff them way too much. ISSUES FOR LONG TERM WEIGHT MAINTENANCE Although everything stated in this report deals with the first year after surgery, it should be a lifestyle that will benefit the gastric bypass patient for years to come, and help keep the extra weight off. COUNTER-INTUITIVENESS OF FLUID MANAGEMENT I admit that avoiding fluids at meal time and then pushing hard to drink fluids between meals is against everything normal in nature and not a natural thing to be doing. Regardless of that fact, it is the best way to stay full the longest between meals and not accidentally create a “soup” in the stomach that is easily digested. SUPPORT GROUPS It is natural for quite a few people to use the rules of the pouch and then to tire of it and stop going by the rules. Others “get it” and adhere to the rules as a way of life to avoid ever regaining extra weight. Having a support group makes all the difference to help those that go astray to be reminded of the importance of the rules of the pouch and to get back on track and keep that extra weight off. Support groups create a “peer pressure” to stick to the rules that the staff at the physician’s office simply can’t create. TEETER TOTTER EFFECT Think of a teeter totter suspended in mid air in front of you. Now on the left end is exercise that you do and the right end is the foods that you eat. The more exercise you do on the left, the less you need to worry about the amount of foods you eat on the right. In exact reverse, the more you worry about the foods you eat and keep it healthy on the right, the less exercise you need on the left. Now if you don’t concern yourself with either side, the higher the teeter totter goes, which is your weight. The more you focus on one side or the other, or even both sides of the teeter totter, the lower it goes, and the less you weigh. TOO MUCH WEIGHT LOSS I have found that about 15% of the patients which exercise well and had between 100 to 150 lbs to lose, begin to lose way too much weight. I encourage them to keep up the exercise (which is great for their health) and to essentially “break the rules” of the pouch. Drink with meals so they can eat Snacks between without feeling full and increase their fat content as well take a longer time to eat at meals, thus taking in more calories. A small but significant amount of gastric bypass patients actually go underweight because they have experienced (as all of our patients have experienced) the ravenous hunger after being on a diet with an out of control appetite once the diet is broken. They are afraid of eating again. They don’t “get” that this situation is literally, physically different and that they can control their appetite this time by using the rules of the pouch to eliminate hunger. BARIATRIC MEDICINE A much more common problem is patients who after a year or two plateau at a level above their goal weight and don’t lose as much weight as they want. Be careful that they are not given the “regular” advice given to any average overweight individual. Several small meals or skipping a meal with a Liquid Protein substitute is not the way to go for gastric bypass patients. They must follow the rules, fill themselves quickly with hard to digest foods, water load between, increase their exercise and the weight should come off much easier than with regular people diets. SUMMARY 1. The patient needs to understand how the new pouch physically works. 2. The patient needs to be able to evaluate their use of the tool, compare it to the ideal and see where they need to make changes. 3. Instruct your patient in all ways (through their eyes with visual aids, ears with lectures and emotions with stories and feelings) not only on how but why they need to learn to use their pouch. The goal is for the patient to become an expert on how to use the pouch. EVALUATION FOR WEIGHT LOSS FAILURE The first thing that needs to be ruled out in patients who regain their weight is how the pouch is set up. 1. the staple line needs to be intact; 2. same with the outlet and; 3. the pouch is reasonably small. 1) Use thick barium to confirm the staple line is intact. If it isn’t, then the food will go into the large stomach, from there into the intestines and the patient will be hungry all the time. Check for a little ulcer at the staple line. A tiny ulcer may occur with no real opening at the line, which can be dealt with as you would any ulcer. Sometimes, though, the ulcer is there because of a break in the staple line. This will cause pain for the patient after the patient has eaten because the food rubs the little opening of the ulcer. If there is a tiny opening at the staple line, then a reoperation must be done to actually separate the pouch and the stomach completely and seal each shut. 2) If the outlet is smaller than 7-8 mill, the patient will have problems eating solid foods and will little by little begin eating only easy-to-digest foods, which we call “soft calorie syndrome.” This causes frequent hunger and grazing, which leads to weight regain. 3) To assess pouch volume, an upper GI doesn’t work as it is a liquid. The cottage cheese test is useful – eating as much cottage cheese as possible in five to 15 minutes to find out how much food the pouch will hold. It shouldn’t be able to hold more than 1 � cups in 5 – 15 minutes of quick eating. If everything is intact then there are four problems that it may be: 1) The patient has never been taught the rules; 2) The patient is depressed; 3) The patient has a loss of peer support and eventual forgetting of rules, or 4) The patient simply refuses to follow the rules. LACK OF TEACHING An excellent example is a female patient who is 62 years old. She had the operation when she was 47 years old. She had a total regain of her weight. She stated that she had not seen her surgeon after the six week follow up 15 years ago. She never knew of the rules of the pouch. She had initially lost 50 lbs and then with a commercial weight program lost another 40 lbs. After that, she yo-yoed up and down, each time gaining a little more back. She then developed a disease (with no connection to bariatric surgery) which weakened her muscles, at which time she gained all of her weight back. At the time she came to me, she was treated for her disease, which helped her to begin walking one mile per day. I checked her pouch with barium and the cottage cheese test which showed the pouch to be a small size and that there was no leakage. She was then given the rules of the pouch. She has begun an impressive and continuing weight loss, and is not focused on food as she was, and feeling the best she has felt since the first months after her operation 15 years ago. DEPRESSION Depression is a strong force for stopping weight loss or causing weight gain. A small number of patients, who do well at the beginning, disappear for awhile only to return having gained a lot of weight. It seems that they almost on purpose do exactly opposite of everything they have learned about their pouch: they graze during the day, drink high calorie beverages, drink with meals and stop exercising, even though they know exercise helps stop depression. A 46 year-old woman, one year out of her surgery had been doing fine when her life was turned upside down with divorce and severe teenager behavior problems. Her weight skyrocketed. Once she got her depression under control and began refocusing on the rules of the pouch, added a little exercise, the weight came off quickly. If your patient begins weight gain due to depression, get him/her into counseling quickly. Encourage your patient to refocus on the pouch rules and try to add a little exercise every day. Reassure your patient that he/she did not ruin the pouch, that it is still there, waiting to be used to help with weight control. When they are ready the pouch can be used once again to lose weight without being hungry. EROSION OF THE USE OF PRINCIPLES: Some patients who are compliant, who are not depressed and have intact pouches, will begin to gain weight. These patients are struggling with their weight, have usually stopped connecting with their support groups, and have begun living their “new” life surrounded by those who have not had bariatric surgery. Everything around them encourages them to live life “normal” like their new peers: they begin taking little sips with their meals, and eating quick and easy-to-eat foods. The patient will not usually call their physician’s office because they KNOW what they are doing is wrong and KNOW that they just need to get back on track. Even if you offer “refresher courses” for your patients on a yearly basis, they may not attend because they KNOW what the course is going to say, they know the rules and how they are breaking them. You need to identify these patients and somehow get them back into your office or back to interacting with their support group again. Once these patients return to their support group, and keep in contact with their WLS peers, it makes it much easier to return to the rules of the pouch and get their weight under control once again. TRUE NON-COMPLIANCE: The most difficult problem is a patient who is truly non-compliant. This patient usually leaves your care, complains that there is no ‘connection’ between your staff and themselves and that they were not given the time and attention they needed. Most of the time, it is depression underlying the non-compliance that causes this attitude. A truly non-compliant patient will usually end up with revisions and/or reversal of the surgery due to weight gain or complications. This patient is usually quite resistant to counseling. There is not a whole lot that can be done for these patients as they will find a reason to be unhappy with their situation. It is easier to identify these patients BEFORE surgery than to help them afterwards, although I really haven’t figured out how to do that yet… Besides having a psychological exam done before surgery, there is no real way to find them before surgery and I usually tend toward the side of offering patients the surgery with education in hopes they can live a good and healthy life.

Lightning strike complications, what the heck are they? I have 2 days to go to my revision to RNY and thought I was well educated and well prepared but I haven’t seen lightning strike complications in anything I have read! I still don’t understand why people fear RNY with its rerouting that technically can be reversed if it has to be but they don’t fear having most of their stomach chopped off and thrown in the bin never to be seen again! I wouldn’t have a sleeve if I had Reflux. It is fairly common knowledge now that the sleeve is not a cure for Reflux and can exacerbate it if you already have it.

Hey all, super new here ! I have been struggling with getting the help from google, or locals who have been sleeved, so I am looking to gather more information to help make the best decision... I was sleeved in June of 2016 - I started at 286lbs, 5ft 6 in tall. Fast forward to now, I am 140lbs, and a BMI in the low 20s. I am active, thin, little loose skin, and LOVING the new life I have been blessed with...for 99% of the time... The kicker is the GERD symptoms I have are out of this world. I was someone who had this pre-op, and had I known what I know now I would have never agreed to the sleeve vs bypass. I have been in the midst of a whirlwind of testing..first my NEW bariatric dr suggested perhaps I have a flare up of the H. Pylori I was known to have after the stomach contents were biopsied, so we started with a stool test for that, thinking we will start small. This came back negative, and I then went in for a barium swallow which showed from his report to me, a "Massive" hiatal hernia in which he defiantly was interested in repairing. Then, I went in for a CTA to look for SMA Syndrome, basically the superior mesenteric artery compressing the duodenum - this was negative. Now, I am waiting on the ph & manometer testing to determine if I am a candidate to just have the hernia repaired by normal forms...but, Here inlays the questions I have, and personal experience is worth every bit to me. IF you have a hernia now (and DID NOT) have one prior to VSG - its causing you so much discomfort that you can not sleep, eating and swallowing pills has become challenging and you basically just refuse it all...what decision do you make..is a hernia repair going to be enough to cure this without the possibility of it returning..OR do you go with the revision to bypass to FIX it once and for all ? My dr has given me a lot of literature to go over and read and things to think about. I just don't know which is best. He has agreed to do either of these to help, provided my esophagus is operating in proper order following the results of my ph probe. He has asked that I TRY to maintain this weight and not lose any more, I am at the bottom of the scale where I ever wanted to be, frequently falling into the high 130s . Other questions I have are - am I going to lose more weight if I am revised to RNYBP? Will I have an intolerance to foods with ANOTHER new tummy? Will I need an open repair to revise this? also, if I choose the hernia repair will I end up with tighter restriction again with them using part of the tiny tummy I have to cuff at the top to fix the hernia? Is mesh safe to repair a hiatal hernia these days should that be the "fix" ? Has ANYONE been through this situation with these quirks. I don't need revision due to weight gain, I am already pretty small for my height. I have been this weight for 15 months or more. Please help! any insight or personal experience either way would be amazing.

I'm 5 years out RNY. I also had Gerd pre-op and my doctor would only do RNY. I haven't had any complications, strictures, hernias or anything of the sort. I stay pretty active and hike often. I think better time is spent researching your surgeon and their rates of complication. That has a much greater effect on your personal outcome than overall averages. If you're confident in your surgeon, I'd say go with the sleeve but be open to revision if necessary. Good luck on your surgery. HW 314 SW 296 GW 177 CW 169

i had some mild heartburn pre Gastric sleeve back in 2015. Nothing I would ever classify as terrible - I and my doctor attributed it to a side effect of carrying so much extra weight. Fast forward to today. I have major GERD, all the makings of Barretts, a healthy hernia I've named Herbert and reflux levels off the charts. I am going in for a revision from sleeve to RNY on Wednesday. My surgeon (same for both procedures) wishes he had gone with his gut and ordered the EGD before surgery last time as his method may have changed. I dont blame him one bit, however, and we're both pretty sure it came about as a result of the sleeve- both are known complications, unfortunately Whatever you decide is best for you - I wish you all the luck in the world!

I'm new here and haven't even introduced myself yet, so forgive me for skipping that part and jumping straight in with a question, but my surgery is scheduled for exactly 1 week from today and I'm feeling the need to get a decision made quickly. I've been in preparations for bariatric surgery for a year now. The plan was always for sleeve. The intestinal rerouting thing just scares the bejeezus out of me, but it's really the rates of longterm complications that scare me the most about RNY, especially the "lightning strike" complications like internal hernia that can pop up unexpectedly years down the road, probably when you're hiking and about 100 miles from any decent hospital if you have my luck. I was much more comfortable with the idea of VSG. However... I have a long history of GERD. It's milder when I lose weight but still there, and I had to switch from ranitidine to a daily PPI (omeprazole 20 mg) several months ago because the ranitidine just wasn't doing it for me anymore. Even with the PPI, I've sometimes had breakthrough heartburn and admit I've taken a second omeprazole later in the day every now and then for it. I figured I'd just have to stay on a PPI after surgery and convinced myself that would be a better option than taking on the added risks of RNY, but my pre-op EGD this morning showed LA grade A esophagitis (i.e. mild esophagitis) and a small hiatal hernia. Those were just the initial impressions and the final report and biopsy results aren't in yet, but the surgeon showed me about how big the hernia is and I'd guess it's 2-3 cm. He says no problem, it can be fixed during surgery and we can treat GERD with medications or, eventually, even LINX if needed, but I'm concerned for a few reasons. It seems ominous to me that I have even mild esophagitis after several months adherence to a PPI regimen that's supposed to heal acid damage. I'm thinking that means I'd have to be bumped up to a higher/more frequent PPI dose after surgery just to keep things stable if I'm lucky. I'm a research person, so I've reviewed most of the recent research regarding GERD and the sleeve, and it looks like there is a large chance of the esophagitis worsening in grade after VSG. It also looks like there's a huge chance of recurrent hernia despite repair and as much as a 1 in 8 chance (according to one small study) of needing revision to RNY later. With that factored in, my chances of needing additional surgery after a sleeve actually appear to be the same or higher than my chances of needing additional surgery after RNY. I also wouldn't look forward to having to pay for EGDs every year to reassure myself that my esophagitis hasn't turned into Barrett's. The general consensus of everything I've read leans toward RNY over sleeve for preexisting GERD, but this doesn't match my surgeon's encouragement to go with sleeve. Then again, he might have that can-do attitude because he knows how much I originally wanted the sleeve? I don't know. Anyway, needless to say, I'm having major second thoughts about the sleeve, but I have so little time left to decide and I'm worried about making the wrong decision. I was hoping my EGD results would give more clarity, but they just seem to have made the waters even murkier. If you made it through that longgg post, I guess my question for you guys is: Am I being overdramatic about a little heartburn? Did any of you have esophagitis on your pre-op EGD? Which surgery did you choose and how did it work out? All opinions and anecdotes welcome and thank you in advance!

I call bullish!t on that! I had a band for twelve years. Lost 30 pounds total before it broke. Walked around in pain for a decade. I finally starved myself from 235 to 160. I got remarried and bloomed back up around 209 by 2018. On January 23rd, 2018, I started the process for a Band to Sleeve revision. My date was set for May 17th. Between January and May, I got to 180. I came home from surgery with extra Fluid putting me at 187. Nearly 8 months later I am maintaining 131 consistently. Size 6 jeans (or 4, depending on brand). Small/Medium tops. Bikinis!!!! I’m 54 and look better, weigh less, measure smaller than when I was a model in my teens and 20’s!!! The band didn’t do this. The sleeve and following the eating plan I’m supposed to to stay healthy with the sleeve did it! (Except that bit of ice cream yesterday...because I’m a human and I’m well under goal...already!) THE VERY BEST TO YOU! Don’t compare yourself/your journey to others. Let others inspire you and show you what’s possible but don’t be discouraged if your pace is different. Follow the plan and it will happen. Pinkie swear!

Like most things, you just never know until you try. I just self paid for my revision because my insurance denied removal and revision. They deemed it “medically unnecessary “. I am on my second appeal, with the help of an outside advocacy firm. I am praying this works to get me reimbursed! I too had the problems of reflux, pain, and night coughs. As a result, my esophagus was getting irritated. I am 18 days out from revision surgery and I feel great! Reflux is gone and I have already lost about 26 lbs! My BMI, at time of surgery was about 33. Not your typical 40+, like most bariatric surgery candidates. Good luck to you Kerri, hopefully you can get your insurance to pay for it! Believe me, I know firsthand, the negative outcomes of lapband!

Yep! I should’ve specified so I edited my post to include RNY. My surgeon said reflux is rampant with sleeve patients and the #1 reason folks come to him for revisions to RNY. Some people just can’t get a handle on it 😥 I hope you can get some relief.

My surgeon has also told me that the chances of oesophageal dysmotility are very high and it is better to take the band out before the oesophagus fails completely . I am revising from band to RNY on thursday. There is generally a very high risk of reflux going from band to sleeve and a lot of people end up going band sleeve RNY. Good luck with your decision

I don't know if most people are all or nothing... I was more or less on the forever train to Sustainville. I was going to work every trick , hack and cheat code possible. Always. But also live my life because I like being alive. I was doing this for life not to stop it but to propel it forward. So I will he constantly revising the plan, reworking the steps, recommitting to new levels of the journey. If I stumble, it will not be the opportunity to join the "nothing",it will the time to remember why I started in the first place. Safe Journey 🎈

Consult run down- my 1st consults I am grouping as one - those were the Mexico ones, which are basically just virtual. Price for both surgeries was between 8-9.5K. Fam begged me not to go to Mexico then my cardiologist said I would come back in a box so they got nixed Right away. FYI, Idid get a quote from Bariatric Pal MX for all those curious. You never "converse" with the surgeon during the process (which is different from the other Mexico consults) and they didn't have any openings until September. My second consult was probably the worst. Surgeon said with the amount of sag I have the implant would have to be done in a separate surgery- which was hard to hear. What was harder to hear was that I would end up part of the itty-bitty titty comittee. He said I would end up possibly a B cup. That is a no go, even for the 4 months in between surgeries. Plus how the hell are you gonna turn a 36DDD into a B. What type of hack job is that? Quote for that 19K. On to today's consults (#3 & #4) first doctor was super personable. He said he'd have no issues doing the implant and lift at the same time. But it would need to be a small implant - with out the implant I would end up a large C but would not have that full round look on top. With implant, rounder, perkier. Arm lift, great candidate, easy-peasy. Scars with be long and knarly, with take a year to lighten. He said I would have drains in the arms for a week, no drains on the breasts. Cost for that 17,513. Second consult of the day(#4 consult) was a bit more dicey. First off Doctor was a little surly (but f*cking handsome) and he had a similar take as the first of the American surgeons. Lift and implants at the same time were not a good idea. Why? Chance of revision would be high, symmetry would suffer, chance of necrosis of the nipple high. What I did like about him was the fact that he crinkled his nose when I said the other doc said I'd be a B. Worst case scenario, large C, probably a D. If they ended up a D, frankly I wouldn't go back for the implant. I might loose feeling in my nipples, yikes. Again, arms no biggy, great candidate. Cost 15,400. He said if I wanted the implant later for fullness on top, he would give me a steep discount. Still two consults to go on January 28 and then I make my decision. Oh, and no one today said anything about it being too soon. So if you want plastics now, go!

For what it's worth, when I started having heartburn, here's what my surgeon told me - I was already on Pepcid 2x a day as a preventative. He told me to do a round of omeprazol on top of the Pepcid, and then take Tums as needed. For me, that got my heartburn under control. My acid still feels a little out of control but it's getting there. I hear it settles down after 6 or so months. See how your body changes - way down the road, there's always the option for a revision to bypass to eliminate the problem should it be necessary, but hopefully it won't be! My surgeon's office also told me to make sure I'm drinking all my water for the day, cause the stomach continues producing acid, and if there's nothing in your stomach to mix with it, it can cause problems - hence the sage wisdom of sip, sip, sip!

Hello All, I am a second time poster on this board. The first time being 3.5 years ago. I guess one stays away as long as things are going well. 40 years old male. I had the lap band surgery almost 9 years ago now. I am posting now because I am wondering whether I should have my lap band removed and if so, how to go about it. Weight loss wise, the band has not failed me. I have lost about 90 pounds with it and have maintained that (despite some yo-yoing in the middle). In fact I am now at my lowest weight ever now because of having to adjust my eating (see point #1). But I am considering removing the band for a number of reasons. 1) Acid reflux. Had it bad for a couple of years (and gained weight on those years) until I changed my eating habits (lower volume, not eating close to bedtime) about a year ago and the problem is now gone (and gone with them the extra pounds). 2) Gas/ bloating/ indigestion. Gas has been a problem from day 1. When everyone usually complained about trapped gas for a few days or a week or two at most after surgery, I remember having trapped gas for a month and half after surgery! And since my surgery, most gas has tended to come up (through my mouth). But I have noticed recently that gas (which I assume comes from indigestion) is becoming a real problem and that I have been spending sometimes hours after a meal suffering from excruciating abdominal pain because of trapped gas that needs to be released. 3) lack of follow-up support/ care. I live in Canada and because I was considered a low-BMI at the time, I had to go the private route for it. A year following surgery, I moved provinces and was thus thousands of kms away from the clinic where I had my surgery. 5 years later, and my surgeon no longer practiced at that private clinic and only now works in the public system exclusively. There are no private bariatric surgeons in the province I live in, and all attempts to follow-up wit a local surgeon through the public system have failed miserably. For fills, I used to either go to my original surgeon or to a fill doctor I know (flying thousands of kms away for both). In the 9 years, I remember I had my band checked once with my original surgeon about 5 years ago, and once at my local hospital here (where they do the public weight loss surgeries) only through x-ray when I thought something was wrong with the band. 4) the increasing stories on the forum and elsewhere about people opting to remove their bands. Very sad and depressing but understandable. I feel I am living with a ticking time bomb that will go off at some point in time (and maybe it already has and I don't know!). So it's a question of when rather than if. I am still debating when and how to go about this. Do I do it ASAP or do I wait a bit more until things are worse? Do I pay for it privately and fly again thousands of kms away to have it removed? or do I try to remove it locally? Is it even possible to do it locally without having to wait until I am dying for the public hospital here to remove it for me? I should mention that my family doctor retired a year ago and so I am now with a new doctor who I haven't had a chance to discuss all of this with at length yet. One thing I know for sure is that I am not revising to any other weight loss surgery privately because I will not repeat not having proper follow-up care locally like I did with the lap-band. This is very hard to live with and I guess I am now more risk averse now that I am older (and hopefully wiser with that lap band experience). Many thanks, Seldom

I just received the date of my sleeve to RNY revision. I will go in on Monday 3/11 and am very excited and hopeful for this surgery. Anyone else get a March date?

I am someone who has come back, as I need a revision. Sent from my SM-G965U using BariatricPal mobile app

and some of us come back because we need revisions!

Here is some info I've got together.. I had lap band to gastric sleeve surgery in 2015. I feel a lot of muscular skeletal pain in my back and side. The pain is very painful and feels like a cramping. I took some OTC pain relievers and they don't seem to work effectively. I am asking anyone out there in the world as to what is causing this pain. It feels neurological and as I know, your not supposed to be in pain with this surgery. I really regret having the surgery and any help would be appreciated. Anyone have any outside opinion in some other state or country? I had the Lap band --- Sleeve revision and found two disc bulges from an MRI.

I had my pre-op yesterday (1/8/19). I actually had 5 appointments. 1) pre-op (surgery is 1/21/19), 2) heart sonogram with cardiologist, 3) blood work, 4) dietitian, and 5) stress test wit the cardiologist. I was surprised to learn I do not have to do clears for 2 week pre-op. My sheet says either 4 protein shakes a day or low calorie, low carbohydrate dies of no more than 50-60 carbs per day. No snack type foods, sweets, or starches (bread, rice, pasta, potatoes, corn, peas, cereal, crackers, etc.) I am having a revision from sleeve to bypass.

I also had no pre op diet, but your girl did one anyways!!!! I needed a jump-start, a transition and I felt a little more accomplished (but... I was not a revision) Countdown time!!!! Yay!!!!🎉🎉🎉

So I have one week to go until my revision from Band to RNY. I have been toldnot to do a preop diet but just to stick to clean eating!! I am extremely happy about that and could have kissed the NUT when she told me that as I remember how awful the preop was before my band. But do you know how confusing clean eating is? Yes I know I need to steer away from processed foods and added sugars but apart from that there are so many different variations. I haven’t been told no carbs but I am trying to keep those to a minimum ( except veg). I’ve also given up alcohol. Hopefully that is enough!

Hope it all goes well for you Mel. Is your preference for a revision to sleeve?

Had sleeve revision to Bypass surgery yesterday afternoon and it was successful! In a lot of pain But the morphine really helps but OMG do not LAUGH!!! Something funny happened and i laughed suddenly and regretted the joke immediately lol Outside of that gas pains sucks walking makes it feel better Overall I’m happy... in a lot of pain but happy for another journey, and this time i will hit my goal weight!!!