Wrapping My Mind Around The Two-Surgery Thing...

[cookies 56]

I have a lap band that I got nearly 10 years ago. It's been non-fuctioning for virtually all of that time (all but about four months).

Anyway, my surgeon initially told me that he could do the two procedures (removal of band and the sleeve) in one procedure UNLESS I had really bad scar tissue, in which case he'd have to just remove the band, let it heal, and do the sleeve as a separate procedure.

I really thought I had taken that in and understood that, but as I now sit here two weeks from my operation, I'm getting fretful. I had my final pre-op appointment with my surgeon today and today he was like "It's more likely than not that you will not get your sleeve at the same time." ACK.

I'm self-pay. My surgeon said that if he could do the two procedures together, he'd charge me just for the sleeve. If I have to have the second surgery it's going to cost me another $15,000, plus possibly another $10,000 on top of that. if I have to wait more than a month or six weeks between the two surgeries, because I would have to have my IVC filter removed...then another one put in for the second surgery.

I want my surgeon to do what is best for me, and I don't want a leak. So I get that if two surgeries is best, that's what I need to do...but man. I was all psyched up and prepared for the sleeve. My house is full of everything I need, I have people coming into town to help me.

I'm just having a pity party worrying about where I'm going to come up with the additional $15,000+ and it's really settling in that I'll probably need a second surgery and a second recovery period.

Blech. And does anyone know what type of recovery time is needed after removal of the band alone? And what type of clear fluids regimen, etc. you were on after that?

[iwannabslim 67]

I hope that they are able to do it in one surgery with no complications. I know that dealing with two surgeries would be stressful AND very expensive. Hopefully the damage won't be very extensive. As for the recovery after the band removal, I don't know. I have known only a couple of people that had their bands out without getting a revision, but they didn't really talk about anything special as far as the diet. I'm sorry that I couldn't help with that part. Good luck and many prayers for you with your surgery.

[scgirl 2]

When I had my band removed it was a pretty easy recovery. The surgery was done outpatient. As far as diet I was on Clear Liquids the day of the surgery and then after that was able to move to a regular diet as tolerated. I had my surgery on a Wednesday and was back at work on Monday.

[Wheetsin 714]

Ok so I typed up a big long response, then hit some keyboard combo and there it all went bye-bye. I'll try again, a little shorter.

To answer your question re: removal, it was a piece of cake. The worst part of it for me was the sore throat from the tubation & such... easily a few times worse than strep. And it lasted like 4 days. But that's not the surgery, that's ancillary. As for the surgery itself, a little sore where the port had been put in (they really want to make sure those things don't move around), but I expected that. I also ended up with an infected incision - but again, that's ancillary. Overall I would rate it just slightly more painful than having the band put in, which was EASY.

There were no specific dietary requirements after that. My restriction stuck around for about 2 weeks, but only in terms of not feeling hungry & getting full quickly. Starting the day of, I could eat what I wanted when I wanted. And after a few years of living with a slipped band, I can't begin to describe how awesome it was to be able to drink in the morning if I was thirsty.

As for 1 vs. 2 surgeries, my thoughts/experiences below. I'm not factoring in $ since I was covered under insurance, and the $ is all you. Just my thoughts...

The risk of complication for a well-healed stomach going into a sleeve is just slightly higher than a "virgin" stomach. The risk of complication for a back-to-back procedure sky rockets to about 30%. I have the exact stats at home, but it's right around there. My surgeon requires 2 months between procedures. That's the timeframe at which he thinks there's the best blanace between risk mitigation and more negative things like weight gain. By "well healed" above, I mean 2 months between.

Most leaks that aren't detected at the time of surgery are "hidden" by swelling. The swelling can artificially close gaps that wouldn't otherwise be closed. So as the swelling goes down, a leak can occur. The less swollen you are, the better. You're going to be swollen either way, but you're going to be more swolen if you've just had your band removed a few minutes ago. So it is directly tied to risks.

Scar tissue cen truly be a factor. In back-to-back procedures, I'd think there always has to be give & take between scar tissue/adhesions, and sleeve. My sleeve was my 4th abdominal lap and I knew I had pretty major scar tissue. For one, I could see/feel it from the outside. For two, it actally caused be discomfort if I put pressure on my abdomen in the wrong way (like when I would read a book in bed and try to rest it on my stomach). My surgeon removed a _lot_ of tissue, and spent a little more than double his average surgery time doing it.

All in all, I'm now glad I had to wait. My 2 months turned into more like 7 because of insurance. But although I initially wanted a back to back procedure, after reading up on the risk rates, seeing what I was like with scar tissue, etc. I'm truly very glad I had some down time in between. I had my band for about 6 years. The length of time you and I have had our bands (yours way longer than mine, but we're both well above the average band lifespan) plays a roll too. The longer it's in, the more adhesions, etc. can form. It makes sense that your surgeon is now indicating a 2nd procedure might be a good idea.

All that said, there are lots of people here who had back to back procedures, and are doing just fine.

[cookies 56]

A 30% complication rate on procedures done together? Yikes.

Thanks for the info. I'm glad to hear the recovery was no big deal. I guess I'll take what comes and be happy my surgeon will do what's best for me.

[crystal525 26]

I had my band removed at 4pm on a Monday and was back at work (desk job) on Wednesday. My surgeon refuses to do single surgery revisions due to the leak issues connected with scar tissue. He said since I'm a revision, he cleaned my scar tissue up completely and I have to wait 3 months for my revision so I can be totally healed. The worst part of the removal was that the port site was sore for a week. I had it out April 9 and even my scars are about healed. I'm just trying to not gain anymore weight (I have gained almost 30 pounds over the last year, the most being since my total unfill in December--I honestly think when the band doesn't work for you, it works against you...). I think my metabolism is finally getting back to normal. Good luck to you!

[Calicolea 38]

Anyway, my surgeon initially told me that he could do the two procedures (removal of band and the sleeve) in one procedure UNLESS I had really bad scar tissue, in which case he'd have to just remove the band, let it heal, and do the sleeve as a separate procedure.

Firstly - best of luck on your upcoming surgery

I am a band to sleeve revision too.... I had my band placed nine years ago and had my revision on the 5/4/12. I was also self pay and was told I might have to have a double surgery by one surgeon but his reason was weak spots on my stomach (from the band) that might cause leaks. He never mentioned scar tissue problems.

The surgeon I ultilmately selected had the same concerns, but part of his pre-op testing was to do an endoscope to make sure there were no weak spots from the band before we did surgery. (and found none)

After surgery, he did tell me that I had a lot of scar tissue, but from a hiatal hernia repair I had three years ago. He never mentioned scar tissue around the band. My surgery took an additional hour to clean up the scar tissue, but no problems and I received my sleeve.

He tested for leaks during surgery and then again two days after surgery and none were found. So it appears the scar tissue didn't effect the sleeve.

I think I am healing on schedule.... everyday day gets better

Sorry for being long winded...... just wanted to share my story in hopes it might give you a bit of encouragement for you upcoming revision.

[PEvette 297]

thank you for sharing....I am too praying that my surgeon can revise me in one procedure...

[suzilouise 13]

Another one who has a band and now getting the sleeve. There was never any question of the band removal and sleeve being a joint op. I had my band removed in November and had to wait until February for an endoscopy to see of there was a scar tissue problem from the band. There wasn't so now I await my sleeve op date, sometime in the next 6 weeks x

[danixbanani 0]

I'm having it done in two surgeries as well. I find that this varies from surgeon to surgeon. My surgeon also said that risk of a leak go up way more if you do the surgeries back to back. I'm getting my band removed July 13th and then (hopefully) getting my sleeve in early November barring any shenanigans from insurance.

however, I understand your concern about having to pay for two surgeries. I know I wouldn't be able to scrape up all that money. My best advice is to let your doctor know your financial concerns and maybe he will try to work with you in the best way possible. Honestly, he really won't know what he's getting into until he's in your stomach. :\

[cmeless 11]

Hi cookie- I am on my husbands profile as he is sleeping recovering from sleeve surgery yesterday- I had the band and it slipped and I had to have it removed this was about 5 years ago and then I had the sleeve done a couple if years after that- I just wanted to say that recovery after the band removal was a piece of cake - no restrictions on diet whatsoever I think clear liquids while in the hospital but that was it - hopefully everything works out and u can have the sleeve at the same time ur failed band is removed though!

[LCS 21]

Hi There,

I had my band for about 6 years prior to having it out. Hated it. I had it out, and sleeve done in one procedure. My surgeon told me that if the scar tissue was too great, he would close and i would have to go back for the sleeve in 4 mos. I was so happy when I awoke and found out that I had it done all in one shot. I am no spring chicken, and I didn't want to go through another surgery if possible. He tested me for leaks, and I had to wear a drain for a week as well. One year later, I'm doing just fine. I had faith that my doctor would make the right decision. I'm sure yours will too. Good luck, and we're pulling for you.

[cookies 56]

It's great to hear the various stories. Thanks for the well wishes.

[MamaM 72]

My surgeon also said he never does removal/revision at the same time. Because of the leak risks due to scar tissue and/or damage from the band. However, he is going to attempt it with me ONLY because my band is completely slipped and has gone UP. The only issue I have is the constant feeling of light pressure on my throat and food siting there as it works it's way thru the stoma. I have NO other issues. No sticking, no reflux, nothing. We wouldn't even know there was an issue except for the pressure that I feel.

He is confident that he will be able to do the revision at the same time b/c of that. We talked at length on the phone and again yesterday to make sure I understand everything.

I have complete confidence that he will do what is best for me.

Having said that- I am REALLY hoping we can do this in one shot! I do not want to have to have another surgery in August. BUT I know that if that is how it needs to happen, then I will be fine.