My Husband had a full gastric bypass: can he have lap band?

Question
My husband had a full gastric bypass in 1997.  He was close to 500 pounds.  He lost down to 225 in the next 2 years, and kept if off for a while.  He is now back up to 400 lbs again, and is having trouble getting it off.  He is hungry all the time, and can't diet.  His first surgery he had his stomach stapled and banded, a section of his small intestine removed and his gallbladder removed.  He had his stomach cut from brestbone to navel. Is there anything he can do now?

Answer
Hi Jessica,

I will try to give you some information, but this is really a better question for John Pilcher - he is the bariatric surgeon who is the expert in this category.

Weight regain is a common issue as people get beyond 2 years from their initial surgery date.  Almost everyone regains a bit from their low; some regain a lot more than others.  Sometimes the issue is surgical, sometimes it is related to lifestyle, sometimes both.

The surgery you are describing does not sound like a traditional gastric bypass - but more like a Fobi Pouch.  The stomach portion of the what you describe also sounds similar to a vertical banded gastroplasty - but if you are sure there is an intestinal bypass, then this would not be the procedure.  

Weight regain can happen for a variety of both surgical and non-surgical reasons, and the only real way to know is for your husband to pursue medical evaluation.  I would suggest a few things:

1) Follow up with a surgeon.  If your husband cannot follow up with his original program (or doesn't want to), then I would find a local program, preferably a Center of Excellence (the list is available at www.asbs.org), and get an appointment with a surgeon who does a lot of revisions.  This is key - you want someone skilled and experienced with revision because revision surgery is riskier and more challenging than the original procedure.  Only a surgeon will be able to tell your husband if a revision will help.

2) Many good bariatric surgery groups now offer "Back of Track" programs for patients who have regained weight.  I would check with bariatric groups in your area to see if you can find one.  Even if your husband is not a candidate for revision, this will put him in touch with a group of people who are all working towards a common goal.

3) Encourage your husband as much as possible.  A lot of times, when patients regain weight they feel like failures - since surgery already seemed like a last resort, they honestly belive that there can't be anything else to help them.  But this is rarely the case - and if you can help him get started in the process, he will likely be motivated by simply knowing that he is far from alone.  

Please let me know if I can provide any additional information.

In Health,

Dr. Jacques

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