Is A Lap Band Revision A Good Idea After Weight Gain?

by Anonymous
(Colorado Springs)

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Hi y’all,

I am three years after my Lap-band surgery. My long-term goal was to lose about 50% of my excess weight, which at the time was about 95 pounds. I got there by year two, or at least pretty close anyways ; )

BUT, now I’m back up to about 80 pounds excess weight and don’t know what to do!

I know, I know, the best thing to do is buckle down on diet and exercise. But I’ve been having a really tough time maintaining healthy habits. I have knee issues which makes exercise difficult and a CRAZY schedule between work and kids, which doesn’t help in the home cooking department. My husband helps when he can, but we both struggle with healthy habits and long hours.

After doing some online research I’m really thinking revision surgery might be a good call for me considering my circumstances.

Sounds like I can get another Band, but doesn’t that just have about as much chance of succeeding as the last one?

I’ve been reading I can get a “revision” to other procedures like the Sleeve or Bypass? Is this a good option? Is there a *best* options?

Any opinions would be MUCH appreciated!

Prayers to everyone reading this!

– Anonymous in Colorado Springs

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Surgeon Response to "Is A Lap Band Revision A Good Idea After Weight Gain?"

by: John Rabkin, M.D., Pacific Laparoscopy

Dear "Anonymous in Colorado Springs,"

Weight regain is an unfortunate common problem following Bariatric surgery (WLS): your experience following your "LapBand" surgery is shared by many other patients.

Revisional WLS offers an opportunity to address your weight regain following your failed "LapBand" surgery. There are many different options: no one revisional WLS procedure (just as no single primary WLS procedure) has proven optimal in all patient's cases. Your choice of revisional WLS procedure needs to be individualized to your specific medical and personal situation.

I do agree with your preliminary assessment that undergoing a repeat "LapBand" surgery would not provide you with satisfactory long-term results. The adjustable gastric bands ("LapBand"/"Realize Band") have not provided the hoped for sustained weight loss for a significant proportion of WLS patients and are, consequently, performed much less commonly now than in the past (although not completely abandoned as a WLS procedure.) However, certainly in your case, it would be even less likely to provide you with your desired outcome having 'failed' as a primary WLS procedure for you.

In general, WLS procedures can be categorized as 'restrictive' (adjustable gastric bands/"LapBand"/"Realize Band", vertical sleeve gastrectomy/VSG) or 'restrictive and malabsorptive' (Roux-en-Y Gastric Bypass, Duodenal Switch.) The 'simplest' approach in your case may be to undergo removal of your "LapBand" and revision to a sleeve gastrectomy which is readily performed laparoscopically (as opposed to an 'open' surgical procedure which would involve a long surgical incision) as a single operation and has been demonstrated to safely provide gratifying early/initial weight loss. As a primary WLS procedure, vertical sleeve gastrectomy now accounts for the majority of initial WLS procedures performed today in the United States.

However, for many patients who have failed a purely restrictive WLS procedure due to weight regain, often moving to a WLS procedure which also offers malabsorption, particularly one which provides true calorie malabsorption such as the Duodenal Switch, offers the best opportunity for long-term sustained weight loss. These revisional restrictive/malabsorptive WLS operations can routinely be safely performed laparoscopically. However, like everything in life, there are 'trade-offs' so you must carefully assess the relative benefits versus risks of each option in your specific case. To allow you to make the correct decision in your circumstance, this can best be reviewed during an in-depth consultation with a Bariatric surgeon experienced in ALL routine revisional options.

John Rabkin, M.D.
Pacific Laparoscopy

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DISCLAIMER: This educational advice is based on the depth of your question and the details provided. The above should never replace the advice of your local physicians as they have the ability to evaluate you in person.

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