Help me anticipate the "real" differences from AGB to VSG

[Wheetsin 714]

I've been reading on here for a while now, and on OH but I don't post there. My AGB exerience was a bit different than the majority of what I'm reading on both sites (I really liked my band and had great results), and I'm having a hard time finding the information I'm seeking for one, and then pulling out the emotional ingredient to get at the fact.

Please share your thoughts. I don't like surprises. I submitted revision paperwork to my surgeon today, but it will be a while before I can access him for Q&A.

1. I've read many reports of consistent restriction from VSG vs. tha random restriction I had from AGB. Is your restriction consistent? Is it consistent both in terms of times of day you can eat and types of food you can eat? Does VSG seem to be effected by the same variables as AGB? (e.g. flying, stress, humidity, PMS/water retention...)
2. With AGB "stuck" foods caused me discomfort or pain, often quite a bit of pain, and often for a fairly long time. Does food stick with VSG? I've read about people brining stuff up, but is this because of failure to pass through some stoma, or is it because of eating more than you can hold? Or both? Does it hurt like it did with your band? When it comes up, is it "saliva + stuck bits" like with the band, or is it actual vomit?
3. I know some dumping can occur with VSG - do you dump? Is it on specific foods, or random?
4. What period is the greatest risk for developing a leak? I see references to 2 weeks, 2 months...
5. Is leak the (currently known) most likely complication of VSG? I see people talking about leaks, and pOuch stretching, but that's about it. Surely there's something else out there...
6. WIthout the need for fills, what does your post-op care look like? Do you have periodoc leak tests as a bandster might have period fluoro or xray?
7. What do you like best about your VSG?
8. What do you like least about your VSG?
9. What did you not know going in, that you wish you did?
10. I keep reading "recovery is a lot harder than with the band," but no one really elaborates. Can someone please share their comparison of recovery?
11. How hard did you find the transition in terns of behavior? I'm assuming there are shared rules such as chewing to goo, small bites, waiting between bites, etc.
12. Do you have a "soft stop" with VSG? (I never had one with AGB, but I'm wondering if it exists with VSG)
13. Did anyone out thyere have a difficult revision due to scar tissue/etc. with the band?
14. Any bathroom problems? (e.g. the terrible stinkies DSers are known for)
15. It seems like most people encounter significant heartburn. Is reflux an issue with VSG? Is the heartburn long term, or does it resolve after a while?
16. Are your food intolerances (if any) the same as with your AGB?

TIA...

[Rev Me Up! 75]

I'll do my best. I'm 3 months out and your mileage may vary...

• I've read many reports of consistent restriction from VSG vs. tha random restriction I had from AGB. Is your restriction consistent? Is it consistent both in terms of times of day you can eat and types of food you can eat? Does VSG seem to be effected by the same variables as AGB? (e.g. flying, stress, humidity, PMS/water retention...)

The retriction is extremely consistent. I seem to be a little tighter first thing in the morning, but it isn't too bad. I am able to eat the same quantity at every meal, but I seem to want to eat a little more often in the afternoon. For example, I am more likely to have a snack or 2 in the afternoon than I am in the morning. The amount I eat in one sitting is no different.

• With AGB "stuck" foods caused me discomfort or pain, often quite a bit of pain, and often for a fairly long time. Does food stick with VSG? I've read about people brining stuff up, but is this because of failure to pass through some stoma, or is it because of eating more than you can hold? Or both? Does it hurt like it did with your band? When it comes up, is it "saliva + stuck bits" like with the band, or is it actual vomit?

I never vomitted withe the band and I do not vomit with the sleeve. When I eat too much (and that is the only time I am uncomfortable) I am very uncomfortable for about 15 minutes. I wouldn't call it pain so much as it feels like I have to burp and it is stuck. SOmetimes I get a wave of nausea. Sometimes I get a flushed feeling along with some exhaustion as if my stomach just demanded that all my blood and energy be diverted to my stomach to process my food. It's not the same feeling that you have with the band. Also, I only get this feeling when I eat too much and I don't chew very well. With the band EVERYTHING got stuck because of the texture, dryness, etc.

• I know some dumping can occur with VSG - do you dump? Is it on specific foods, or random?

I haven't had any terrible reactions to food. I have foud that I don't like the taste of anything sweet now, but a small piece of cake does not send me to the toilet.

• What period is the greatest risk for developing a leak? I see references to 2 weeks, 2 months...

I was told 2 weeks, but I think there may be risk up to 2 months, because that is how long it would take for incisions to completely heal.

• Is leak the (currently known) most likely complication of VSG? I see people talking about leaks, and pOuch stretching, but that's about it. Surely there's something else out there...

I have not heard of much else besides complications from leaks. There are strictures that some people get when their pouch heals too narrow in the middle. There are peripheral effects like dehydration, and Vitamin deficiency.

• WIthout the need for fills, what does your post-op care look like? Do you have periodoc leak tests as a bandster might have period fluoro or xray?

My US doctor does not have flouro or barium swallow as part of their follow up protocol. My MX surgeon recommends a barium swallow at 3 months, which I have not had yet. The US protocol is a series of bloodwork to make sure you are not nutrient deficient. It is my understanding that a leak would be apparent in profound discomfort, fever, etc.

• What do you like best about your VSG?What do you like least about your VSG?

I love that it works. Sounds like your band experience has been good, but mine just didn't work. 2 things about the sleeve are tough for me: 1) that I needed a sleeve at all. 2) the recovery is so much harder than the band. The sleeve really forces you to eat less - this is a good thing, but it is so hard to get your mind adjusted to your new reality. I think having a bad befoer is helpful because you are used to not drinking with food, taking small bites, etc.

• What did you not know going in, that you wish you did?

I devoured the posts on this board, so there were not a lot of surprises. I think that the experience of going through it is different than reading about it.

• I keep reading "recovery is a lot harder than with the band," but no one really elaborates. Can someone please share their comparison of recovery?

liquids for 3 weeks. That is rough. Also, your stomach is so much more damaged with VSG that you simply can't eat the way you did after band surgery. Remember that after band surgery you could eat fairly normally for several weeks before you got your first fill? This is extreme restriction and serious stomach altering from day 1. You may be horribly exhausted for 6 weeks or so. You will be desperate to eat something after the liquid phase and you will be very disappointed when you find you can't tolerate hardly any food at all. It is a very tough mental transition.

• How hard did you find the transition in terns of behavior? I'm assuming there are shared rules such as chewing to goo, small bites, waiting between bites, etc.

Same rules apply. I think it varies with each person as far as how hard it is. I find those rules easy to follow. The hard part for me was dealing with the restricted post-op diet. It is a tough emotional ride the first month.

• Do you have a "soft stop" with VSG? (I never had one with AGB, but I'm wondering if it exists with VSG)

Don't know what a "soft stop" is?

• Did anyone out thyere have a difficult revision due to scar tissue/etc. with the band?

There are a few people on this board who have. I had my band for 3.5 years and I had adhesions on my liver and stomach. These were corrected in my surgery and it was not presented as being excessively dangerous. I went to a VERY experienced surgeon with regard to revision. My surgery took about 90 minutes.

• Any bathroom problems? (e.g. the terrible stinkies DSers are known for)

No - I have been really regular (for the most part) since surgery. I also found that my gas is not very smelly at all. Must be my new diet?

• It seems like most people encounter significant heartburn. Is reflux an issue with VSG? Is the heartburn long term, or does it resolve after a while?

Yes, acid is a problem. My doc said to take an omeprazole based acid reducer for several months after surgery, whether I have symptoms or not. I had acid issues (even with the PPI) for the first month. I have since switched to Zegerid OTC and have had no problem at all. I may try to wean off the acid reducer around the 6 month mark. Some people take them forever, some people don't. I did not have any acid probelms with the band or before the band.

• Are your food intolerances (if any) the same as with your AGB?

Not at all. I found that my band was really picky with dry food or certain textures. I did not eat chicken for 3.5 years because I could not get it down with the band. Right now, all food goes down just fine. The difference is what you feel like after the food is safely in your stomach. Sugar makes me queasy. chicken is my new favorite :-)

Best of luck on your decision

[TexasT 99]

• I've read many reports of consistent restriction from VSG vs. tha random restriction I had from AGB. Is your restriction consistent? More so with solid foods/proteins than with slider foods. But much more so than with the band. Is it consistent both in terms of times of day you can eat and types of food you can eat? Yes. With the band I couldn't eat Breakfast, but now I can. Does VSG seem to be effected by the same variables as AGB? (e.g. flying, stress, humidity, PMS/water retention...) Not for me. I flew overseas with no problem post-VSG, altitude caused me problems with the band.
• With AGB "stuck" foods caused me discomfort or pain, often quite a bit of pain, and often for a fairly long time. Does food stick with VSG? Never for me. I've read about people brining stuff up, but is this because of failure to pass through some stoma, or is it because of eating more than you can hold? Or both? I've never had an issue with food coming up,but I've been careful not to overeat. Does it hurt like it did with your band? When it comes up, is it "saliva + stuck bits" like with the band, or is it actual vomit? I've never vomited with the sleeve.
• I know some dumping can occur with VSG - do you dump? Is it on specific foods, or random? I've never had a dumping problem. I had my gall bladder out at the same time as my revision and now fatty foods nauseate me, but sweets are fine.
• What period is the greatest risk for developing a leak? I see references to 2 weeks, 2 months... That's a doctor question, but I think you have to be careful for a couple of months until you are completely healed.
• Is leak the (currently known) most likely complication of VSG? I see people talking about leaks, and pOuch stretching, but that's about it. Surely there's something else out there... That's all I've heard also, though I didn't have any problems.
• WIthout the need for fills, what does your post-op care look like? I only went back to my surgeon once post-op. After that my primary care doc handles everything. I just have labs once or twice a year. Do you have periodoc leak tests as a bandster might have period fluoro or xray? No.
• What do you like best about your VSG? The ability to eat healthy foods that I couldn't with the band (salads, certain fruits/veggies), not having to ever worry again about eating too much - I can't, being able to eat like a "normal" person (not counting calories, fat grams, etc.). I eat whatever I want, but in moderation.
• What do you like least about your VSG? There are times your brain still wants to pig out on something, but your body can't do it, so you have to just deal with that. I lost more muscle than I would have liked to, but that I can build back up.
• What did you not know going in, that you wish you did? I was pretty well informed, but I guess I didn't realize how hard it would be to get all my Protein in without supplements. I still have to eat Protein Bars to get it all in.
• I keep reading "recovery is a lot harder than with the band," but no one really elaborates. Can someone please share their comparison of recovery? I've had 12 surgeries in my life, so I may be an old pro about it, but I thought my recovery was just as easy. I work from home on the computer and was back at my desk the day after I got home from the hospital for short spurts. Pain was minimal.
• How hard did you find the transition in terns of behavior? I'm assuming there are shared rules such as chewing to goo, small bites, waiting between bites, etc. You don't have to worry about chewing everything up super small with the VSG like you do with the band or taking small bites. The opening to your stomach is the same as anyone else's, so that's not an issue anymore. I eat just like anyone else.
• Do you have a "soft stop" with VSG? (I never had one with AGB, but I'm wondering if it exists with VSG) Not sure what that means...
• Did anyone out thyere have a difficult revision due to scar tissue/etc. with the band? My surgeon did both the band and my revision to VSG. He had put my port in there really good, so it was a bear to get out. I was left with a large open area internally that filled with blood and caused a hematoma. The incision above the hematoma opened up, the blood drained, and the hole had to then heal from the inside out. I had to keep it packed with cotton tape and change twice a day for a couple of months. I also had a hiatal hernia that I fell was caused by the band. The doc fixed it during the revision surgery.
• Any bathroom problems? (e.g. the terrible stinkies DSers are known for) None at all. In fact, I used to have IBS but no more.
• It seems like most people encounter significant heartburn. Is reflux an issue with VSG? Is the heartburn long term, or does it resolve after a while? I continue to take a PPI to control acid, so it's not an issue.
• Are your food intolerances (if any) the same as with your AGB? I can eat or drink anything I want with the sleeve, no restrictions. I choose to NOT eat much bread, as it swells with liquids and takes up room in my tummy I should be filling with protein. I can tolerate anything - spicy foods, wine and spirits, etc.

[anonynurse 13]

I don't have answers as my sleeve portion is next week, but my band came out last week. I just wanted to wave at you, because I didn't have any issues with my band as well (and I also had it for 3.5 years). I had a few things, but nothing to the extremes I read about here. Had my pre-op for the sleeve portion earlier today and was told there were no adhesions to deal with internally, no hernia and my liver is nice and small and nonfatty - they took me off the pre-op diet and just told me to eat 1200 calories per day or less

Welcome to the board and this journey. It may encourage you some to know that this surgery has been around for a long long time, being done in cases of stomach cancer or ulcerations of the stomach. It has only recently been done as a weight loss surgery, but the long term complications when it was done for other reasons are extremely low.

[Oregondaisy 2,021]

• I've read many reports of consistent restriction from VSG vs. tha random restriction I had from AGB. Is your restriction consistent?
• Yes, I can eat more mushie food like yogurt, but meat 2-3 oz
  
• s it consistent both in terms of times of day you can eat and types of food you can eat?

Yes I eat anything I want for breakfast lunch and dinner,

• With AGB "stuck" foods caused me discomfort or pain, often quite a bit of pain, and often for a fairly long time. Does food stick with VSG? Never for me. I've read about people brining stuff up, but is this because of failure to pass through some stoma, or is it because of eating more than you can hold? Or both? I've never had an issue with food coming up,but I've been careful not to overeat. Does it hurt like it did with your band? When it comes up, is it "saliva + stuck bits" like with the band, or is it actual vomit? I've never vomited with the sleeve.
• I know some dumping can occur with VSG - do you dump? Is it on specific foods, or random? I've never had a dumping problem. I had my gall bladder out at the same time as my revision and now fatty foods nauseate me, but sweets are fine.
• What period is the greatest risk for developing a leak? I see references to 2 weeks, 2 months... That's a doctor question, but I think you have to be careful for a couple of months until you are completely healed.
• Is leak the (currently known) most likely complication of VSG? I see people talking about leaks, and pOuch stretching, but that's about it. Surely there's something else out there... That's all I've heard also, though I didn't have any problems.
• WIthout the need for fills, what does your post-op care look like? I only went back to my surgeon once post-op. After that my primary care doc handles everything. I just have labs once or twice a year. Do you have periodoc leak tests as a bandster might have period fluoro or xray? No.
• What do you like best about your VSG? The ability to eat healthy foods that I couldn't with the band (salads, certain fruits/veggies), not having to ever worry again about eating too much - I can't, being able to eat like a "normal" person (not counting calories, fat grams, etc.). I eat whatever I want, but in moderation.
• What do you like least about your VSG? There are times your brain still wants to pig out on something, but your body can't do it, so you have to just deal with that. I lost more muscle than I would have liked to, but that I can build back up.
• What did you not know going in, that you wish you did? I was pretty well informed, but I guess I didn't realize how hard it would be to get all my Protein in without supplements. I still have to eat protein bars to get it all in.
• I keep reading "recovery is a lot harder than with the band," but no one really elaborates. Can someone please share their comparison of recovery? I've had 12 surgeries in my life, so I may be an old pro about it, but I thought my recovery was just as easy. I work from home on the computer and was back at my desk the day after I got home from the hospital for short spurts. Pain was minimal.
• How hard did you find the transition in terns of behavior? I'm assuming there are shared rules such as chewing to goo, small bites, waiting between bites, etc. You don't have to worry about chewing everything up super small with the VSG like you do with the band or taking small bites. The opening to your stomach is the same as anyone else's, so that's not an issue anymore. I eat just like anyone else.
• Do you have a "soft stop" with VSG? (I never had one with AGB, but I'm wondering if it exists with VSG) Not sure what that means...
• Did anyone out thyere have a difficult revision due to scar tissue/etc. with the band? My surgeon did both the band and my revision to VSG. He had put my port in there really good, so it was a bear to get out. I was left with a large open area internally that filled with blood and caused a hematoma. The incision above the hematoma opened up, the blood drained, and the hole had to then heal from the inside out. I had to keep it packed with cotton tape and change twice a day for a couple of months. I also had a hiatal hernia that I fell was caused by the band. The doc fixed it during the revision surgery.
• Any bathroom problems? (e.g. the terrible stinkies DSers are known for) None at all. In fact, I used to have IBS but no more.
• It seems like most people encounter significant heartburn. Is reflux an issue with VSG? Is the heartburn long term, or does it resolve after a while? I continue to take a PPI to control acid, so it's not an issue.

• Are your food intolerances (if any) the same as with your AGB? I can eat or drink anything I want with the sleeve, no restrictions. I choose to NOT eat much bread, as it swells with liquids and takes up room in my tummy I should be filling with protein. I can tolerate anything - spicy foods, wine and spirits, etc.

[Wheetsin 714]

Thanks for the responses! I've had my band over 5 years. I'm not sure how long it has been slipped since I didn't have the normal slip symptoms. I'm guessing since 2008. I lost about 175 lbs with my band, and regained about 60 with a pregnancy. I'm now about 90 lbs from goal, was about 30. > My body is tolerating the slip well. I don't get sick, I have some reflux but not often, etc. I'm completely unfilled but still have moderate restriction, but I always had restriction from the start. My surgeon's PA suggested we could leave the band in as long as I did not present with additional symptoms or discomfort, and I considered that, but I'm wary of damage being done that isn't detectable until it's too late. And I'm too fat and too bad at maintaining weightloss to go it alone. And don't want a malabsorptive procedure. Which lands me here.

For those of you not familiar with the "soft stop" term - some AGB patients have a physical signal that their pouch is nearing capacity and it's time to stop eating. That's the "soft stop." The "hard stop" being the pain/emission when you eat too much. A "soft stop" is often something like a sigh, or watery nose, or slight headache. I know some people who will sneeze, or their eyes will Water. I never had that, but when something was stuck, I would always hiccup & burp (together, more like a hiccurp) when I was finally clear.

anonynurse - what did your surgeon do to detect the adhesions prior to surgery?

Rev Me Up! -- did your surgeon detect the adhesions prior to surgery?

My gallbladder was taken out about a year after my band went in. I do have some concerns about adhesions & scar tissue, how they will be handled, the impact on the procedure, etc. I know that with both prior surgeries, and just my tendency to scar, it may be a problem. I will definitely ask my surgeon about this.

It seems like port removal can cause some complications. I've read 10 - 15 encounters of complications related to the effort required to remove the port. (I'm actually a little surprised they remove it, if it can cause that much trouble.)

[TexasT 99]

I had tons of adhesions myself, as the revision was my 6th abdominal surgery. My surgeon spent a lot of time removing them, and used a mesh substance inside to help prevent more from forming. And even with my hematoma complication, I'm glad the port is out. It always got stuck under my ribs, you could see it from the outside, and now there is no "foreign" plastic thing in my body anymore.

It sounds like you are a perfect candidate for the sleeve. You should be able to meet goal very quickly. Best of luck!

[Tiffykins 673]

• I've read many reports of consistent restriction from VSG vs. tha random restriction I had from AGB. Is your restriction consistent? Yes, my restriction constant, and consistent.
• Is it consistent both in terms of times of day you can eat and types of food you can eat? Just like with a my big huge stomach, slider foods, mushy consistency food goes down much easier, and I can eat larger amounts of these foods so restriction does vary based on what I choose to eat. Rice, Pasta, potatoes, and some breads are all sliders for me, dense Protein I still max out at around 3-5oz depending on which protein I choose to eat, and how it is prepared. For me there are a lot variables to my capacity. Meaning if I use food lube such as gravy, ketchup, steak sauce I can get in a couple more bites, or if I mix veggies with my meat, I can get in a few more bites. If I stretch my meal out over the 20-30 minutes, I can fit more food in.
• Does VSG seem to be effected by the same variables as AGB? (e.g. flying, stress, humidity, PMS/water retention...) I've had zero issue with altitude, or humidity effecting my restriction. BUT, I have horrific allergies/sinus issues, and just like with the Band, my stomach does get full of sinus drainage, a simple Sudafed, or Zyrtec before the major symptoms sneak in seem to resolve this issue.
• With AGB "stuck" foods caused me discomfort or pain, often quite a bit of pain, and often for a fairly long time. Does food stick with VSG? Nopers. I've read about people brining stuff up, but is this because of failure to pass through some stoma, or is it because of eating more than you can hold? Or both? Does it hurt like it did with your band? When it comes up, is it "saliva + stuck bits" like with the band, or is it actual vomit? I've compared it to that one last bite coming up. It's not the retching, hurling, gagging experience puking that I had when food would get stuck with the band. I was a really consistent and religious measurer of portions before I learned to eyeball my food intake. I use references like a deck of cards, or the food amount that would find in the palm of my hand when measuring wasn't available. We don't have stomas. We have intact pyloric valves so pretty much bringing food back up is related to taking that one or two last bites, and simply not having room for it.
• I know some dumping can occur with VSG - do you dump? Is it on specific foods, or random? I have never dumped. I developed lactose intolerance that mimics dumping syndrome, but I eat every type of sugary, fat laden food imaginable without issue.
• What period is the greatest risk for developing a leak? I see references to 2 weeks, 2 months... 6 weeks
• Is leak the (currently known) most likely complication of VSG? I see people talking about leaks, and pOuch stretching, but that's about it. Surely there's something else out there... Leak is the most common and most dangerous. Sleeve stretching is not the same as pouch stretching. The sleeve matures after the healing period. There just isn't enough tissue left to stretch out the stomach tissue that remains after a partial gastrectomy. I'm 2 years out and eat just about the same amounts that I was eating at 7-9 months out when I was getting into maintenance. Of course, there are ways that I cheat the sleeve to fit in more food, and I am not longer restrictive with my food choices, I keep things in moderation, but do not deprive myself of any foods. Strictures, I would say are the 2nd most dangerous and common complication with VSG even though I've read only a handful of stricture issues, they do occur with VSG. Other complications are typically temporary, such as dehydration, nausea, and pain.
  
• WIthout the need for fills, what does your post-op care look like? I had follow up appointments for labs at 3.6.9,12, 18, 24 months, and it was recommended to get a scope done at a year out. I had my gallbladder removed at 8 months out, and had a scope. This is just the program through the military hospital I had VSG. I will have labs pulled at 2.5 years out after I deliver Sprout, and then again at 3 years post-op. After that, I will be put on an annual follow up program with the bariatric department to monitor my weight, nutrition and labs. This is all part of the follow up studies to show that VSG is very viable option for weight loss, and with consistent follow up, I hope this will help get Tricare and Medicare to fully cover VSG as of right now it is still considered investigational and is only performed at a handful of military hospitals. Do you have periodoc leak tests as a bandster might have period fluoro or xray? No
• What do you like best about your VSG? No medication and no food intolerances. I also love that I do not have have physical hunger at even 2 years post-op.
• What do you like least about your VSG? Not applicable. Honestly, there is nothing to not like.
• What did you not know going in, that you wish you did? Not applicable
• I keep reading "recovery is a lot harder than with the band," but no one really elaborates. Can someone please share their comparison of recovery?
• How hard did you find the transition in terns of behavior? I'm assuming there are shared rules such as chewing to goo, small bites, waiting between bites, etc. Actually my initial recovery from the sleeve was easier except for residual port pain where they removed my port. To this very day, I still have random pain in that area.
• Do you have a "soft stop" with VSG? (I never had one with AGB, but I'm wondering if it exists with VSG) I never pushed this issue, and today I still try to not eat until full. I can get some pressure or a hiccup if I'm getting close to full.
• Did anyone out thyere have a difficult revision due to scar tissue/etc. with the band? I had a horrific leak due to scar tissue that was detected on my final leak test. It was repaired immediately, and I had an extensive recovery. I would honestly endure every complication to live the life I have today.
• Any bathroom problems? (e.g. the terrible stinkies DSers are known for) None
• It seems like most people encounter significant heartburn. Is reflux an issue with VSG? Is the heartburn long term, or does it resolve after a while? There are varying answers out there. I stay on a PPI because I choose to do so. I never had reflux and have been on Prilosec, now Nexium due to the pregnancy since being around 6 weeks out. I haven't attempted to wean off the PPI because I've read other vet sleevesters stories about rebound reflux and returning hunger.
• Are your food intolerances (if any) the same as with your AGB? There is nothing that I can't eat, and I eat anything and everything I want. The only thing that still settles heavy in my sleeve is pork, and scrambled eggs. If I put enough cheese on the eggs, I have zero issues. Pork chops, pork tenderloin still sits heavy, like 2oz in and I'm super full and uncomfortable.

[anonynurse 13]

My surgeon does this in two separate surgeries. There is an increased incidence of leaks if all done at once due to swollen tissues potentially masking an opening in the stitch line, so he takes the band out, lets the body calm down, then does the sleeve two weeks later. So that is how he knows I have no adhesions - he was just in there last week when my band was removed.

The big complication with port removal is the formation of a seroma - Fluid build-up under the skin where the port had been. My doc left a pressure dressing on the area for a full week - two stuff gauze balls taped down taut over the incision. That incision definitely hurts more than the others combined and it itches something fierce.

[Rev Me Up! 75]

Hi---

Your question:

Rev Me Up! -- did your surgeon detect the adhesions prior to surgery?

No, he did not detect them before surgery, I don't think they can see it under regular flouro / xray. This was my 4th abdominal surgery, so it was understood that there would probably be some scarring in there.

[Wheetsin 714]

Has anyone seen stats on the incidence of leaks specific in AGB - VSG revisions? I mean universal stats, not any particular revision surgeon's stats.

My grandfather died of sepsis from a stomach ulceration, and an aunt recently spent 12 weeks in the hospital after a surgeon nicked her esophagus during a procedure to remove a tumor. It's definitely a risk that is close to home.

(If you can't tell, I'm one of those analytical/data sponge type people!)

It makes sense that 2-in-1 might lead to hier rates of complication, and the rationale for doing a revision in 2 separate surgeries make perfect sense. I wonder why the tendency is to do them in a single procedure.

I'm also adding to my list of questions for the surgeon -- does he take precautions for this, what type of staple technique does he use, assuming I have significant scar tissue, what changes? Etc.

[Tiffykins 673]

Has anyone seen stats on the incidence of leaks specific in AGB - VSG revisions? I mean universal stats, not any particular revision surgeon's stats.

My grandfather died of sepsis from a stomach ulceration, and an aunt recently spent 12 weeks in the hospital after a surgeon nicked her esophagus during a procedure to remove a tumor. It's definitely a risk that is close to home.

(If you can't tell, I'm one of those analytical/data sponge type people!)

It makes sense that 2-in-1 might lead to hier rates of complication, and the rationale for doing a revision in 2 separate surgeries make perfect sense. I wonder why the tendency is to do them in a single procedure.

I'm also adding to my list of questions for the surgeon -- does he take precautions for this, what type of staple technique does he use, assuming I have significant scar tissue, what changes? Etc.

I was simply told and had read (but didn't book mark any of the notices) that the risk for a leak triples to quadruples for leaks for an all in one procedure.

My leak repair was not the standard repair. The band had done so much damage that when the stapler when through the scar tissue (even though my surgeon removed so much of it), it didn't seal properly, 2 days post-op, swelling went down and it opened up on my final leak test. My leak was repaired immediately by my surgeon going in, and literally removing all of the damaged tissue and then piecing my stomach back together from 2 separate pieces. I hope that makes sense.

We could not see the damage the band had done. All my adhesions had formed on the outside of the band, and I adamantly refused to get bypass if a sleeve was not possible. So, he worked with what he had, and he couldn't just remove the band, so he performed the VSG in one procedure. Also, I could NOT have an unfill as my port had migrated and was flipped about 70% and encased in scar tissue so no luck on getting the unfill and allowing my stomach to relax before the sleeve was performed.

Sometimes, it's cost of hospital charges, anesthesia etc etc that insurance companies want it in one procedure. Other surgeons that I've read about have gotten in, removed the band and made the patient come back later. But, for the most part having them done 2 in 1 is the popular procedure.

Big question to ask is "If I have leak, how are you going to repair it?" Some use stents, and drains, others go in and heavy suture and mesh/seal over it. Others try to allow it to heal on it's own with just a drain. I was on TPN for over 2 weeks while my stomach healed, didn't eat or drink anything, not even ice chips for over 3 weeks, so my recovery was extensive and exhaustive. I had a secondary hospitalization due to abdominal abscesses that formed about 5-6 weeks later, and then I had more drains placed, and heavy IV antibiotic therapy to clear them up.

[Wheetsin 714]

Wow Tiffykins, that's quite an ordeal. I think I read in a past post of yours that your leak was from your esophagus? What was the issue with your band - were you an erosion? All in all, how long did your recovery take - until you could resume normal activity?

My band is completely unfilled - fortunately. And while I'm told my slip is bad enough that they don't want to attempt a reposition or reband, it's not really messing with me that much. I'm "tolerating" it in such a way as that I don't present with many of the typical symptoms. But who knows what I look like on the inside. I know that from my band surgery, there is a lump of scar tissue I can feel from the outside (if I "try"), so I know it's likely to be an issue.

I suspect my surgeon will put me on a significant liquid diet prior to any procedures. His "generic" liquid pre-op diet is only 2 days, but I've heard his revision diet is more like 6 weeks. I never wondered why, but maybe it's to prevent secondary or tertiary swelling caused by processing solids.

I too have had someone tell me that revision patients are at 3X the risk for complications. I think I'd gladly take a second procedure if it's an option. I'll just tell him to use blanket sutures & mesh "just in case" -- just do my sleeve as though I already have a leak.

Yes, how to treat leaks is on my list of questions, and how to diagnose: how many leak tests, when, which types of tests does he use, how frequently -- as well as his accessibility to me or other providers post-op. He's only about 45 minutes from home, but when I live 5 minutes from another hospital, that can be significant if there's an emergency.

[Tiffykins 673]

Wow Tiffykins, that's quite an ordeal. I think I read in a past post of yours that your leak was from your esophagus? What was the issue with your band - were you an erosion? All in all, how long did your recovery take - until you could resume normal activity?

My band is completely unfilled - fortunately. And while I'm told my slip is bad enough that they don't want to attempt a reposition or reband, it's not really messing with me that much. I'm "tolerating" it in such a way as that I don't present with many of the typical symptoms. But who knows what I look like on the inside. I know that from my band surgery, there is a lump of scar tissue I can feel from the outside (if I "try"), so I know it's likely to be an issue.

I suspect my surgeon will put me on a significant liquid diet prior to any procedures. His "generic" liquid pre-op diet is only 2 days, but I've heard his revision diet is more like 6 weeks. I never wondered why, but maybe it's to prevent secondary or tertiary swelling caused by processing solids.

I too have had someone tell me that revision patients are at 3X the risk for complications. I think I'd gladly take a second procedure if it's an option. I'll just tell him to use blanket sutures & mesh "just in case" -- just do my sleeve as though I already have a leak.

Yes, how to treat leaks is on my list of questions, and how to diagnose: how many leak tests, when, which types of tests does he use, how frequently -- as well as his accessibility to me or other providers post-op. He's only about 45 minutes from home, but when I live 5 minutes from another hospital, that can be significant if there's an emergency.

My surgeon not the severe erosion on the inside of my stomach but on the outside, I don't know if that makes sense. But, my port had flipped early out, and my douchebag band doctor ignored my complaints of pain for months, it got to where the port migrated, and the tubing was pulling on my band that was wrapped around my stomach.

3.5 months for me to resume normal activity. I actually didn't have a pre-op liquid diet. I just had to low carb it, and then fast the night before surgery after midnight. I don't know many revision patients that have to do a prolonged liquid diet unless they are having major issues with their band and even then I've never read more than 2 weeks of Protein shakes and other liquids including yogurt, sugar free popsicles, pudding and Jello.

My leak was directly where the band was wrapped around my stomach. I did lose additional stomach tissue from that area, but it was not at the esophagus/stomach connection.

My leak was discovered on my 3rd and final leak test with contrast fluid(gastrographin Fluid should be used since barium is not Water soluble).

[anonynurse 13]

I think all-in-one is what most people want, so that is what docs do, along with documenting they were fully informed of the risks. My doc won't do it for anyone, for any reason. I work for him and he won't do it for me :laugh: (he didn't do my band, a different surgeon did). I probably would have taken it all in one if he would have been willing, but it probably is good he isn't. I will say though, controling my intake has been a challenge with the band out. I have not been able to eat this volume in years and it seems to have awakened a bit of a sleeping monster in me. I will be glad to have the grehlin reduction.