The Band Failed Me, Thinking About RNY.

Hi guys. I was banded 9/2010 and lost 45 lbs in the first 3 months, but haven't lost anything since Jan despite sticking to the diet and working out.  My surgeon saw me last week and told me that the band just isn't working for me and that I should consider revising to the sleeve or to bypass. 

I have 8.75cc in a 10cc band and I have restriction and I eat what I should but I still don't get results! Makes it really hard to stay motivated.

I read a few things about the sleeve that freaked me out... someone said it's just like the band but without the fills.  The band didn't work for me, so if that's the case, the sleeve won't work either (that's my fear).  I also read that it's easy to cheat with the sleeve.  The one thing about bypass is like is the dumping syndrome because it'll make it literally IMPOSSIBLE for me to eat sweets and fat.  

Anyone on here experience something simlar to my "failed band" diagnosis and convert to RNY? Is the weight loss slow or moderate?  I have about 70 more lbs I'd like to lose.  

Thanks guys!!

My daughter had the sleeve done May 17 and has lost 50 lbs so far.  She has had no trouble with it at all.  I wanted the sleeve, but because of my severe reflux, I was not a candidate for it.  I had the RNY  July 7.  I have lost approx 28 lbs.(8 lbs preop)  I am also a diabetic and the rny is better for that as well

One thing to keep in mind about RNY is that only about 30% of people dump.  And those that do can often tolerate small amounts of sugar and fat.  Like, I'm Ok with about 12 grams of sugar.  So I can eat one cookie, depending on how big and what kind it is.  I could eat one cookie every couple of hours, and not dump.  That could add up to quite a few cookies a day.  So don't rely on the idea of dumping to keep you from eating sweets if you go with RNY.

I think that you really need to honestly look at WHY you did not succeed with the band because, in the end, it is true that all you are getting with the sleeve -- or even with RNY (once the initial 18 months of caloric malabsorption is gone) -- is a permanent band that has no ability to be adjusted.

You say that you are sticking to the diet and that you have restriction... if those are both true then you will probably NOT get any better results with the sleeve.  How often are you eating?  I have never had the band, but both of the people I know who had one and for whom it "failed" admitted that they did not always follow the rules or were eating too often or were drinking their calories (and drinking too many calories) because eating made them sick.  You can eat around any WLS.

Even with the RNY, you CANNOT count on dumping to make it "impossible" for you to eat sweets.  Only 30% of people with RNY dump, which means that chances are that you will be among the 70% who do not.  With RNY you will get about 18 months of caloric malabsorption (and a lifetime of vitamin non-absorbtion), and then basically all you have is your healthy eating habits and a permanent pouch (think permanent, unadjustable band) to keep the weight off.  What the RNY will give you is that first year of malabsorption to help get the weight off.  If you do not change your eating habits, though... and if you do the same kinds of things to "cheat" the pouch the same way people can "cheat" the band... you will likely regain the weight.

Quite honestly, the "down" sides to RNY (vitamin deficiencies, inability to ever take NSAIDs (Aleve, Motrin, Celebrex, etc.), possible reactive hypoglycemia and ulcers) are significant.  Unless you can identify something specific that caused you not to succeed with the band that would be different with RNY, I would strongly reconsider having a RNY (especially to "only" lose 70 more pounds).

Lora

Can you clarify on the malabsorbtion?  My surgeon told me I would have malabsorption forever, not just for 18 months.  Any info you can give would be greatly appreciated.

S

The caloric malabsorbtion part of the RNY only last about 18 months to 2 years.  You will have the restriction part a lot longer.  However, by the time the caloric malabsorbtion is over, you have learned good eating habits and changes that will help you maintain your weight loss.  You will have some malabsortion forever which has to do with the vitamins. 

You will have malabsorption of VITAMINS forever (the only part of the intestine that is physically able to absorb the vitamins and micronutrients is the part that has been bypassed), but will only have malabsorption of CALORIES for about 18-24 months because your body actually changes its ability to absorb macronutients (calories, fats, protein) as a survival mechanism. 

Almost as soon as you have surgery, your body realizes that part of your intestines have been "lost" (and therefore part of your body's ability to properly utilize food has been lost) and it starts to adapt in order to overcome this.  The intestinal tract begins to grow the villi -- the very tiny finger-like tentacles that line the intestine and grab the macronutrients.  The existing villi get longer and "stronger" and new ones are added in, which enables us to absorb more of the macronutrients from the food that passes through... which means that, as the body continues this process, we are able to absorb more and more of the calories we eat.  The process varies from one person to another, but appears to be mostly complete in 18-24 months... but is not unheard of as early as 12 months or as late as 36 months.

There are LOTS of studies on this phenomenon in patients who have lost part of their intestine due to cancer or who have "short bowel syndrome" for other reasons.  The studies I read indicated that the body is able to overcome 80-90% of the malabsorption, but since we were not malabsorbing everything to begin with, by the time you are only NOT absorbing 10% of the original malabsorbed amount, once the body completes this process, you are absorbing CLOSE to all of the calories you eat.

You can google "intestinal adaptation" (but most of the articles and all of the studies are, not surprisingly, written by physicians and are difficult to read without a decent knowledge of physiology).  Your surgeon SHOULD, however, already be aware that the body does this!  I would specifically ask him/her about it.  Some surgeons emphasize the lifetime problem with absorbing vitamins so that their patients understand that they will need to commit to the vitamin regimen for life, and they do not make ity explicitly clear that this does not apply to caloric intake.  There are, however, a few surgeons who just want to convince people to have the RNY surgery so that THEY make money, and will out and out lie to prospective patients about the caloric malabsorption because some people will decide not to have the RNY once they know about it.

Lora

Don't feel bad about the band thing..  My Dr told me that its not meant to be used the way most are using it.  Its for someone who needs to drop some weight in order to qualify RYN...   Get the reversal & the RYN..  

Your doctor told you the band was meant to be used for someone that needs to lose weight in order to qualify for RNY?  That's not what the company that makes the band says.  They market it as an alternative to RNY and other types of WLS.  And how many people out there have to lose weight in order to qualify for RNY?

Yes, that is what he told me..  He said that the band was pioneered in Europe & that it turns out to not be all that..  He said that he does more revisions of them then ever before.  From what I understand, you have to be under a certain weight to be able to get the RYN.  Either way, he told me that he doesn't recommend them unless there is some other health issue that might keep you from having success with the RYN.