Revision to DS or RNY

[kyal]

Hi Everyone,

I had been watching the DS forum on the OtHer site for many years and now that its time to consider further surgery, I found out you all up and moved. Anyway good to see these forums are back to being useful once again.

Back in 2002 I had my first WLS, a lap band. Like everyone I was sold on its good points without knowing all of the possible downsides. I had my small band replaced with the new larger band in 2004 after a slippage and never lost anymore weight, in fact I put most of it back on. My surgeon then abandoned me saying it was my fault, I eat to much on purpose, don't come to followups and don't exercise. In reality I had a personal trainer, was having fills every two week and I COULD eat anything which wasn't supposed to be the case with the band in the first place.

I looked at other options and was set to convert to the RNY until I went interstate to see another surgeon who offered the VSG. He was cheap, I was poor and it sounded very attractive so I booked in and had it done. When I woke up I found out he stapled a bougie inside of me laproscopically and had to open me up to remove it. Two days later I developed a leak, some serious infections and was in hospital for a month.

I got down to about 255lb with the VSG but have put a lot of weight back on, up to 326lb. In the last 10 months I have worked hard to get back down to my current 263lb but I can't get any lower and I am terrified of putting it all back on. I feel great, doing things I haven't done before and wearing clothes I never could and I don't want it to end.

So I am considering further surgery. I figure I might as well try them all since I have come this far. I had been in discussions with another surgeon who recommended a simple DS without reducing the stomach further but this Dr retired suddenly. His replacement is happy to reduce the stomach further as best as he can and we are in discussion on exactly how to do that. I had told him that I want as close to the BPD/DS procedure that he can get but he has recommended some thing more along the lines of an RYN. Being young and fairly active he suggested that the bathroom issues would slow me down. His told me he has patients who can't leave the house in the morning because of the bathroom issues but ultimately he has left the decision with me.

Now I know a fair bit about both procedures. I see people on these boards who live with both surgeries fine. I see people who have issues with both surgeries as well. I don't want to live on the toilet but I also know the stats behind both operations. I know the RNY won't provide as much EWL% as a DS and I know there is often medium to late term regain with the RNY.

He has now made me doubt my initial decision for a DS. So really does anyone have those extreme bathroom issues? Has anyone here had an RNY to DS conversion who can perhaps comment on both?

There is no obstacle for either procedures, I don't have to get approval from insurance in my country, just pay the gap between what the Dr charges and insurance coverage so I can pretty much pick the best procedure.

Thanks,
Kyal

[Paula]

Hey Kyal,

Welcome. Glad you decided to stop on over and join our merry little corner of the internet. Im writing this from the standpoint of someone who has an RNY currently and will be revising to a DS in 2 months. I lost 200lbs with my RNY and gained back 100lbs of it. I still struggle with blaming myself for what I feel is my failure. But I digress...

I wont tell you what to do because its my belief that only you are going to know what is best for you. But if I was in your shoes myself and facing the same decision you are, I personally think Id go with the DS since you already have the first part of it completed with your VSG. If you decided to go with the RNY, they would take your fully functioning sleeve and butcher it to create a pouch. This would take your pylorus out of the equation altogether. Now you might be one of those people who dont dump (like me). Well, I did dump once early out...and quite literally thought I was going to crap my brains out while feeling nauseous and lightheaded all at the same time. Or you might be one of the types who do dump. While you will still malabsorb some vitamins and minerals, the malabsorption of what you eat seems to die down by about the 2nd year out. The body is an amazing machine with this uncanny ability to adapt to what we do to it. It just gets better at getting everything out of the food we eat than it was in the beginning. Then you get back to where Im at right now. Needing to revise to a surgery powerful enough to do the job Im asking it to do. Or something mechanically goes wrong with your RNY and you need to have it revised. Stuff happens and we dont always know how things are going to turn out. So lets call this worst case scenario...you went with the RNY and it had to be revised for whatever reason. You've now entered the land of clusterf**k.

The RNY to DS is the most complex procedure out there. There are only a handful of surgeons here in the US (and Dr. Gagner up in Canada) who can do it. Id assume the same could be said for experienced revision surgeons in Australia as well, but Im not familiar with any of them to be able to say one way or the other. But essentially what has to be done is they have to take your pouch down and reconnect it with the rest of your sleeve that was rendered a blind stomach during the RNY. Then they'd reroute your intestines once again to match those of the DS if that was the way you went. Risks include things like leaks and the usual host of problems that come with major surgery. Its not impossible, but its a much more difficult procedure. Plus already having 3 previous procedures (the band, the VSG, and the RNY), you are going to have developed scar tissue and adhesions that a revision surgeon will have to work through.

What I would really suggest is that you take a long look at yourself and what your needs are from your bariatric procedure. The success rates are about equivalent for both the VSG and the RNY...so if the VSG didnt work for you, are you confident in the RNY's ability considering they are about on par with eachother? Are you the type who can get by with a restriction only surgery...or are you needing a two-pronged approach (restriction and malabsorption)? Only you can decide what's best for you and I wish you luck in making the right decision FOR YOU. I know what Id do if it was me.

[sandyv63]

That bathroom nonsense is such a myth. Very few people are chained to the bathroom. It just isn't typical. Those few that have these issues generally have an underlying problem like C. diff. You can improve your situation by taking a good probiotic now and continuing with them for life. You should also start a good vitamin regiment (if you haven't already) so that if you have bowel tolerance issues, you can resolve them prior to surgery when it won't be so traumatic. Now don't take the same quantity of vitamins a DS post op would take; just take whatever quantity you require as a VSG patient.

That being said, I second what Paula said. You aren't likely to do much better long term with the RNY and if that is the case, why butcher yourself? If a DS really sounds scary to you, continue working with your VSG instead of imposing more trauma on your body. I don't think you need to try every surgery that is available. I think you deserve better.

My first consultation with a DS surgeon was similar to yours (thank goodness I switched surgeons.) He told me I'd be 'farty' and have many bowel movements durning the day. Never happened. I have less gas now than I had prior to surgery and I tend to be constipated. I would like to spend more time in the bathroom! Never in my life did I think I'd ever say that...

[kyal]

Hi Paula and Sandyv,

Thanks both for your replies.

Paula: I believe I already know what will be best for me but the surgeon has gone and done what they do best I guess and put second thoughts in my mind for some reason. When I had the VSG done I really wanted the DS but they wouldn't do it. I continually keep getting told to take the easier and less invasive option when really I would just prefer to do it right in the first place.

I've heard that the dumping is pretty damn awful. I can see its benefit for those of us that need a physical restraint to stay away from sugar, which is me, but it wouldn't make for an amazing quality of life if it was constant. I really do think I need the malabsorption for this to actually work but it seems that part of the RNY isn't very good unless you go for a distal, and then you might as well just go for the DS.

I would be looking at being re-sleeved so in essence the whole BPD/DS procedure. My sleeve wasn't made small enough to begin with and I barely notice I have had it done. My surgeon did say RNY first and convert to the DS after if its not successful but I think that's really a waste of time and in my experience once a surgeon here operates once they won't operate again.

Sandyv: I had a feeling the bathroom thing is probably overblown. Either by surgeons who are reluctant to do the DS for what ever reason or perhaps putting the worst possibility forward to cover their butts if it does happen. Least they can say "we warned you". I don't see a forum full of people complaining they are super glued to the dunny, I see people who have lost a stack of weight, have an occasional issue but generally do better than the rest.

Unfortunately working with the VSG isn't an option. I am now 6 years out from having it done and its barely there. It was made way to big in the first place as they were more conservative back then and I really can't tell I have had it done accept for the occasional wind if I eat a really big meal. So its either get fat/stay fat or do some thing about it. After being on every diet in creation and knowing the research I find it really hard now to even think about going on some program that will be a huge waste of money and eventually fail.

I already take some vitamins now so I am good for that. I take a D and multi vitamin each day and give my self a monthly B12 shot. I take my meds and vitamins religiously so I don't see my self ever falling off the vitamin train.

Really I do think my mind is made up. The DS makes a hell of a lot more sense but surgeons do have a way of making you second guess your self. I really don't have the option to change Dr's either as Australia is a small place and there aren't many who do bypass or DS. Add to that finding one who will agree to and is confident and qualified enough to do revisions on some one who has been banded and sleeved is almost impossible.

I have a little more thinking and posting to do before I set a date but really I just want it done. What was supposed to be a "miracle solution" (the band) has turned into one long and reoccurring nightmare.

Thanks for listening,
Kyal.

[hoosiermama]

In my research, I "think" that a lot of the bathroom stuff came from the scarpino (sp?) version....it's carried. The current DS is done much differently. Now, in saying that. If the surgeon you picked has operated on patients that can't leave the bathroom in the morning from pooping after the first few months (which I will attest aren't fun), maybe he's a lousy cutter. I'm two months out. If I take my calcium and mag I actually have formed stool (tmi, sorry). I will tell you I haven't thrown up since I had surgery. I have had some bathroom issues early out but that's to be somewhat expected. I'm temporarily or permanently lactose intolerant...I can live with that. I've lost probably 50 pounds (I weigh on tuesday so I'm guessing but I gotta hold my pants up LOL

Don't let anyone cut on you that doesn't know what they are doing and whatever you are planning on, plan on it to last forever. And don't let them give you an rnly (or some weird long version of the rny), I've heard it doesn't work.

me

[teachmid]

I think it's been said in so many word, but I'll mention it again. If you didn't succeed with a restrictive picadors, then doing another restrictive procedure is probably not goi going to help.

Another point, people who have revisions tend to lose weight more slowly and may not reach that magic number. I speak as someone who had a RNY to DS revision. I also had been close to getting a RNY to RNY revision, but thank goodness I had insurance issues which gave me the opportunity to research the DS.

Good luck on your decision.

[Band to DS]

Hi Kyal,

I got a lap band in 2008. I only ever lost 38 pounds - through strict diet & exercise. (I honestly don't think the band was any help at all.) I gained it all back when I developed swallowing problems. Last summer, I started thinking about a revision. At first, I was convinced that I wanted a RNY. The DS scared me & I knew that the VSG wouldn't work since the band didn't work. I started reading articles in medical journals because I didn't want to make another huge mistake like I did with the band. I ended up deciding that the DS was the way to go. Unfortunately, there aren't many surgeons who are qualified to perform the DS. You may end up having to travel to get the best care. Lots of folks in the States do this too. Check out the website www.dsfacts.com/ for a list of "vetted" DS surgeons and lots of other useful information.

Good luck with your decision,
Shelli

[zoetrope]

I've had the RNY and the DS. I was chained to the bathroom WITH THE RNY. Your mileage can and will vary. The DS released me from GI problems.

[Deleted]

The surgeon is selling you a bill of bullshit so that he can sell you what he knows how to do. I would consider it the height of insanity to convert a VSG stomach to an RNY pouch and I think he's being a nincompoop, at best, for even suggesting it.

[larra]

I think in your case, converting from VSG to DS would actually be less involved than converting to RNY, as your stomach could be left as is. Given that you've had 3 surgeries on your poor stomach already - the band, removal of band and conversion to VSG, and then fixing the complication with the bougie - and on top of that the infection you had that required a month in the hospital - there could easily be a lot of scar tissue on and around your stomach, placing you at higher risk for further complications with any additional cutting on your stomach. Any surgery that avoids your poor stomach would make more sense to me.
And that's aside from the superior weight loss and resolution of comorbidities with the DS. And no, we don't all live in our bathrooms.

Larra

[Seeking Healthy]

I am a RNY to DS revision. I have lived both lives and I can tell you from personal experience that DS life is far BETTER. I am not chained to a bathroom. I go maybe once a day and sometimes two. I work professionally outside the home and interact with people all day. I control my gas by what I choose to eat. I eat normally and can actually enjoy my food again. The RNY/ERNY messed me up. I had to convert to the DS to get healthy (which I am still working on but it is getting better).

Reasons why I would not recommend RNY (personally, I think they should ban it):

1 - Food intolerance. I could tolerate hardly any meats, rice, pasta, basically any dense foods. Things would get "stuck" all the time. I spent more time in the bathroom throwing up then I care to mention and it WAS NOT because I did not chew enough or that I ate to much. I would have days where I could tolerate a food but the very next day I would eat the same exact thing and get sick. This made it extremely difficult to determine what my "safe" foods were.

2 - Reactive Hypoglycemia. Yep, I developed this about 5 years out and it got so bad I was starting to pass out. Not fun.

3 - I don't care what any RNYer says. Dumping is not a "positive". It sucks. Of course I never did get into negative reinforcement.

4 - The malabsorption IS NOT permanent.

5 - It messed up my metabolism. After the regain started, I could not loose a pound if my life depended on it. I was taking in 800 calories a day and exercising and I still could not loose the weight. Of course this was after the honeymoon period.

I could go on and on but I think you get the picture.

Your doctor is giving you wrong information IMO. Why would any one want to revise to an RNY and then…. if it doesn't work "we will go ahead and revise yet again to the DS"… A revision from a RNY to the DS is the most difficult revision and the most risky. You have already had several surgeries on your stomach. There could be a chance if you went the RNY route, then later it may not be possible to reconstruct your pouch back to your stomach and make a sleeve.

Even getting your sleeve redone, as you are considering, has a certain amount of elevated risk to that as well. Choose your surgeon wisely. Revisions are tough and you only want the very best. Don't go into this thinking if this don't work out then you can just revise again. Go into it planning for your final revision to a procedure that will work for you.

Personally I would run as fast as I could from any doctor who is telling you that you would be best to go for a RNY and then revise later to the DS. He is not the one who has to live with it should it go south. He is not going to care if you had made the best choice or not. Not if he is recommending a surgery with the thought to revise later. That just makes no sense to me.

Of course only you can decide what is best for you and your life style. Please do more research. As you know revisions are not fun and they will only get more complicated the more you have your stomach cut on. I do wish you well on your decision and your new journey.

Best of Luck,
SH

[lauralisi]

Hi, Kyal,
I am a RNY to StomaphyX to DS revision. I wish to high heaven that I would have had the Best surgery first. Finally, I can control my weight! And no, I'm not chained to the toilet either.

Hopefully, you'll select the the surgery with the greatest chance for success. Then, in 10 years you'll be Done and not have to undergo another bariatric surgery!

Best of luck to you,
LL

[Girlrocker]

I had the RNY in May 2002, and revised to the DS five weeks ago. My original surgery weight was 278, my highest weight was 315. My lowest weight was 180 - for 5 minutes and I could not stay under 200 lbs no matter what I did, and I was 100% dedicated to nutrition, diet, exercise, supplements. I had a complication that landed me back in the hospital one week later, a second surgery 3 weeks, developed a serious incisional infection that put me out for 3 months, hernia repair 1 year after that. I had some PS/skin removal done (panni, arms) at the same time of the hernia repair and that's when I hit that 180 for five minutes.

My constant battling, struggling caused me tons of depression, I bounced up to 240, took it off, and then did it again. The RNY to the DS is an extremely specialized surgery and I knew it was the most difficult revision of them all, the RNY first has to be undone, then the DS applied. I went for 3 consults - Dr. Keshishian and two others; one wanted me to do the lapband around the pouch, the other wanted to revise to an ERNY (distal). I know plenty of RNY success stories, but I knew Dr. K was my guy, the RNY failed me, and I realized there was no way I wanted to have this plumbing any more.

I had been through hell with my RNY, and was absolutely nervous about another surgery, especially one this complex. But I decided that compared to the pain and suffering of my obesity, it was worth it. I wish I'd had the DS in the first place but it was never option for me because my insurance didn't cover it.

I didn't have the RNY to dump, and I hated it, all it did was make me sick, did nothing for me.

I constantly dealt with food getting stuck, throwing up.

The DS bathroom issue is not an issue. I personally always have had 'nervous stomach' issues, which were worse with my RNY, I had to take stool softeners. Having issues now since I'm still new,that's to be expected, waiting to see how it plays out. I can tell you that it feels really good to have a real stomach again.

My labs were good but I worked at it very hard, and I continue to do so. I had major hair loss.

You have to do what will be the best for you, wishing you luck!

[kyal]

Thanks everyone for sharing your experiences with me. Some of them are very personal and i can relate to most of you who have been on the weightless surgery ride from hell. I was sitting next to you. I will try and reply to you all in a separate message.

I guess I am only getting one side of the story, that DS isn't all negative. If I really wanted an RNY I could ask in that forum but thats never been what I have wanted.

I went in for endoscopy/gastroscopy last Friday to see if there was any problems inside my stomach and to assess the shape of it. The top part of the stomach is very wide, where the funds is. Towards the bottom it resembles close to an enlarged sleeve. So its still huge and not doing me any good. Theres no sign inside the stomach of the previous fistula (leak) from my sleeve.

The surgeon has proposed a BPD (scopinaro) without DS, where the pyloric is removed and bowel is joined on to a smaller stomach pouch (sounding like RNY by stealth?). He has asked me to come see him again to discuss how I want to proceed. I asked him about re-sleeving and doing the Duodenal switch and he told me that it was difficult and risky and doesn't believe the extra time under anaesthesia is worth it. I don't agree.

I have made the follow up appointment with him to see what he says. I have a huge list of questions for him about who he trained with, the numbers of times he has done this surgery, he told me around 40 but I didn't ask specifics such as how many revisions, etc. His a good surgeon, very experienced from his resume but I don't know if his in the same league as the big revision surgeons in the US. Then again I don't think anyone here is in that league.

I did find research from another surgeon the next state over from me who has done 200 Duodenal switches with long term follow up. Unfortunately after emailing his office I find out he no longer performs the DS, but they have given me another surgeons name who does and from checking him out he looks to be performing revisions as well. I'm awaiting an email back from them and if it sounds like a better option I will book in and fly over to see him for another opinion and to keep my options open.

I envy you all who are close enough to get to a Rabkin, Ganger or Smith of the DS surgeon world. Send one of them my way for a holiday?

Kyal

[kyal]

hoosiermama: Bingo. After seeing surgeon last week for gastroscopy that is what he hinted at doing to me, Scopinaro. I don't want that if at all possible. I know its a good procedure, works well, but you have dumping and obviously this toilet issue. No such thing as tmi here... were all friends with similar issues at one stage or another - I was on xenical so I know all about the orange stuff that ... I digress
I won't be having an RNY of any type. Particularly not a distal or ERNY.

teachmid: Hi Gail, That was my thinking too which is why I was a little perplexed that he recommended another mostly restrictive procedure. I know the weight loss can be a little slower, I can live with that if it is. I tend not to have problems loosing weight up to a certain point and then its like quick sand.. Can't get any lower. I have lost about 116 lb since last March just through various diets, exercise and what have you. My biggest problem is keeping it off, I have put on 11lb after loosing that 116lb but I am now managing to keep it stable at 105lb lost using prescription diet pills and some exercise. Keeping it off is defiantly my biggest challenge which is why I think the DS would be better for me.

Shelli: I know that feeling. And how shitty do the surgeons make you feel when it doesn't work? I was told it was my fault for not attending follow up, yet I was there every 2 weeks. I was also told I didn't exercise enough, if the band worked in the first place the five days a week I went to the gym should have been sufficient. I'm sorry you went through that as well. Some band surgeons are pond scum.

I had a look at that site. My surgeon isn't on that list and there are only two in the country who are and I will be looking at seeing them. I also have found another surgeon who isn't on the list but is performing revisions to DS in another state. I am looking at traveling to see him for another opinion. Thanks

eloisie: RYN Sucks. After going through all the research again for what must be the 10th time in 10 years I now know why I keep asking for the DS. Its track record.

EN: I was hoping your words of wisdom would make its way onto here. I think you may be right. While this guy is a very good Upper GI and General Surgeon, I am still to be convinced of his skills in revisions and the DS. He says he has performed around 40 of these which is probably about right given how popular the hype band is here and how unpopular any other kind of surgery is. If he told me he had done 400 I would know he was lying. His now suggesting a BPD (scopinaro without DS) which is obviously an easier procedure to perform. My stand point is surgeons like Ganger and Smith are performing these kinds of revisions laparoscopically so I don't see how it can be that much more difficult to re-sleeve and DS a patient instead of a simple BPD. Either way your cutting the stomach and bowel. I will meet with him again and ask these questions and also meet with others to keep my options open and see who else is around.

larra: Unfortunately my stomach is misshaped, was never sleeved small enough and has stretched out. It needs to be re sized down again. The Scopinaro BPD has been suggested as a safer alternative to re-sleeving but I don't see the difference. Either way the stomach and bowel have to be cut. The though of some one severing my bowel with a scalpel sends shivers up my spine...

Seeking Healthy: Your right.. I am looking for the best option that will mean I never have to be cut again and I really know the RNY isn't the right choice. Measure twice, cut once is what contractors say. I don't want to have to be returning for further revisions. I don't think his intention was to try one and revise.... he put it there as a last resort option should RNY fail... It won't fail because I'm not having one.

lauraisi: Thanks... Your right this needs to be a life time decision. I don't plan on going back in again unless its to remove loose skin.

Girlrocker: I know that whole 5 minutes of glory feeling. The moment you get to the lowest weight you have ever been but you wake up the next morning and its gone. I have experienced that twice now and its amazing when it happens but frustrating when its gone. I just wish we had the caliber of surgeons who do DS here that you have in the US. Its slim pickings here.

[larra]

Kyal, sorry about what now sounds like a sleeve that wasn't done right to begin with. So you won't be able to avoid some kind of revision on the stomach, but please, whatever you do, don't let this guy suck you in to an old Scopinaro BPD. There is a reason why it isn't being done in the USA anymore, except rarely by some old fogies who haven't learned the DS. There is a reason it has been REPLACED by the DS - the risks of nutritional problems are too high, too much problems with diarrhea, and of course, once the lower part of the stomach, including the pyloris is REMOVED, there is no way to ever revise to a real DS. The common channel, which is too short in the BPD, could be lengthened, but the stomach part you are stuck with for life.
My advice, for what it's worth, would be to not even go to the follow-up appt with this surgeon. The operation he is proposing is outdated. It's history. It is no longer a standard of care operation, at least not in the USA. I understand about real DS surgeons being hard to come by where you are, but even if you did nothing, you would be better off than with a Scopinaro BPD.

Larra

[bb212]

Hi Kyal,

I agree with Lara, if your doctor is suggesting the scopinaro it is time to move on to another surgeon. That is a red flag one shouldn't ignore- good doctors are up to speed with the best surgical techniques, and they don't recommend obsolete/defunct procedures. If there are better doctors in other states it's time to start researching them to pick the best one. Many patients in the USA who needed a revision had no choice but to travel in order to find a qualified DS surgeon, so you're not alone in having trouble finding a reputable/vetted surgeon for a DS revision.

Good luck and let us know how your surgeon search goes!

[Deleted]

The BPD is the WORST OF BOTH WORLDS.

RUN RUN RUN, far and fast. That surgeon is worse than useless for you.

It sounds to me like what you need is a full fledged DS with redo of your subtotal gastrectomy to do it right this time.

The Scopinaro procedure is totally outdated and essentially abandoned, except as a means of very last resort in a very limited number of cases. There are a couple of people around here who wound up with what is essentially a Scopinaro procedure after bad complications left them with pretty much no other (or only worse) options.

You do NOT want this. It's time to plan to travel to a REAL DS revision surgeon.

[zoetrope]

Do not get rid of your pyloric valve. That's what caused me all the pooping with the RNY. Terrible.

[Seeking Healthy]

Jan 17, 2012 8:31:15 GMT -5 kyal said:

hoosiermama: Bingo. After seeing surgeon last week for gastroscopy that is what he hinted at doing to me, Scopinaro. I don't want that if at all possible. I know its a good procedure, works well, but you have dumping and obviously this toilet issue. No such thing as tmi here... were all friends with similar issues at one stage or another - I was on xenical so I know all about the orange stuff that ... I digress
I won't be having an RNY of any type. Particularly not a distal or ERNY.

teachmid: Hi Gail, That was my thinking too which is why I was a little perplexed that he recommended another mostly restrictive procedure. I know the weight loss can be a little slower, I can live with that if it is. I tend not to have problems loosing weight up to a certain point and then its like quick sand.. Can't get any lower. I have lost about 116 lb since last March just through various diets, exercise and what have you. My biggest problem is keeping it off, I have put on 11lb after loosing that 116lb but I am now managing to keep it stable at 105lb lost using prescription diet pills and some exercise. Keeping it off is defiantly my biggest challenge which is why I think the DS would be better for me.

Shelli: I know that feeling. And how shitty do the surgeons make you feel when it doesn't work? I was told it was my fault for not attending follow up, yet I was there every 2 weeks. I was also told I didn't exercise enough, if the band worked in the first place the five days a week I went to the gym should have been sufficient. I'm sorry you went through that as well. Some band surgeons are pond scum.

I had a look at that site. My surgeon isn't on that list and there are only two in the country who are and I will be looking at seeing them. I also have found another surgeon who isn't on the list but is performing revisions to DS in another state. I am looking at traveling to see him for another opinion. Thanks

eloisie: RYN Sucks. After going through all the research again for what must be the 10th time in 10 years I now know why I keep asking for the DS. Its track record.

EN: I was hoping your words of wisdom would make its way onto here. I think you may be right. While this guy is a very good Upper GI and General Surgeon, I am still to be convinced of his skills in revisions and the DS. He says he has performed around 40 of these which is probably about right given how popular the hype band is here and how unpopular any other kind of surgery is. If he told me he had done 400 I would know he was lying. His now suggesting a BPD (scopinaro without DS) which is obviously an easier procedure to perform. My stand point is surgeons like Ganger and Smith are performing these kinds of revisions laparoscopically so I don't see how it can be that much more difficult to re-sleeve and DS a patient instead of a simple BPD. Either way your cutting the stomach and bowel. I will meet with him again and ask these questions and also meet with others to keep my options open and see who else is around.

larra: Unfortunately my stomach is misshaped, was never sleeved small enough and has stretched out. It needs to be re sized down again. The Scopinaro BPD has been suggested as a safer alternative to re-sleeving but I don't see the difference. Either way the stomach and bowel have to be cut. The though of some one severing my bowel with a scalpel sends shivers up my spine...

Seeking Healthy: Your right.. I am looking for the best option that will mean I never have to be cut again and I really know the RNY isn't the right choice. Measure twice, cut once is what contractors say. I don't want to have to be returning for further revisions. I don't think his intention was to try one and revise.... he put it there as a last resort option should RNY fail... It won't fail because I'm not having one.

lauraisi: Thanks... Your right this needs to be a life time decision. I don't plan on going back in again unless its to remove loose skin.

Girlrocker: I know that whole 5 minutes of glory feeling. The moment you get to the lowest weight you have ever been but you wake up the next morning and its gone. I have experienced that twice now and its amazing when it happens but frustrating when its gone. I just wish we had the caliber of surgeons who do DS here that you have in the US. Its slim pickings here.

Kyal Good for you for doing your research and knowing yourself! Sounds like you are truly looking at all aspects of your options. I *exalt* you for this.

Like the others have mentioned…. PLEASE STAY AWAY FROM THE BPD OR THE ERNY…. not good….

Whatever your choice I wish you much luck on your new journey. Please keep us posted…


SH

[baileymouse]

So many of us RNYers revise. The smart ones choose the DS.

[Jody]

As eloisie said - DO NOT GET RID OF YOUR PYLORIC VALVE!! That's the main reason I have Reactive Hypoglycemia and reflux... nothing stopping the acid and bile from coming back up.

And I'd like to get one back....

[kyal]

larra: Yes to put it politely my sleeve was botched, butchered, screwed up and totally ruined. I had my sleeve done back when it was protocol to remove band and sleeve at the same time, now thats not the case as they remove the band and wait 6-12 weeks before a second procedure to do the sleeve. Add to that my surgeon stapled the bougie or sizing tube into my stomach and I had to be opened up for him to essentially cut it out. I had a small leak about 3 or 4 days post op, was in hospital 24 days longer than expected for a total of 28 days, infections in the hospital, a serious infectious abscess when I returned home which had to be surgically drained, a large hole that had to be packed for weeks and generally speaking I was out of action for 4 months post op with complications.

EN: Given I have been hacked up inside I might be one of those people who's only option is the BPD. I will cross that bridge when I have all the evidence though, I'm not signing any consent forms for that procedure in a hurry I can tell you. I would want photographic evidence of the exterior of my stomach showing that a re-sleeve is impossible before even considering a BPD.

Everyone Else
__________

Relax.. I have no intentions of letting anyone take my pyloric sphincter or any other sphincter for that matter

I can't just ditch this surgeon though. If push comes to shove and I have to sell my soul to the bank and go overseas I will still need aftercare when I return home and his one of the only ones who would do that in my home state. Add to that the damage done to my stomach during the sleeve may mean this is actually the only safe procedure for me but I'm not ready to accept that just yet.

I have two other surgeons to contact, one who is actually on the vetted list. I'm going to ask my current surgeon to indulge my curiosity and see if he will admit me to hospital for a Laparoscopy to have a look at the outside of my stomach. It would be handy to see what actual damage has been done and some pictures would be good should I need a second opinion or to send overseas to other surgeons. That way they would know pre op what they may be getting them selves in for should I go to them for a revision. Plus while I am in the OR he can remove the enormous softball sized fat tumour I have as well.

I have managed to find two other DS patients on here in Australia. Both seem to have gone out of the country for the procedure which says some thing.

[larra]

I understand your concerns about staying on good terms with this surgeon, if he's the only one you'll have available for follow-up.
The laparoscopy to get a look at the current sleeve may not be as simple as you think. Unless I miss my guess, there are probably lots of adhesions on and around that poor thing, after all it has been through, and it wouldn't make sense to go through the effort (and risks) of taking down all those adhesions just to get a look. While I understand how nice it would be to know what the future DS surgeon would encounter, you would develop new adhesions from the takedown of the old adhesions, so really, you wouldn't gain anything except for having the softball removed. And as nice as that would be, it really isn't your big concern.

We've had some patients who were scheduled for revisions to DS who, because of severe adhesions and/or other problems from their prior surgeries, could only get the sleeve, and had to go back a few months later for the "switch" part of the DS. It may turn out that you need 2 operations, first to get your sleeve redone into a true, proper sleeve, and later to get the switch. I hate to even put this possibility out there, but even if it comes to that, it would still be better than going to a BPD.

Larra

[sarahanne]

Would you consider going somewhere outside of OZ not in the US? Dr. Andre Keidar in Israel (my surgeon) is really good and has done quite a few revisions. I don't know what he charges for revisions but I know its quite competitive. If you want his email address I can PM it to you.

[kyal]

Hi Larra,

Jan 19, 2012 11:10:01 GMT -5 larra said:

I understand your concerns about staying on good terms with this surgeon, if he's the only one you'll have available for follow-up.

My GP would be capable of doing most of it but should I have post op complications when I arrive home I would need a surgeon. Better to have a positive relationship before hand than to end up in one of the public hospitals where they really have no idea what weight loss surgery really is.

Jan 19, 2012 11:10:01 GMT -5 larra said:

The laparoscopy to get a look at the current sleeve may not be as simple as you think. Unless I miss my guess, there are probably lots of adhesions on and around that poor thing, after all it has been through, and it wouldn't make sense to go through the effort (and risks) of taking down all those adhesions just to get a look.

I'm mainly thinking more to have a look at what adhesion's are actually there. Cutting through them to get a look at the actual stomach would be pointless, your dead right.

Jan 19, 2012 11:10:01 GMT -5 larra said:

While I understand how nice it would be to know what the future DS surgeon would encounter, you would develop new adhesions from the takedown of the old adhesions, so really, you wouldn't gain anything except for having the softball removed. And as nice as that would be, it really isn't your big concern.

I want the softball removed at home if I have to go OS for the DS. Its one less thing for them to do and I can get it done here for nothing on my insurance. I have also asked a couple of OS surgeons if there is any value in having my gallbladder removed before the revision.

Jan 19, 2012 11:10:01 GMT -5 larra said:

We've had some patients who were scheduled for revisions to DS who, because of severe adhesions and/or other problems from their prior surgeries, could only get the sleeve, and had to go back a few months later for the "switch" part of the DS. It may turn out that you need 2 operations, first to get your sleeve redone into a true, proper sleeve, and later to get the switch. I hate to even put this possibility out there, but even if it comes to that, it would still be better than going to a BPD.

Lets not think about that right now.. That would be my nightmare come ture

Thanks for your reply
Kyal

[kyal]

Jan 19, 2012 11:18:53 GMT -5 sarahanne said:

Would you consider going somewhere outside of OZ not in the US? Dr. Andre Keidar in Israel (my surgeon) is really good and has done quite a few revisions. I don't know what he charges for revisions but I know its quite competitive. If you want his email address I can PM it to you.

Indeed I would. I have made a couple of inquiries outside of the US already but would certainly be open to emailing your surgeon in Israel. If you could PM me the address that would be great.

Thanks,
Kyal

[omeaga7]

Jan 17, 2012 15:01:32 GMT -5 @en said:

The BPD is the WORST OF BOTH WORLDS.

RUN RUN RUN, far and fast. That surgeon is worse than useless for you.

It sounds to me like what you need is a full fledged DS with redo of your subtotal gastrectomy to do it right this time.

The Scopinaro procedure is totally outdated and essentially abandoned, except as a means of very last resort in a very limited number of cases. There are a couple of people around here who wound up with what is essentially a Scopinaro procedure after bad complications left them with pretty much no other (or only worse) options.

You do NOT want this. It's time to plan to travel to a REAL DS revision surgeon.

Ya know I hinted my disagreement to the doctor who suggested this procedure (Scopinaro) to me and he is adament thats all he will do. Just not feeling it.

[omeaga7]

Kyal thanks for the post. I need all the information I can get. I am looking for my B.E.S.T. option for a RNY to DS revision. This is the final. Insurance would only do LapBand or RNY and still only does those two. I have a few dollars saved now and know I will be traveling outside the US and DS is it.

Thanks everyone for your post.