Large Sleeve - Bypass Revision

[Butterflylegacy 64]

I wasn't sure where to post this topic/question, so I am starting here.. I would appreciate any links or references to this topic in responses. Thanks!

I was sleeved in June 2010. I had no complications following my VSG and was doing great! At 6 months post-op, my gall bladder tanked, and I was rushed to ER for emergency gall bladder removal. Between the time of my sleeve, and gall bladder removal, I had lost 80 lbs. I was shooting for a total of 150 overall. Since my gall bladder removal, I have lost nothing. As a matter of fact, I've gained 20 lbs. It has been almost 2 years since I had my gall bladder removed. In the past 2 years since having my gall bladder removed, I've dealt with chronic diarrhea immediately following each meal. More so after Breakfast to lunch meals. It would appear that waiting longer into the day to eat would seem to subside this significantly so I would battle every day between waiting to eat, and being starving by 1pm-2pm and eating.

I finally contacted the surgeon who removed my gall bladder 2 years ago, to see if there was any solution to this chronic diarrhea. I had waited so long because so much of what I'd read and been told was that it would eventually subside on it's own. The diarrhea happened REGARDLESS of what I ate. It did not matter if I ate an apple, a banana, a salad, or a chocolate chip cookie. The instant food hit my stomach, within 10-15 minutes I was in the bathroom 2-3x and it would just go on like that all day up til about 2pm.

When I met with the gall bladder surgeon this week, he seemed less concerned about my diarrhea, and more concerned that I'd waited so long to see him (or my bariatric surgeon) regarding my lack of weight loss. The gall bladder surgeon is also a bariatric surgeon, but not the one who did my sleeve.

When he walked in to the exam room, he told me he remembered me from 2 years prior, because he remembered how large my sleeve was, when he removed my gall bladder. He asked me about restriction to which I told him I have little to none, and he told me that I should not be able to eat more than what can fit into the palm of my hand. I have not experienced that at all. I can some days eat whatever I want, and other days not. I have completely fallen off the wagon and it's as if I never had surgery to begin with. (Note: I stopped seeing my original bariatric surgeon because 3 months post-op they stopped accepting my insurance, and I could not afford the $150.00 office visits).

The gall bladder surgeon began discussing with me that I would be considered a "surgical failure", since my sleeve is too large, and I haven't lost a significant amount of weight. I started the process at 314 lbs. At my lowest - prior to gall bladder surgery, I was 232 lbs. I am now at 252 lbs. His solution was to try to get me in before the end of the year for a sleeve to bypass revision.

Unfortunately for me, since I was originally sleeved, my husband has changed employers, and new insurance does not cover bariatric surgery. So any hopes of having this revision is pointless unless I can pay out of pocket. This is not an option for me at all, as I also have a special needs child who consumes all of our medical budget for his surgeries (which are done with out of network specialists - another source of frustration).

I contacted my original sleeve surgeon yesterday and discussed with the nurse what the gall bladder surgeon told me. She seemed pretty annoyed that he would have told me this. She said that I probably do NOT need to have a revision and wants me to come in for a consult with the original surgeon. I'm a little wary of this visit, although I did schedule it mostly out of curiosity. I also contacted a very close friend of mine who is an ER Critical Care Nurse. She was interested in being sleeved by my surgeon after I had it done, and was stopped because of an exclusion in her insurance that didn't allow her to go outside of her hospital network. While she was researching though, she spoke to several Surgical Nurses who told her that the surgeon she was considering (mine) was known for sleeving his patients large and that he was also known for not prescribing a specific medicine that would prevent the gall bladder from going bad. According to this close friend, this particular surgeon did this so that he could almost guarantee two surgeries for each patient. First the sleeve (done too large), and then second, a revision because the patient would come back after a certain amount of time, being dissatisfied with their weight loss. Or, first the sleeve (done too large), and then wait for the gall bladder to go south and then schedule the patient for the removal.

Based on this, I would fall into that pattern, and as of right now because I had to have the emergency gall bladder removal he did not get that 2nd surgery out of me. But this information is what is making me wary, because if going to see him on the 12th, he tells me that it is MY fault that I haven't lost weight because I did not stick to the diet plan (which I did between sleeve and gall bladder removal) and that I have some how stretched my sleeve, and I now need to have the bypass, he would/could get the potential second surgery out of me. EXCEPT - I don't have insurance to cover it this time.

I have a lot of emotions about this... I did a lot of research on which was the best option for me, best surgeon for me, best long term results for me, etc. Even the gall bladder surgeon was impressed with my depth of knowledge on the topic and the questions I was asking. My emotions are multiplying by the day. I am angry, and frustrated that I am still struggling with my weight and I did not have a higher weight loss out of the gate. I am frustrated that I appear to be "stuck" now because I do not have an insurance plan that will cover it. I am worried that I am going to be fat for the rest of my life. I am afraid of what the original surgeon is going to tell me that any of this is my fault.

Based on the information my friend relayed to me from the Surgical Nurses, I looked online to see if I could find information about this to corroborate their claim. I can find nothing but high reviews for my surgeon. Everyone seems pleased with their results, and that's frustrating me even more. Any negative reviews have more to do with his office staff or dealing with insurance issues than anything relating to the success/failure rate of the VSG.

I'm not really sure what my question is.. I guess I'm just wondering if anyone has had a similar situation. Maybe some advice. I'm feeling pretty emotional and if I'm being honest, my inclination is to eat my feelings. I'm doing a good job so far not doing that, but it has been a trying past couple of days.

Thanks in advance for advice, support, suggestions, and solutions!

[woo woo 872]

For what it's worth, I considered Dr. Kim for a while, even filled out the paperwork online.

Then I googled for reviews. There were many positive, yes, but there were plenty of negative. Enough that I immediately crossed him from my list.

This was over a year ago, but I remember specifically one was complaining about having to go through multiple surgeries with him and being angry about it but feeling they had no choice but to stick with him.

I also read one describing how he had caused someone to cry during a consultation, saying how they failed themself again, as they always had in the past or something like that. Multiple complaints regarding his bedside manner.

I think it's worth doing the consult to see what he has to say about the situation, but don't feel like you need to stay with him for the revision if you don't want to.

Also don't forget there are financing options for the revision.

Hugs to you!!

[jenbaby75 283]

I would be pretty upset. This is your life, and body he is playing with. He is not God. He clearly does not value his patients as fellow humans, he looks down on them, and their weaknesses. That is disgusting. I would do my best to gather all research, go in armed, and see how he reacts. Find out how many of his patients vs other surgeon's patients, have to have multiple surgeries. Sleeve size, etc. Consult an attorney. Bypass surgery is awful. I wouldn't do it. Why can't they make your stomach smaller?

[Recycled 2,182]

First, I will say that I can understand your frustration and sympathize with your predicament. However, any attempts to gather advice on what you should do from an online forum would be ill advised. Your situation entails very specific medical details and needs medical professionals with hands-on understanding of your specific case. No one on here is qualified to suggest a course of action for your specific needs.

You are already pursuing the logical path with obtaining advice from other surgeons and even approaching your original surgeon to find out his take. Having an attorney on board might even be a good idea. However, keep in mind that undesirable outcomes typically cause us to make assumptions or jump to conclusions that may not be valid. Get all the facts from your medical records and continue to consult with the other professionals on your options, so you can make a rational decision about what to do next. Good luck.

Edited November 1, 2014 by Recycled

[BitterSweet* 835]

I'm always perplexed by members telling someone not to listen to advice from other members, and then give advice themselves. Truly perplexing.

To the OP, thank you for sharing your story. You do sound very well informed about your situation, both before and after surgery, and I'm sorry you've had less than ideal results; especially having the secondary gallbladder surgery. That does suck. Good luck to you and please keep us posted on your progress.

[Recycled 2,182]

Bittersweet said: I'm always perplexed by members telling someone not to listen to advice from other members, and then give advice themselves. Truly perplexing.

You must easily be perplexed.

The only advice (as you put it) I gave..... is to suggest she only rely on medical advice from professionals and to reinforce confidence in her own knowledge of her specific situation........ rather than from online forums. Try to keep up.....

But in order to avoid perplexing you, she shouldn't pay any attention to my post either......

Edited November 2, 2014 by Recycled

[BitterSweet* 835]

Hurt dogs will holler.

I'm not easily perplexed nor do I need to "keep up", but thanks anyway. People are intelligent enough to filter information on their own without needing a disclaimer. You have no idea what experience or expertise someone reading this thread may have that could benefit the poster. The members on this forum come from a variety of professional backgrounds and even those that don't may have information that the poster finds useful.

It really is ok to just state your opinion without the legal disclaimer.

[Butterflylegacy 64]

Thank you everyone for the kind words, reinforcement, and encouragement.

I intend to visit with my original surgeon on the 12th. I will pay $50 for the office visit, and another $50 for the fluoroscope. I have made double sure that my visit is WITH the surgeon, and I fully anticipate being told by him that I did something wrong, didnt followers instructions, etc.

I'll accept the responsibility partially. I didnt gain all this weight because I make smart food choices, and I wasn't in "the program" long enough in my opinion for new habits to be formed.

I am doubtful that I will resume care by him. I already dislike and distrust him, and I have a better relationship with the bariatric surgeon who removed my gall bladder. Based on his preliminary questionnaire I feel like there's a bit more due diligence upfront, to ensure a better or more long lasting outcome. At least this time, I have the benefit of having an experience to compare it to, and I can use that to my advantage.

To answer a previous poster's question - I don't know why they can't make my stomach smaller. That will be one of my questions, both when I see the original surgeon on the 12th, and when I see the gall bladder surgeon on the 20th. I didnt think to ask the gall bladder surgeon when I saw him last week, probably because I was still trying to process the info he was giving me at that time. With that said, my preference would be to be resleeved rather than bypassed. I intentionally didn't choose bypass originally, and I would still not prefer it.

I will come back and update after each visit. I agree with the poster about the importance on relying on the advice of medical professionals. My original post was me reaching out for my fellow sleevers to lift me up and surround me with their positivity and support. I was in no way looking for someone to blatantly guide me towards one decision versus another. If anything, I was curious to know if anyone else had a similar experience, and could share their outcome. One is a lonely number afterall....

I hope that through my experience, I can share my results and provide the light at the end of the tunnel for someone else, should I find that light, and should someone else find themselves in the darkness of uncertainty.

[BellaLuce4 261]

It sounds like you have put a great plan into action. Go into his office strong and empowered!

Maybe take time to write down all the things you want to ask the doctor that did your sleeve. Even bring a close friend or relative with you if you are comfortable with that. I did that this year when I had a different medical issue and in retrospect I thank god she was there with me! Another set of eyes and ears is never a bad thing!

I wish you the best in this new journey. Keep us posted as to how your appointment goes????????????

[Butterflylegacy 64]

I had my appointment with my Sleeve Surgeon yesterday. It actually went a lot better than I was expecting. Per the PA, my sleeve is not abnormally large, and she said it was typical of what she would expect to see on a sleeve patient 4 months Post-Op. Dr. Kim said it was stretched slightly, but not enough to be of concern to him, and certainly not enough to warrant any additional or subsequent surgeries.

Dr. Kim's response to my concerns was that I should not overlook the fact that I've lost (and kept off) 60+ lbs since being sleeved, and reminded me that this is not an insignificant number. He essentially told me that I need to start taking care of myself, and stop putting everything first, like my job, my special needs child, or my struggling marriage. All of these things are impacting my inability to lose the weight, and enabling me to make poor choices in my food. He's 100% right there. I feel my weight is a direct reflection of the amount of the level of uncaring I am feeling after taking care of everyone and everything else.

In a nutshell, Dr. Kim said it would not really be possible for the gall bladder surgeon to have been able to note the size of my sleeve when removing the gall bladder due to their locations in regards to each other. He said he would have had to do a lot of "dissection" in order to come to that conclusion. And, since the gall bladder surgeon did not do any type of imaging (barium swallow test) while I was in the ER/Hospital or during any subsequent follow up visits to him, he feels it's speculation on his part to suggest that my sleeve is too large, or was not done right.

Additionally, Dr. Kim disagreed with the prescription and approach to dealing with the chronic diarrhea I've had, so he prescribed me a different medicine. The gall bladder surgeon's prescription has not had much of an impact on it, so we'll see if Dr. Kim's approach works.

All in all, I have an appointment on the 20th to see the gall bladder surgeon. Dr. Kim's office gave me a print out of my sleeve from my barium swallow test, which I will bring with me. I have another follow up visit with Dr. Kim's office on Dec. 1st, to meet with the Nut, and I am supposed to get lab work and keep a food log between now and then.

At the end of the day, it's all about getting back on track. Eating more Protein, less carbs, getting more fluids, exercising up to 2.5 hours if/when possible.

The story continues....

[IsaacPol 0]

I just had my sleeve redone, I had a very large sleeve and I had it made smaller. With images in hand I would seek a 2nd and 3rd opinion. I am not very good are "reading" x rays but comparing what my sleeve looks like to yours, yours seems rounder. Again it may be something else I am looking at but have an expert read it with a different perspective.

What may seem large to one may be normal to another one. Some surgeons do smaller sleeves. For some surgeons losing 60 % excess weight may be a success for others success is 90% of EWL. While 60 lbs is very good weight loss if it is not enough for you keep looking. It may be that you need o change habits but it may very well be that your sleeve is too big.

When I knew my sleeve was too big I searched for revision surgeons that had experience in making sleeves smaller.

With my new sleeve I can see a huge difference in restriction. I now know what I should have done originally. 40 lbs less in 2 months and I can say that this is what I had always needed.