Should I Consider A Revision?

[GataAnime 19]

Hi, I just had a four year surgiversary yesterday. In the first two years I made it down to 185-187 from 252. I did the calculations, and that was only about 25%-26% of my body weight lost. Doing the research, I've found that anything less than a 50% weight loss in the first two is generally considered failure.

I maintained around 185-190 for over a year, and then gained 20 pounds seemingly overnight without changing much--we all have our lapses, but this was not enough to explain a 20-pound weight gain. Also, I am approaching The Change, so maybe this is part of that. All I know is I'm frustrated, and I'm not even sure that my initial surgery was successful.

I guess I'm asking what other members of The Order Of The Sleeve who got sleeved at late 40s-early 50s have experienced. I plan to talk to my PCP, but what do you think? Should I consider revision based on the initial results? Would it even be worth doing at this point?

[NickelChip 1,253]

I'm not sure where you found the 50% body weight number, but I had my 6-month appointment with my surgeon today and was told that losing 20% of your starting weight and keeping it off is the definition of "success" from a medical perspective. So, if you started at 252, that would be a 50 lb loss. Prior to gaining weight, you were at 65lbs lost, making your initial results within the successful range and if you are currently at 205, you're just slightly out of that range for longterm success.

I think you may have confused the percentages of "body weight" and "excess body weight." To determine your excess body weight for a woman, you start with 100 lbs and add 5 lbs for each inch over 5 feet tall. So for you, that would be 120 lbs. (That's not a goal weight, but rather an "ideal" for a person your height who has never been overweight.) You would then subtract that from your starting weight, giving you 132 lbs of "excess" body weight. 50% of that is 66 lbs, which is essentially what you lost after surgery.

Current research is showing that gastric sleeve surgery is not as durable for weight loss for some people. The Pound of Cure podcast has a lot of episodes that address this (you can find it on Youtube). It's certainly worth talking to your doctor about your options, which may include revision or GLP-1 medications. You'll want to find out your insurance coverage options, too. Of course, the first thing you'll want to do is make sure you are following your nutrition plan and exercise guidelines and cutting out bad habits to see if that helps you reverse some of the gain. If you haven't had a physical lately, definitely go in for that as any number of things can crop up, especially during perimenopause, that can cause weight gain.

Wishing you luck! I'm 50 and I'm definitely nervous about reaching my goals and keeping the weight off at this age.

[Arabesque 7,332]

I agree with @NickelChip, you’re not a failure. Not just from a statistical perspective but also from the perspective that you lost weight & kept it off for a while. That in itself is a success because we know how hard it is to lose any weight at all let alone keep it off for anything more than a week.

Yes, there has been some discussion around the long term effectiveness of the sleeve but I think it could be said of any of the surgeries - it may work for some but not all. And what sometimes defines as a success may differ too. Too many external and internal factors can affect how successful you are in the short & long term too.

I had my surgery when I was almost 54 because peri menopause & then menopause did a number on me & my weight. Quickly pushed me to my usual high weight then I swear overnight, to my all time high of 91kg, (Hormones are the gift that just keep giving whether you’re producing what you need or your production is decreasing as you near &/or are in menopause.). So yes, being in peri menopause or menopause could mess with your weight.

I’d get in touch with your surgeon and ask him about a revision, GLP-1 meds and any other options. The fact you are ready & want to do something is such a positive position to be in.

All the best.

[ShoppGirl 4,861]

I would ask about the GLP-1 first and if that doesn’t fit for whatever reason then consider revision to Bypass or SADI. I am 3 weeks post sleeve to SADI revision and down 29 pounds. We had similar starting weights although I’m a bit taller than you. I was 235 when I did my sleeve and i gained it all back plus some so you are in a better boat than I was. Since you have alot less to lose that I did and you have kept a big chunk of the weight off I personally would try the GLP-1 first if it’s medically appropriate but that’s a decision your doctor will be able to help you make.

[catwoman7 11,215]

it's 50% of EXCESS body weight - not total body weight. Also, a 10-20 lb rebound weight gain after hitting our lowest weight is VERY common - it happens to the vast majority of us, usually in year 3. In fact, that's why I intentionally went under my goal, to account for that very common 10-20 lb bump up. (and like you, for most of us it just kind of happens without much "effort" on our part - it's basically your body settling in at a weight it's comfortable at)

so everything you said is completely normal, and certainly not indicative of failure. That said, if you DO want to lose more weight, then yes, a revision or something like a GLP-1 would likely help. But you certainly didn't fail the surgery.

[GreenTealael 25,383]

You are not a failure, obesity is a complex disease. It often requires many tools to tame. There’s no shame in that.

As a person who has had both VSG and RNY, I can tell you first hand that If you are relying on further restrictions to help you *may* not get that. Almost always the pylorus is bypassed so no there will sphincter holding food in your sleeve creating that classic VSG full sensation. However there are a lot of behind the scenes biological changes that *may* happen but you won’t know how you will respond until after surgery.

The new class of obesity med may help immediately (if you can afford them). They are spectacular. In the time it will take you to go through referrals, appointments, testing and waiting for a date, you may lose the weight. They work that fast. Of course there are risks, some who cannot tolerate them or are very slow responders but the beauty is you can decide week by week if it’s worth it. If not, nothing permanent has been done. That’s the other issue. These are permanent use meds just like HRT or TRT. Maintenance doses are still being fiddled with by individuals so what permanent use looks like may not be weekly. Do a ton of research and ask your Bari/weight management team (if you still have one) what they think.

Good Luck!

[MrsFitz 441]

The way I had it explained to me is that they take my pre-op weight away from what my weight would be if I had a BMI of 25. My target is to lose around 65-70% of that excess weight, NOT my total body weight.

I don’t know if that’s any where near your figures?

[SleeverSk 635]

22 hours ago, ShoppGirl said:

I would ask about the GLP-1 first and if that doesn’t fit for whatever reason then consider revision to Bypass or SADI. I am 3 weeks post sleeve to SADI revision and down 29 pounds. We had similar starting weights although I’m a bit taller than you. I was 235 when I did my sleeve and i gained it all back plus some so you are in a better boat than I was. Since you have alot less to lose that I did and you have kept a big chunk of the weight off I personally would try the GLP-1 first if it’s medically appropriate but that’s a decision your doctor will be able to help you make.

what is SADI ?

[catwoman7 11,215]

8 hours ago, SleeverSk said:

what is SADI ?

it's a modified version of the duodenal switch.

[ShoppGirl 4,861]

9 hours ago, SleeverSk said:

what is SADI ?

Like @Catwoma62 said it’s a switch surgery similar to the DS but the bypass portion of it is modified to make it a little less risky. It fairly new but they are starting to find it to be a good alternative to bypass. little as a revision to a sleeve. It’s a little more aggressive than bypass but the research is suggesting that the weight loss as a revision to bypass is not consistently great and with SADI revision it’s a little better. Plus the ability to keep weight off long term is believed to be better with the SADI revision. Not all surgeons do it yet and many will not reduce the size of the sleeve when they do a revision so they will do some tests to look at your sleeve first to make certain that it is still in good shape or it may not be the better option. There are many other factors in terms of which option is best and the surgeon is best to help you decide but it is another option to ask them about.

[GataAnime 19]

Hi, thank you all so much for your answers (I'm just seeing them, sorry for the late reply)! I feel a bit better about it. It's just hecka frustrating to not know what you might be doing wrong.

That said, the sleeve is still sleeving; my restriction was ridiculous yesterday. My husband and I took our youngest out for Sarku Japan and I swear I didn't even make a dent in my food. I was really shocked. Some days are like that where I feel like I'm back in my 3-4 ounce days. I said to my husband, "Looks like this is gonna be another one of those things that takes me three days to finish!" I'm not exaggerating. We went for ramen last year, and it literally took me three days.

I'm going to continue to adjust accordingly, take inventory of any bad habits. I guess I need to fight harder. I'll look into the GLP-1 thing definitely; but that stuff is caro.💀🐾

[ShoppGirl 4,861]

1 hour ago, GataAnime said:

Hi, thank you all so much for your answers (I'm just seeing them, sorry for the late reply)! I feel a bit better about it. It's just hecka frustrating to not know what you might be doing wrong.

That said, the sleeve is still sleeving; my restriction was ridiculous yesterday. My husband and I took our youngest out for Sarku Japan and I swear I didn't even make a dent in my food. I was really shocked. Some days are like that where I feel like I'm back in my 3-4 ounce days. I said to my husband, "Looks like this is gonna be another one of those things that takes me three days to finish!" I'm not exaggerating. We went for ramen last year, and it literally took me three days.

I'm going to continue to adjust accordingly, take inventory of any bad habits. I guess I need to fight harder. I'll look into the GLP-1 thing definitely; but that stuff is caro.💀🐾

Actually a lot of insurance companies are starting to cover it. Moreso if you are at high risk for heart disease but some just depending on BMI. I have one friend on it for $25 a month and another with a coworker on it for zero copay!! I would have a chat with your team and see what your coverage would be.

[GataAnime 19]

16 minutes ago, ShoppGirl said:

Actually a lot of insurance companies are starting to cover it. Moreso if you are at high risk for heart disease but some just depending on BMI. I have one friend on it for $25 a month and another with a coworker on it for zero copay!! I would have a chat with your team and see what your coverage would be.

Really? I'll have to talk with my provider! Thanx so much!🐾

[ShoppGirl 4,861]

1 hour ago, GataAnime said:

Really? I'll have to talk with my provider! Thanx so much!🐾

Of course. It’s really hit or miss. It’s weird. Some insurances still don’t cover them at all. Some doctors are getting their own compounded versions too that are a little more affordable. My family doctor said they were looking into getting one. Hoping they could get it below $200.

Edited September 17 by ShoppGirl