RNY to DS Revision

[jskasick]

I swear every time I think I am getting somewhere I wind up back at square one. This is such a frustratingly confusing experience for me.

I am looking to get a RNY to DS revision. I had originally planned on going to Dr. Greenbaum in NJ because he had such a great reputation and he is also willing to work with my primary doctor for follow up care (I'm from MO and not able to travel on a regular basis). Then I find out he had issues with not giving TRUE DS's and instead doing ERNY's. This scares me. I also found out he only does it open and requires a week in the hospital and 2 weeks in NJ following surgery.

I then thought about doing a BOB with a local surgeon. After doing a second upper GI and endoscope I found out my pouch is rougly half the size of a normal stomach and a lot larger than originally thought. I would feel better doing the DS and knowing that the failure rate is less than BOB because I surely do not wanna go through this again.

I am now set on DS again, but I don't know what to do. I contacted Dr. Stewart in TX. He sounds like a great option but he has so many "extra" fees on top of surgery fees and from what I hear he won't follow up with a local doctor either, he requires in person visits. This is not really an option for me. I need a doctor that will work with my primary. I will be compliant, I just need someone that will work with me and give me the education I need and follow up care I deserve.

I have insurance, so I have to find a doctor that will work with my insurance carrier and require as little as possible up front. To max out my insurance benefits it is $1500. This includes my deductible and coinsurance. I would like that to be my only out of pocket expenses other than travel related expenses. I Would also prefer it done lap because of the easier healing and less chance of infection.

I know I put a lot on the table, but does anyone have any input here? I'm lost

[Noodle]

My only two cents is run far far away from any procedure that includes a band placement-like the BOB. I had the crapband for four years and then had a revision to the DS. You are at the right place to receive education about a RNY to DS revision. I know several experts will add their advise. Best of luck to you. BTW, I opted to self pay so that I could have the DS over a RNY.

[larra]

Agree wtih Noodle - statistics for BOB are unknown, but it doesn't make sense to be to add a procedure with the highest failure rate of any wls to an already failed wls.

Your options for revision to DS are limited. Dr. Stewart has a great reputation, and before you give up on him, I would recommend making awfully sure he isn't willing to work with your local pcp.
Others to consider are Dr. Rabkin in San Francisco, Dr. Keshishian in Glendale (near Los Angeles), Dr. Roslin in NY, Dr. Buchwald in MN, and Dr. Simper in Utah. And unless I'm forgetting someone, that's about it.

Larra

[Deleted]

I believe Dr. Elariny in Fairfax, VA also does the RNY to DS revision.

[Paula]

Ill third the sentiment to AVOID THE BOB LIKE IT WAS THE PLAGUE. Putting something with an extremely high fail rate on top of a surgery that isnt working as it is anyway doesnt make any sense. If you are going to go through the motions of getting cut again, do it for the reason you are thinking about doing it and going with a surgery that at least is going to give you a fighting chance.

My RNY to DS revision surgeon was Dr. Simper. There is a program fee that isnt covered by insurance, but for me (with Medicare)...mine was $500. Then I had to pay the copayment for Dr. Simper, Dr. Smith (another RMAP doctor and the assistant on my surgery), and my copayment for St. Marks. Dr. Simper also does surgery at another hospital in Salt Lake City, but I had to have mine at St. Marks because its a Medicare COE. My surgery was lap and I was in the hospital a total of 4 days, but would have been out after day 3 were it not for trying to get the whole situation with my Lovenox bridge straightened out. My situation with Lovenox and warfarin is specific to me personally and not something that is standard operating procedure. I went directly by taxi from the hospital to the airport and flew home that afternoon. My PCP here in Oregon and Dr. Simper's office also have a collaboration as far as my care goes, but what you have to kind of keep in mind too is that your PCP and surgeon having a relationship is not vital to your success with the DS. Dont get me wrong, its nice. But I get my labs drawn here in Oregon via my PCP and copies are faxed to Dr. Simper's office. I do generally get calls back from Dr. Simper's office with suggested tweaks to current supplementation schedules. I had a problem with a recurring stricture. My first EGD was down in Utah with Dr. Simper and the second one that I had two months later was up here in Oregon with a local gastro doc. This was my experience with Dr. Simper and obviously I endorse people going to him for revisions because of the success Ive had, but the other surgeons Larra listed are all top-notch in revisions as well.

[Deleted]

Dr. Greenbaum's major criterion for whether to do ERNY or RNY-DS is whether or not your stomach pouch was transected (sp?) in your RNY. I can't keep straight which procedure he uses in which case, though.

Yes, he does only open procedures. IMNSHO it's the way to do an operation of this magnitude.

The BOB, Stomaphyx, ROSE etc. have minimal statistics available, but the reports coming back thus far say they all are just about completely useless.

Hang in there. True revision surgeons are great rarities, but they are worth the hunt, the wait and the effort.

[Girlrocker]

You can never put too much on the table here when it comes to seeking information! Hi, I'm Sharyl and I had the RNY to DS revision just over a year ago. I had Dr. Keshishian, as I live in Los Angeles, was very fortunate to have one of the top notch, handful of vetted surgeons who can perform this revision practice 15 minutes from where I live.

I concur with everything said so far. Dr. K also has a program free that covers a year of after care. Depending on your situation, he might be able to offer you payment options; there's also medical financing available. Take your time to find the surgeon that's going to be right for you. Traveling for surgery is not always easy and something you have to know going into this - like we did the first time - is that surgeries come with the potential of risks and complications. I've been very blessed that for all the nightmare I went through with my RNY (complications, second surgery, hernia, more surgery, open wound, loss of job, etc) I have had a beautifully smooth revision recovery. Others here have as well, and then some are dealing with some very challenging, longer complications. I say this because its something to consider if you need to travel for surgery.

Personally, and as someone who has had both lap and open surgeries, I wouldn't let that be a deal breaker. What you need to focus on is what is THE BEST option for you given your own history and medical status. And you have to know even the best surgeons can't see everything from tests, x-rays, when they go in they might find more (as in adhesions, scar tissue, etc)

You can research here, and, also re-post and ask in the subject for input from Dr. Greenaum patients.

I know how stressful this all is, but take the time to research, ask questions, and get the right fit on all fronts!

[melindap444]

I'm right there with you.
I'm not sure how to start a that on here...new to this Forum, but i had laparoscopic rny in September 2000.
Of course had all the complications.....lost 200lvs, gained back 100. However having serious pains in I'm my lef abdomen. Tests show my stomach isn't emptying properly. Been reading all about Dr hilario juarez who performed my surgery in 2000. Now my situation is...what is this pain in my side? What type if revision do u need? What doctor do i trust?
Any feedback is greatly appreciate.
Thank you for reading.

Melinda

[yvette37]

I would like to talk to the person who is getting the Revission with Dr. Greenbaum.
Iam actualiy in the process of seeking a revission. Last month I had a visit with Dr. Greenbaum . I wanted the DS. But he doesnt think i should have the ds but instead he wants to revise the RNY.
He told me RNY the surgery failed me. I had RNY 2/1/2007 By dr. Pasopathy . I only lost 35 lbs in 1 yr and then my put me On phenterime which I started dropping wieght faster then the wls. I started visiting a weightloss dr in Philadelphia PA, taking diet pills and I lsot 50 lb with the combination of both . but how hever I was only able to get 65 lbs off intotal in 3 yrs . and the second I get off of diet pills I start to regain the weight.

So I visit Dr. Greenbaum . he said he can revise the RNY that I had . But I only will loose 65 lb. o Iam disappointed from hearing that. I want to know does anyone know a good Dr. in NJ who is willing to do the RNY to DS Surgery.

I have a little doubt about dr. greenbaum. Bc he wants to due the surgery at virtua In Mount Holly. I use to work there. That hospital is filthy and dirtysome of my co-worker contracted MRSA and patient aswell. House keeping does a terrible job at cleaning. And you dont have private rooms. They have shared rooms . the only time you get a private room there is if you request and pay for it. I ask him is he willing to use the New Virtua that is bulit in Voorhees NJ. which is 30 min away from there. I gave birth to my daughter there last yr. The new virtua in voorhess isimacualant . He said no. So Iam rethinking another dr, who is able to perform the surgery at a clean facility that will provide privacy. Private room.`Because when you share a rm it is technically a HPA vilation. Because your room mates gets to hear your patient information.

I wanted to no has anyone had a revision ? and what amount of weight did you loose and how long did it take you?

[yvette37]

Oh By the way Dr.. GreenBaum had broke his shoulder before christmas . so surgery will be delayed.for a few months

[Deleted]

Jan 4, 2013 0:19:24 GMT -5 yvette37 said:

I would like to talk to the person who is getting the Revission with Dr. Greenbaum.
Iam actualiy in the process of seeking a revission. Last month I had a visit with Dr. Greenbaum . I wanted the DS. But he doesnt think i should have the ds but instead he wants to revise the RNY.
He told me RNY the surgery failed me. I had RNY 2/1/2007 By dr. Pasopathy . I only lost 35 lbs in 1 yr and then my put me On phenterime which I started dropping wieght faster then the wls. I started visiting a weightloss dr in Philadelphia PA, taking diet pills and I lsot 50 lb with the combination of both . but how hever I was only able to get 65 lbs off intotal in 3 yrs . and the second I get off of diet pills I start to regain the weight.

So I visit Dr. Greenbaum . he said he can revise the RNY that I had . But I only will loose 65 lb. o Iam disappointed from hearing that. I want to know does anyone know a good Dr. in NJ who is willing to do the RNY to DS Surgery.

I have a little doubt about dr. greenbaum. Bc he wants to due the surgery at virtua In Mount Holly. I use to work there. That hospital is filthy and dirtysome of my co-worker contracted MRSA and patient aswell. House keeping does a terrible job at cleaning. And you dont have private rooms. They have shared rooms . the only time you get a private room there is if you request and pay for it. I ask him is he willing to use the New Virtua that is bulit in Voorhees NJ. which is 30 min away from there. I gave birth to my daughter there last yr. The new virtua in voorhess isimacualant . He said no. So Iam rethinking another dr, who is able to perform the surgery at a clean facility that will provide privacy. Private room.`Because when you share a rm it is technically a HPA vilation. Because your room mates gets to hear your patient information.

I wanted to no has anyone had a revision ? and what amount of weight did you loose and how long did it take you?

Greenbaum's patients have private rooms. Show me evidence of substandard care or substandard cleanliness there. You are gossiping and nothing more. Obviously you have not been at Virtua Mt. Holly in a very long time, so stuff it.

Yes, you should go somewhere else. Very far away.

[larra]

Yvette, surgeons have operating privledges for certain operations only at certain hospitals. If Dr. Greenbaum does his revisions at Virtua, that's where you would have to go if he becomes your surgeon. I have never been there and have no idea what the conditions are like, good or bad.
More to the point, it sounds like the operating Dr. Greenbaum is offering you isn't what you want, so what you really need is a different surgeon, not just a different hospital. There is no one else in NJ who does RNY to DS revisions, but you are relatively close to Dr. Roslin in NYC, who is very experienced with this complex surgery and very highly regarded. I would recommend you arrange for a consultation with him. I would also recommend avoiding the other supposed RNY to DS revision surgeons in NYC, who are more likely to try to steer you towards staying with your RNY (based on the recent experience of other people in the same boat with you)
I can't promise you that Dr. Roslin will offer revision to DS - sometimes, depending on how your prior surgery was done, it just isn't possible. But I do think he's your best bet in the NJ/NY area.

Larra

[MsVee]

Head west! Contact Dr Keshishian or Dr Rabkin. This is your health. You may have to move outside your comfort zone for the best results.

I live in New York and I traveled to California for my revision from RNY to DS. It was not convenient but it was the best chance I had for the surgery I needed with a skilled surgeon. I do not regret my decision.
JMHO


MsVee

[yvette37]

Thanks Everyon who has responded. If anyone hears anymore good dr. please let me no. Thank you for your support. I needed this

[yvette37]

sorry to hurt your feeling. But Im curently an employee there now. The places is filthy. Several co - workers of miine came in contact with MRSA. and A relative of mine had surgery 4 months ago , and came incontact with MRSA. No the Dr. was not Dr. greenbaum.
But have you work there. We, us staff have been complaing about house keeping not disinfecting the rooms proper. so for you to call me a liar is an insult. You take a chance an go to Mount Holly and see for yourself.

As I was Talking to Dr. Green baum he said I wouldnt have a private room. I would have to share it.

If you Notice Virtua has a new facility in Voorhees. Its imaculant. Very clean. Which I ask him can he perform my surgery there and was told he will not . Only Lords or the hospital in Mount Holly. Ive been a Nurse there for 20 yrs.
So as an employee we no what goes on in the inside . As a patient you do not no.

[alaja957]

I have Dr.Roslin as my RNY to DS surgeon. I live about 8 hours outside the city and I found him really accommodating regarding my travel needs. For my actual revision surgery I was in the hospital four days then I traveled home and had to return a month later for my first follow up. Dr.Roslin is almost always available by email.

[ladylucky]

Dec 28, 2012 10:29:36 GMT -5 jskasick said:

I swear every time I think I am getting somewhere I wind up back at square one. This is such a frustratingly confusing experience for me.

I am looking to get a RNY to DS revision. I had originally planned on going to Dr. Greenbaum in NJ because he had such a great reputation and he is also willing to work with my primary doctor for follow up care (I'm from MO and not able to travel on a regular basis). Then I find out he had issues with not giving TRUE DS's and instead doing ERNY's. This scares me. I also found out he only does it open and requires a week in the hospital and 2 weeks in NJ following surgery.

I then thought about doing a BOB with a local surgeon. After doing a second upper GI and endoscope I found out my pouch is rougly half the size of a normal stomach and a lot larger than originally thought. I would feel better doing the DS and knowing that the failure rate is less than BOB because I surely do not wanna go through this again.

I am now set on DS again, but I don't know what to do. I contacted Dr. Stewart in TX. He sounds like a great option but he has so many "extra" fees on top of surgery fees and from what I hear he won't follow up with a local doctor either, he requires in person visits. This is not really an option for me. I need a doctor that will work with my primary. I will be compliant, I just need someone that will work with me and give me the education I need and follow up care I deserve.

I have insurance, so I have to find a doctor that will work with my insurance carrier and require as little as possible up front. To max out my insurance benefits it is $1500. This includes my deductible and coinsurance. I would like that to be my only out of pocket expenses other than travel related expenses. I Would also prefer it done lap because of the easier healing and less chance of infection.

I know I put a lot on the table, but does anyone have any input here? I'm lost

I am working with Dr. Berntsen in Topeka, KS. She does revisions and the DS. I will be a revision from VSG to DS but I believe she does revisions from RNY to DS as well. I don't know if you have to do your follow up at their office or if they will work with your PCP. I live in Wichita, KS so my plan to to drive the 2 hours and see her directly. Anywho, depending on where you live in MO, it might be a good option. Even St. Louis or even Springfield are only about a 7-hour drive.

Dr. Berntsen requires you to pay your portion up front, so be prepared for that. But, my portion is $4,600 so your $1,500 looks great to me!

Something else to consider is air travel. You can get flights to Dallas from most major cities for around $100 online. So the cost isn't bad at all if you select a surgeon in TX. Just a thought.

Good luck!

[zoetrope]

To OP:

This is a massively inconvenient surgery. I'm not even talking from a pain standpoint. It's not easy to arrange UNLESS you happen to be a.) geographically gifted AND b.) have really good insurance (unlike many of us who have insurance companies who want to dodge this revision bullet.)

Many people end up having to travel and stay there for awhile; others have to pay cash. Some have to do both things.

Have you checked your policy to make sure that you don't have a "one surgery per lifetime" clause?