Jedediah Kaufman, MD

Your story is concerning and it sounds like you are receiving care.  I recommend an upper GI to look for slip, erosion and esophageal dilation.  Upper endoscopy is also very important.  Removing fluid from band now is key to decreasing risks.  

Pouch dilation and esophageal dilation both cause feeling if no restriction but what's really occurring is a reservoir phenomenon above the band.  Erosion can occur when band is overfilled or inflammation occurs at band site chronically.  Leakage from band fluid out of band typically isn't painful but a slip or erosion definitely can be.  I'd make sure all these diagnoses are ruled out and often insurance will only cover band revision to a different Bariatric operation with a technical failure, so ask your surgeon to carefully document any such findings!  Good luck.

Possible and probable are difficult things to discuss.  I would never say it's impossible for a young, very motivated person willing to lift weights 4-6d week or some for of strength training and add cardio exercising and careful structured eating to lose all of their excess weight. However, most patients lose about 1/3 of their total body weight or 50-70% of excess weight.  Any way you calculate the estimate, the variables that improve your odds of losing more are mobility and willingness to exercise, age, diabetes and some other medical conditions that might hamper weight loss should be evaluated by a trained physician.  Gastric bypass tends to offer more weight loss in current literature than the sleeve gastrectomy, however, follow up and long-term care in a dedicated program can equalize those results some.  If you plan on having children, some surgeons feel the sleeve gastrectomy is a safer choice due to lower risk of twisted bowel or internal hernia.

Excess skin depends on genetics, where you carry your weight and age.  If you are willing to lift weights and do strength training this may greatly help.  The younger you are the better chance you have of a good cosmetic outcome.  Seek out guidance about this and avoid surgery for cosmetics or excess skin for at minimum 18 months after Bariatric surgery to allow you to reach your lowest weight and continue to change your body muscle composition. Good luck!

Unfortunately no.  A slipped band and a normal or low BMI won't qualify you for a revision operation.  The great news is that you are now at a BMI where with proper nutrition and a very good exercise program you probably can keep the weight off.  Also, a new medication exists call Belviq or locarserin that is designed for long-term use that helps decrease hunger.  It can be expensive.  It really works best with exercise and with a nutrition plan.  Topiramate can also greatly decrease hunger but does have side effects such as feeling a little forgetful sometimes, temporary numb fingers, and dry mouth.   With a slip the band really does need to be removed to avoid a severe emergency such as a larger slip that decreases blood flow to the stomach.  Good luck!

Short answer is yes.  In general patients with a BMI over 40 with or without comorbid conditions related to obesity qualify and those with a BMI between 35-40 with medical conditions or comorbid conditions like sleep apnea or hypertension also qualify.  Whether or not your medical insurance allows bariatric surgery or has an EXCLUSION for bariatric surgery is the key.  Medically you qualify.  I would talk with a high volume bariatric center the does a lot of sleeve gastrectomies and they can help you figure out the insurance and whether you need further testing like cardiac studies or a sleep study to look for sleep apnea.  Good luck on your journey!

Good question.

Usually people lose weight in the first few weeks due to fluid shifts from around the time of the operation and based on the diet and foods they are eating.  Most of the actual weight loss that occurs in the first week is due to getting rid of the several liters of fluid (2.2 pounds per liter, usually patients get 3-6 liters or 6-12 pounds of fluid) they receive during and immediately after the OR.  I suspect much of your weight loss in that first week was actually just your body getting rid of the fluid.  The real weight loss will now start more so once you are able to increase your protein intake and now that you are really stopping the simple sugars, carbohydrates and once you are allowed to start to exercise.  

Good luck.  I would also talk to your doctor and make sure you are doing well.  It's important to feel comfortable asking the doctor who did your operation if labs or anything else needs to be checked.