Revision Surgery in Nebraska?

Hi...

I had RNY in 2004 and have gain a lot of weight back.  I'm wondering if anyone has a similar story and have either looked into or had a revision using a Nebraska surgeon.  Does Dr. White do revisions? Thanks for your help and thoughts.

Before you start looking for a surgeon, you need to decide which sort of revision you want. The most effective is to revise your RNY to a DS, but that takes a highly skilled surgeon and there aren't a lot who do this. If you'll read some back posts, there's a list of RNY-to-DS surgeons posted here.

When I started looking into revision from RNY, I found out that the subject was a lot more complicated than I realized.  After a lot of research, I found most of the best results had been found with revision to DS.  If you picture a spectrum of surgeries, from simplest (lap band), to more complex ( RNY, "virgin" DS) to most complex (revision of RNY to DS, you find that the largest pool of surgeons do the simple; the number that do more complex is fewer, and the number of surgeons who specialize in the revision to DS is very small (only about 8 surgeons in the US).

I originally was referred to a surgeon in Nebraska.  Upon speaking with his office to make an appointment, I was told that he does not revise to DS.  I am not sure what else he does, but other surgeons who offer revisions are speaking of doing a lap band on top of the bypassed pouch (Band over Bypass), or leave the pouch alone and increase malabsorption by making the bypassed section of small intestine longer (distal limb RNY).   The distal RNY has the worst record for serious protein malnutrition, and a lap band on top of the already small pouch can cause erosion of the pouch, vomiting, ulcerations of the esophagus.  The risks of side effects are much higher, and the weight loss results may be disappointing.

I live in Wyoming, so I was very disappointed to learn all this.  The surgeon in Nebraska would have only been a two hour drive for me.  The nearest surgeon who is very experienced with RNY to DS is in Salt Lake City, which is a six hour drive.  I have an appointment in one week with him, to see if I can have surgery.  I have had several abdominal surgeries in the past, and I already know I have a lot of adhesions in my abdomen, and I have two hernias which have been operated on 3 times to repair, only to have them tear again, and I have a colostomy (for a problem not related to weight loss surgery).  So, I am considered a very complicated case.  I already know the odds of me being able to have a laparoscopic surgery are about zero.  If this surgeon does not wish to take me on, the next nearest is 1000 miles from me, two surgeons in California.  

I would recommend that you do a lot of reading and research about the surgeons and the procedures.  Contact the surgeon you wish to see, and specifically ask them what type of revision they do.  Surgeons will try to sell the surgeries that they can do.  If they don't do revision to DS, they will offer you one of those patchwork type fixes.

I wish you well in finding the best solution for you.