what is

what is a revision? a am about 200 pounds and had my surgery in aug. 28th 2003. i have PCOS and it seems i will never be skinny. i guess i will be fat forver.

Hi, A revision surgery is where they go in the "fix" something mechanically(ie something wrong w/the plumbing) with your bypass. Did you have a VBG or a RNY? Has something been diagnostically confirmed( ie upper GI and/or CT-Scan) that something mechanically is going on w/your bypass? I am not sure what PCOS is but is this a medical condition that might be contributing to a medical/behavioral issue that might be stopping your weight loss? I would call your surgeon to ask about sending you for a CT-Scan/upper GI to make sure nothing is going on. I wish you nothing but the best and wish you well. Hugs Tavia

oh see i thought a revision is where they go back in an do the rny if you cant loose more weight and you want to. i had open RNY. pcos is a ovory problem and we tend to gain weight and lack of periods ect.... what if i ask my srgeon for a CT scan or upper GI and what will they do and how is it done?

Hi again, If your lack of weight loss is due to a mechanical problem(ie a relaxed stoma or a fistula etc) then the surgeon has something to back in to fix. If there isnt anything w/the plumbing then there isnt anything to fix. Maybe its a behavioral issue going on? I dont know. A CT-Scan is where they you drink a couple of cups of kool-aid type stuff and an hour or so later you lie down in the big machine that takes 3D pictures of your belly. They shoot this contrast dye in your IV to get a better picture as well. If there is something really mechanically wrong they can usually find it on a CT-Scan. An upper GI series is where you drink the chalky white stuff called barium. The radiologist takes X rays while you take sips of it to see if they can see anything wrong(like a stricture, obstruction, twist, hernia or how nicely the barium flows through the two connections etc). I would just look into contacting your surgeon and let him know what is going on. I am sure he can help you find the kind of help/support you need. Good luck and I am sure everything will work it way out in the end. Hugs Tavia

There is treatment for PCOS they may prescribe Metformin or some other type of diabetic medication to control your insulin level. I have something similar to PCOS and take metformin. Good luck with your weight loss. Sheretta

Do I need A REVISION? Some questions to ponder because the solution/recommendations may be different depending on your answers....Everyone thinks at 6-12 months out something broke, but reality is that is much rarer than behavioral and normal body changes..... 3 things may be happening independent or together: 1. Broken Surgery 2. Behavioral issues (not using tool) 3. Wrong tool/surgery #1) BROKEN SURGERY: WERE YOU Open or Lap? Were you transected (pouch and distal unused stomach severed by staples and cut now separated by space?) If not maybe the issue is a staple line disruption/failure (SLD)...food is going into the old tummy and no malabsorbtion is happening. Or a fistuala ("A gastro-gastric fistula is simply a communication between the new "pouch" and the "old" stomach.)*Same as SLD your getting food into distal stomach. and it avoids the bypass. Have you had an upper GI endoscopy? (Scope down throat) to see if pouch is intact and how large your stoma is (connection of pouch and intestines). Many have an enlarged stoma allowing them to eat larger quantities w/o feeling full, kind of like a chute. *normal stoma measures 1-2cm or 10-20 mm (15 they say is perfect!) This is usually not patients or surgeons fault but many pts stomas relax on them...A lap band may help here or a surgical revision of stoma or a fixed silastic ring, but it isn't always possible (adhesions etc). Also many are using sclerotherapy they say for this (inject substance thru upperGI scope into tissue to produce scarring) They may also do a upper GI w/ barium study usually both are helpful! #2) BEHAVIORAL (not using tool to potential): I am not saying it is behavioral just asking a few? What do you eat in a given day? Calories track on www.fitday.com % fat/protein/carbs. Do you drink with meals? Drink calories? Soda? Do you do protein shakes? (type/number) Do you do vitamins? Which ones? When were your last FULL set of labs/Dexascan? Do you exercise? How often? Amount? Type? What other meds are you on? Medcial conditions? Age, Height? Starting BMI Current BMI. (Basically looking for % of excess you lost) Do you follow pouch rules? http://www.digitalhorsewoman.com/pouchrules.htm We can eat more at 6 mo out (quantity and variety is), it is also time malabsorption of calories decreases for many as body adapts. (they have proof the small intestines can lengthen, grow more folds and villi for absorption!)...Sadly we never get the absorption of vitamins and minerals back! OKAY the above questions are just to help us figure out some potential behavioral issues. Again I am NOT saying the failure of you or anyone is strictly behavioral. It is just one thing. Any surgery can be defeated if the tool isn't used, BUT if the tool is used reasonably it may be broke or may of been the wrong tool (surgery) for you! #3) WRONG SURGERY: We do not always know this until after. Some surgeons realize the higher the BMI of the patient the more distal bypass they should be. Or the type of eater someone is may lend itself to one surgery over another. Some fail to lose wt with a VBG or lap band only to lose well with a RNY or many with a proximal RNY fail to lose wt and do great with a distal RNY or others don't do well with RNY and do fantastic with a BPD/DS...you get my point. One surgeon had this to say about choosing your surgery type for you. (*I am not sure there is any real one size fits all though on deciding!) http://www.alagsa.com/Bariatric_Surgery.htm ______________________________________________________________________ They (?) say 50% of excess wt lost is a successful surgery. I agree *but why accept this? When others lose 75, 80, 90, 100%? I know everyone is different but if there are means to allow most to lost 80+ % why shouldn't everyone have the opportunity? We all have to weigh the pros and cons. Going BPD/DS or more distal has risks, a lap band has risks etc. Many lose 80%+ and regain after 1, 2, 3 ,5 yrs. Not always behavioral or mechanical. It is JUST their body is real good at adapting and hence they probably had wrong surgery.... I hope this helps some and doesn't really confuse you. Regain scares me too! I see/read/hear about wt regain more and more online and read more about revisions. WLS has come a long way, but maybe just maybe some day we'll get the right surgery the first time! One that we can behaviorally adapt to and use and that won't break! ONE CAN DREAM! For now if your using your tool to its potential, doing all the behavioral and lifestyle changes required then the wt loss you have is what the tool can give, if more than 50% excess is lost and maintained that is the goal of the tool (may not be our goal) many of us have unrealistic expectations, we want it all gone, no surgery can do that for all people yet. L Surgery gives us a head start on developing a healthy life it is up to us to live that healthy life, it isn't the magic pill we all dreamed of and hoped for and we had for the first 6-12 months of so...For me I am working darn hard to keep my regain within that 10# range...so far so good. It isn't esy but to me it is worth the daily challenges! Join us on: http://health.groups.yahoo.com/group/OSSG_Off_track/ to get back on track with the lifestyle! So with that if you have time to answer some of the ? I posed maybe the group can steer u in right direction! I think a good revision surgeon is key to lower risks, I wouldn't go to just anyone! And I know many on the group could help u with someone good! Dr Fox and Oh in Washington State. http://www.aboutmso.com/pp/prospectivepatients.cfm http://www.ohtobethin.com/ In our neck of the woods I hear about Dr. Gagner in NYC: http://wo-pub2.med.cornell.edu/cgi-bin/WebObjects/PublicA.woa/5/wa/viewService?s\ ervicesID=636&website=wmc+weightloss&wosid=jUbZj2bhNrNdLLnxrMtdQM http://www.cornellweightlosssurgery.org/about/our_tea.html?name1=Our+Physicians+\and+Staff&type1=2Active This is a great group of people who can definitely lead you in the right direction! http://groups.yahoo.com/group/WLSrevisionsupport/ I also know OH has a Revision Forum. Not sure how good it is but more info is always helpful! http://www.obesityhelp.com/morbidobesity/amosforums/failed_wls_second_time_aroun\d/ http://www.obesityhelp.com/morbidobesity/surgtype-forums/Revision/ Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45 before Surgery) Plastics 6/9/04 & 11/11/2005 Dr. King "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"