Re-sleeve or revision

[sweetsagi 28]

Hi everyone,
Has anyone had or going to have a sleeve revision? If so re-sleeve or will you revised to gastric bypass?

[Orchids&Dragons 9,047]

It would depend on why you need the revision, I think.

[sweetsagi 28]

He said my stomach stretched some. I was sleeved in 2012. Lost about 65lbs and recently gained about half of it bk.

[sweetsagi 28]

Was given both options. Told I would lose more weight with the bypass but I also know that’s a little more serious of a surgery than the sleeve.

[Frustr8 7,886]

And as the old Carnival barker was reputed to say " You pays your money, you takes your choice!" Think things through, decide what works best for you, maintain a firm commitment to see everything to the conclusion. Know what is working best for me, but we are all are similar in some thongs, differing in others. But we all want the best results possible!😛🍀❤🌈

[RickM 1,752]

Some stretch, or growth or adaptation is to be expected - we don't stay at eating only 3 tablespoons forever. This doc gives a good idea of the progression of meal volume that can be expected, and is consistent with my experience -

You may or may not get along with his prescription for countering this effect, but it is a viable one. In short, we need to learn to accommodate some increase in eating volume without allowing the calories to get out of hand - taking up that added volume with high bulk, low calorie veg is a good way to do it.

As to which procedure to go for a revision, the first thing I would want to know is whether the stretch that your doc sees is unusual - sleeves done by docs early in the learning curve of doing sleeves (and 2012 is consistent with that for many surgeons) may have undue stretch if it wasn't formed well to begin with. Sometimes excess fundus (the stretchy part of the stomach that is largely removed with the VSG) is left behind at the top or bottom of the stomach, or other shaping issues may lead to the problem. If the sleeve is nominally well done, there is probably little to gain be resleeving it - you will lose some at the outset from low capacity due to surgical inflammation and the very restricted diet that we have early on, but overall you shouldn't expect great things from it. Likewise, a bypass is similar in its overall power to the sleeve, but does have some temporary caloric malabsorption that can help get a little extra weight off, but doesn't do any better when it comes to resisting regain; in some patients it is worse in that regard due to reactive hypoglycemia inducing more inter meal hunger.

Overall, when I think in terms of revisions, I see a procedure that is more complicated than the original virgin WLS, and usually less effective overall (think in terms of your stomach originally having a capacity of 32-64 oz, and now a few years post op it may have a capacity around 6 oz, so there is less difference to play with. Being more complicated both in implementation and in the reason for doing it in the first place, I like to get a second, or even third, opinion on the matter - different surgeons have different experiences and perspectives on these things. There is also the aspect that while doing a virgin sleeve is a fairly straightforward procedure, and most surgeons are now fairly well up the learning curve in doing them, repairing or revising a faulty sleeve is another matter, so I would look to a surgeon who has done lots of them. In NJ, I would suggest Dr. David Greenbaum as a good guy to consult with.

A final thought - what is the capacity of your sleeve now? How much chicken or steak (and nothing else) can you comfortably eat? We usually remain fairly restricted on firm meats for a long time, but can eat an almost unlimited amount of "sliders" - things that just slide on through with limited restriction, which are frequently also pretty junky.

[PepperCat 30]

Bypass. My doc didn’t even give me the re-sleeve option. My situation was because my sleeve had stretched.