problems with band to sleeve revisions...

[mommytoethan 1]

for those of you who had the band and then went to the sleeve, did you have any problems with the sleeve?

my band is coming out and i'm getting the sleeve procedure done next month.

i've seen a few posts where people talk about leaks, and now i'm nervous. i dont really know ALL there is to know about the sleeve yet. i'm still in the pre-op process with my surgeon.

are problems a common thing with the sleeve or a low amt like with the band?

help ease my mind! i have a 3 year old little boy that needs me to come through this problem free!

[Tiffykins 673]

I did have a leak, and it was repaired immediately. The risks with the sleeve are very minimal once the healing process is over. Unlike the band, the sleeve doesn't leave you with the foreign or needing fills. It's instant restriction, and honestly it's been great with the sleeve.

Here are some links that you may find helpful with some research. I don't recall what type of problems you are having with your band, but getting a complete unfill and giving your stomach time to relax before the sleeve revision is usually done to help decrease the risk of complications. Unfortunately, my port was inaccessible even under fluoro, and could not be unfilled.

Here's those links for you to read.

Long-term Sleeve Experiences - 2 Years

on January 15, 2010 9:11 pm

Diligence-is-always-required

Stalls-Happen

Update-from-a-2-Year-Post-Op-VSGer

2-year-surgiversary-and-feeling

Two-and-one-half-years-post-op

TWO-YEARS-YALL

Just-Passed-My-2-Year-Surgiversary

questions-for-post-ops-2-years-out-or-more

2-years-out-food-amount-info

anyone-2-years-out

Happy-2-year-anniversary-to-me

2-years-post-op-TODAY

2-5-Years-After-a-VSG

Everday-life-at-2-5-years-out

2-1-2-year-update

Has-it-really-been-2-years

2-1-2-year-update

Two-Year-Surgiversary

2-year-update-portrait-of-a-heavyweight-a-bit-late

Two-year-surgiversary

2-and-1-2-years-later

2-years-since-my-surgery-any-advice-on-face-lift

2-year-post-op-pics

Two-Years-Before-amp-After-Pic

2-year-update-portrait-of-a-heavyweight-a-bit-late

Thought-you-might-enjoy-an-update-with-a-few-pics

Busybusymom-is-back-2-years-post-op

TWO-YEARS-BABY

Any-old-timers-still-lurking-the-boards

Long-term Sleeve Experiences - 3 Years

on June 8, 2009 10:43 pm

Three years out

Three and a half years after Vertical Gastrectomy My Story

A quick 2 year and 3 year VSG update

Third Year Surgiversay

Not always easy but always worth it

Very Discouraged 3 years out

Links for researching the VSG

on March 15, 2009 11:18 pm

Here are some links I've collected when I was researching the sleeve. ASMBS position paper on sleeve - includes reports of early studies

LapSF Educational presentation to FACS - includes some 2 year results

LapSF Two Year Study

LapSF Five Year Study - abstract only

LapSF Five Year Study - presentation (requires Windows to play)

Literature review on the sleeve - requires $$ to get the full text unfortunately

Sleeve best for over 50 crowd

Video of a sleeve with lots of education discussion

Video of a sleeve that is more about the operation

Ghrelin levels after RnY and sleeve

Ghrelin levels after band and sleeve

Diabetes resolution in RnY vs. Sleeve

Comparison of band to sleeve - literature review

Also this explains VSG and is pretty informative.

Vertical Sleeve Gastrectomy Information by Dr. Gregg Jossart

Welcome

Welcome to vertical sleeve talk. This forum is dedicated to providing patients with accurate and comprehensive information on the VSG procedure. This procedure is extremely appealing to many individuals considering weight loss surgery, but have been hesitant to proceed due to concerns about other, widely established procedures. If you have knowledge or questions about this topic, please participate by posting to our message board and introducing yourself.

History

The Vertical Sleeve Gastrectomy procedure (also called Vertical Gastrectomy, Sleeve Gastrectomy, Greater Curvature Gastrectomy, Parietal Gastrectomy, Gastric Reduction, Logitudinal Gastrectomy and even Vertical Gastroplasty) is performed by more than 50 surgeons worldwide. The procedure is titled “VSG forum” to include the two most common terms for the procedure(vertical and sleeve). The earliest forms of this procedure were conceived of by Dr. Jamieson in Australia(Long Vertical Gastroplasty, Obesity Surgery 1993)- and by Dr. Johnston in England in 1996 (Magenstrasse and Mill operation- Obesity Surgery 2003). In 1997, Dr. Gary Anthone refined the Duodenal Switch procedure to just the VSG in a patient with special indications. In 2001, Dr Gagner, in New York, offered the Laparoscopic VSG to a high risk patient who could not safely undergo a Duodenal Switch. In 2007, Dr Jossart and Dr. Cirangle in San Francisco published the largest series of over 200 patients with results comparable to other stapling procedures and superior to adjustable gastric banding. Their experience is now over 1300 patients. Several surgeons worldwide have now adopted the procedure and have offered it to low BMI and low risk patients as an alternative to laparoscopic banding of the stomach or as a safer option for higher risk, higher BMI patients.

Anatomy

This procedure generates weight loss through gastric restriction (reduced stomach volume) and possibly by hormonal mechanisms. The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from 1-5 ounces (30-150cc), depending on the surgeon performing the procedure. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while reducing the volume.

Comparison to prior Gastroplasties(stomach stapling of the 70-80s)

The Vertical Gastrectomy is a significant improvement over prior gastroplasty procedures for a number of reasons:

1) Rather than creating a pouch with silastic rings or polypropylene mesh, the VSG actually resects or removes the majority of the stomach. The portion of the stomach which is removed is responsible for secreting Ghrelin, which is a hormone that is responsible for appetite and hunger. By removing this portion of the stomach rather than leaving it in-place, the level of Ghrelin is reduced to near zero, actually causing loss of or a reduction in appetite (Obesity Surgery, 15, 1024-1029, 2005). Currently, it is not known if Ghrelin levels increase again after one to two years. Patients do report that some hunger and cravings do slowly return. An excellent study by Dr. Himpens in Belgium(Obesity Surgery 2006) demonstrated that the cravings in a VSG patient 3 years after surgery are much less than in LapBand patients and this probably accounts for the superior weight loss.

2) The removed section of the stomach is actually the portion that “stretches” the most. The long vertical tube shaped stomach that remains is the portion least likely to expand over time and it creates significant resistance to volumes of food. Remember, resistance is greatest the smaller the diameter and the longer the channel. Not only is appetite reduced, but very small amounts of food generate early and lasting satiety(fullness).

3) Finally, by not having silastic rings or mesh wrapped around the stomach, the problems which are associated with these items are eliminated (infection, obstruction, erosion, and the need for synthetic materials). An additional discussion based on choice of procedures is below.

Alternative to a Roux en Y Gastric Bypass

The Vertical Gastrectomy is a reasonable alternative to a Roux en Y Gastric Bypass for a number of reasons:

1) Because there is no intestinal bypass, the risk of malabsorptive complications such as Vitamin deficiency and Protein deficiency is minimal.

2) There is no risk of marginal ulcer which occurs in over 2% of Roux en Y Gastric Bypass patients.

3) The pylorus is preserved so dumping syndrome does not occur or is minimal.

4) There is no intestinal obstruction since there is no intestinal bypass.

5) It is relatively easy to modify to an alternative procedure should weight loss be inadequate or weight regain occur.

6) The limited two year and 6 year weight loss data available to date is superior to current Banding and comparable to Gastric Bypass weight loss data(see Lee, Jossart, Cirangle Surgical Endoscopy 2007).

First stage of a Duodenal Switch

In 2001, Dr. Gagner performed the VSG laparoscopically in a group ofvery high BMI patients to try to reduce the overall risk of weight loss surgery. This was considered the ‘first stage’ of the Duodenal Switch procedure. Once a patient’s BMI goes above 60kg/m2, it is increasingly difficult to safely perform a Roux-en-Y gastric bypass or a Duodenal Switch using the laparoscopic approach. Morbidly obese patients who undergo the laparoscopic approach do better overall in their recovery, while minimizing pain and wound complications, when compared to patients who undergo large, open incisions for surgery (Annals of Surgery, 234 (3): pp 279-291, 2001). In addition, the Roux-en-Y gastric bypass tends to yield inadequate weight loss for patients with a BMI greater than 55kg/m2 (Annals of Surgery, 231(4): pp 524-528. The Duodenal Switch is very effective for high BMI patients but unfortunately it can also be quite risky and may be safer if done open in these patients. The solution was to ‘stage’ the procedure for the high BMI patients.

The VSG is a reasonable solution to this problem. It can usually be done laparoscopically even in patients weighing over 500 pounds. The stomach restriction that occurs allows these patients to lose more than 100 pounds. This dramatic weight loss allows significant improvement in health and resolution of associated medical problems such as diabetes and sleep apnea, and therefore effectively “downstages” a patient to a lower risk group. Once the patients BMI is lower (35-40) they can return to the operating room for the “second stage” of the procedure, which can either be the Duodenal Switch, Roux–en-Y gastric bypass or even a Lap-Band?. Current, but limited, data for this ‘two stage’ approach indicate adequate weight loss and fewer complications. <

[mommytoethan 1]

thank you for your help.

the problem with my band is....well, i'm not really sure what it's called. every time i get a fill, i'm fine for a few weeks, then it's so tight that i cant even get Water down. so then i do a huge unfill to give the swelling time to heal. then we start all over - doing very TINY fills. i've had an upper GI done and my band has NOT slipped. after almost a year of messing with it, he finally decided that it should come out.

would you suggest that i get a complete unfill to give my stomach time to relax? my port is still able to be accessed. do you think that if you were able to have your band unfilled you wouldn't have had the problems? i'm just getting a little nervous now. LOL

is there anyone else out there who had a band to sleeve surgery and didn't have ANY problems? or are leaks pretty common with band to sleeve revisions?

[Tiffykins 673]

Check the "band to sleeve revision" forum for all of the other stories. I think I'm the only one out of the several members that are band to sleeve revisions that had a leak.

I am not sure if the unfill would have prevented the leak, but it probably would have helped with my swelling, and issues that I had specifically. I don't have a recommendation on the unfill, but you can definitely bring it up to your surgeon and see what he thinks would be best for your personal medical needs.

I wanted an unfill, but there was no way to get to my port.

[3636millie 3]

I had a revision from band to sleeve. The band nearly killed me. Spent the last few months of my "band life" getting I.V. fluids 3-4 times a week. I couldn't get anything to go through my band, including Protein shakes, on some days even when I was unfilled. It is a VERY long story......

Anyway, I am so VERY, VERY happy with my sleeve. The difference is like night and day. My surgery ended up being 3 times longer than most revisions due to all the adhesions I had in my abdomen. Any where the band touched, I had adhesions. I feel that I didn't have any problems with my revision due to the skill of my surgeon.

It is so very important that your surgeon has skill and experience doing revisions. Please, whatever you do, don't "settle" on a surgeon until you have done your research.

As far as unfilling the band before surgery. My surgeon recommends unfills several weeks before the procedure. This will help ensure that any swelling you may have due to the band being full will be decreased the day of surgery.

You are gonna be so glad to get rid of the band. OMG, I can't believe the difference in the quality of life. Good luck to you!!!

thank you for your help.

the problem with my band is....well, i'm not really sure what it's called. every time i get a fill, i'm fine for a few weeks, then it's so tight that i cant even get Water down. so then i do a huge unfill to give the swelling time to heal. then we start all over - doing very TINY fills. i've had an upper GI done and my band has NOT slipped. after almost a year of messing with it, he finally decided that it should come out.

would you suggest that i get a complete unfill to give my stomach time to relax? my port is still able to be accessed. do you think that if you were able to have your band unfilled you wouldn't have had the problems? i'm just getting a little nervous now. LOL

is there anyone else out there who had a band to sleeve surgery and didn't have ANY problems? or are leaks pretty common with band to sleeve revisions?

[Ellisa 6]

Mommytoethan,

Hmmm... I'm in the same boat you are. My band has not slipped, but even slight fills will have it way too tight at times and way too loose at others. In fact it is now completely unfilled and I may not be able to drink Water first thing in the morning, but can eat a nearly "normal" sized meal in the evening.

My issue is an extra large hiatal hernia that was repaired when my band was originally placed but the repair didn't hold. Now I'm dealing with hideous reflux as well as gaining weight due to the band being completely unfilled. It's not possible in my case to adjust the band because my stomach isn't where it is supposed to be and is at an angle it isn't supposed to be.

My husband was banded almost 5 years ago and he has absolutely no problems. I went about 18 months before having any. My sister has had hers 3 years with no issues and my 76 yr old mother was banded 18 months ago and has no problems. All of us have been successful with weight loss (until mine had to be unfilled). I honestly think my band would have been fine had I not had the hiatal hernia issue.

Edited June 5, 2010 by Ellisa
Spelling/clarification

[ElizabethO 4]

I have the band now. Looking into the sleeve.

[scotter 3]

I was banded April 2015, I had a super rare complication and had to have it removed in august 2015. I got the sleeve Nov 5th 2015, I am extremely happy with the sleeve! I wish I had chose it from the beginning.

[NoMoBand 278]

Mommytoethan, From other forums and reading others similar stories, the band getting too tight weeks after a fill is due to lots of scar tissue build up on the band. These people did qualify and had revisions and are pleased with the results. This is not an official medical statement, but, is what I've read of others.

I had revision 8 months ago due to esophagus issues and couldn't be happier. My weight loss has been slow, but, I'm ok with it. Just the fact that I live a normal life without all the side effects of the band is worth it all!

As far as some of the major risks, leaks, as someone mentioned are minimal. You may end up with bouts of heartburn (acid reflux) that may or may not go away, but, nothing meds can't handle. I had it for the first 6 months and is just about normal now without meds. You do have to take daily Vitamins, B-12, Calcium and possibly Iron supplements and this is because the size of the stomach may not allow you to get all the supplements you need due to the small amount of nutrition we take in. The post-op diet is a bit tougher than the band's post-op, but, very worth the sacrifice.

Of course there are much more potential issues, but, I just shared what I've endured. I have no regrets and very much endorse the sleeve. I really like my new WLS lifestyle. Hope this helps some. jake

Edited December 28, 2015 by NoMoBand

[liannatx 897]

I had revision from band to sleeve. I had a perfect recovery. I only took pain meds for 2 days and went back to work full time after 7 days. I have had zero complications...

I do still have an overproduction of stomach acid but it is easily controlled by taking Prilosec, so I don't consider that a complication. I don't get any heartburn or actual GERD or anything. I no longer have vomiting, sliming, inability to eat certain foods/solids, trips to the ER, fills and emergency unfills, etc... It has been great to be rid of all the painful and embarrassing issues I had with the band.

The risk of complications with the Sleeve is very low... I work in a large school and know 6 people besides myself that have had the sleeve and none had any complications, not from during surgery and none longer term. I am the only revision person I know personally, and I had the band for 9 years. Honestly, the first month or two transitioning back from liquids to solids is the only hard part. I love my Sleeve. I love that it is maintanence free not needing fills and unfills. I love that I can eat small meals of things like steak and broccoli, and not worry about getting "stuck" or vomiting. It is everything I wanted the band to be.

[titan05 174]

I had revision in June 2015 and have lost 65 pounds since then and am at goal in 10 pounds. No complications but have developed a incisional hernia I am having fixed January 7th.

[IrishGermanRN 151]

So encouraging to hear. I've had my band since 09. Getting it removed and going to sleeve Jan 20th.

I had all the issues with mine as you did with yours.

[ssoler02@gmail.com 0]

So encouraging to hear. I've had my band since 09. Getting it removed and going to sleeve Jan 20th.

I had all the issues with mine as you did with yours.

What was the process or what symptoms you guys had that you had to have a revision? I'm always uncomfortable, I vomitbat least 3 times a week, today I had half of the liquid removed to see if it gets better but now I'm afraid I'll just start getting hungry at all times

[IrishGermanRN 151]

My band slipped. Fluid removed and then had a full and never got back the restriction. I was always slimming or vomiting and never knew what food would do it. When my weight creeped back up and I was still slimming I decided to just have it removed. Then read about the sleeve. I'm looking for consistency. Tired of always going to the restroom at a restaurant regardless of what I eat

[iamshazza 41]

Mommytoethan - My story is about the same as yours as well. it's been a miserable year for me. And I was just approved to get the band out and revision to sleeve. Thanks to everyone with all the great information posted here. It's helpful. I'm so looking forward to getting this band out.

My sister had the sleeve 2 years ago and has been very successful and hasn't had any complications. Unless you count acid reflux - which she had before surgery. I've never had an issue with that so hoping it won't be become a problem for me.