Sleeve questions from an RNY patient
You can find my post on the main board about what the past few months have been like. Long story short: I had my RNY in April. In May I started having a lot of burning when I eat. Ulcer diagnosed by EGD on 6/6. 3 separate hospital admissions on 7/7, 7/15 and 8/3 due to ulcer not healing, vomiting, malnutrition. EGD today showed that my ulcer has gotten larger and I now have a 2nd one. I've been on Carafate, four times a day and Protonix twice daily since May with no relief. I can't keep going like this. My surgeon suggested a reversal, but I don't want to lose this tool. I would prefer to have a revision, but my surgeon is concerned about the ulcers reoccuring.
As I sit in the hospital contemplating what my options are to get rid of these ulcers I came across a few cases where people had their RNY revised to a VSG to help with ulcers. A few questions?
What is it about the RNY that makes NSAIDS so dangerous versus the VSG? I'm curious why they are okay with one, but not the other?
I know VSG patients have their pyloric valve. What exactly does that do?
What is the typical regular diet like for a VSG patient?
As I sit in the hospital contemplating what my options are to get rid of these ulcers I came across a few cases where people had their RNY revised to a VSG to help with ulcers. A few questions?
What is it about the RNY that makes NSAIDS so dangerous versus the VSG? I'm curious why they are okay with one, but not the other?
I know VSG patients have their pyloric valve. What exactly does that do?
What is the typical regular diet like for a VSG patient?
Sorry to hear about all of your troubles :-(
I'm really not sure... but I don't know you a revision to a VSG could work... the bypass part is more extreme than what they do for the sleeve... I don't know if you can go back... I don't totally understand the pyloric valve, but I don't think you can get it back...
What kind of revision has your doctor mentioned???
(((hugs))) I HOPE it will work for you to go to a sleeve....
I'm really not sure... but I don't know you a revision to a VSG could work... the bypass part is more extreme than what they do for the sleeve... I don't know if you can go back... I don't totally understand the pyloric valve, but I don't think you can get it back...
What kind of revision has your doctor mentioned???
(((hugs))) I HOPE it will work for you to go to a sleeve....
The doc would have to take down your bypassed pouch - basically reattach the bottom part to the top part. I know it can be done, but I don't have a clue how! Your pyloric valve is still there at the bottom of the bypassed part of the stomach.
NSAIDs are bad for everyone because they can cause ulcers. It seems to be a bigger issue with RNY - I assume because of the stoma, but not sure.
Partial gastrectomies (which is what a VSG is) have been used for a long time to cure ulcers, basically by removing them and the part of the stomach they occupy. But you're talking about a complicated surgery to get all this done.
NSAIDs are bad for everyone because they can cause ulcers. It seems to be a bigger issue with RNY - I assume because of the stoma, but not sure.
Partial gastrectomies (which is what a VSG is) have been used for a long time to cure ulcers, basically by removing them and the part of the stomach they occupy. But you're talking about a complicated surgery to get all this done.
NSAIDs are a no-no in the RNY due to the anastomoses you have with that surgery type (where they make a connection between tissues).. these connections are much more likely to have ulcers and scarring due to many reasons related directly to the surgery including tension from the roux limb, bile reflux, acid from the stomach pouch.. they are very sensitive connections and when you add NSAIDs, it just significantly ups the chance. Since the VSG makes no "connections" the risk is significantly lessened overall. The risk of ulcers after VSG returns to the normal baseline after healing is complete with the VSG.
If you search on OH for pyloric valve, you will get pages upon pages of what it is, what it does.. why it's important to consider it.. It is responsible for keeping the contents inside the stomach and releasing controlled amounts of chyme into the small intestine after the stomach has started digestion..
You may need to travel outside your area for a true reversal/revision. Completely taking down a RNY is a very involved surgery and not all surgeons do it. You may want to X post this in the revisions forum for better answers from others that had to revise from RNY to something else.
A typical diet is protein forward meals 3-5 a day depending on your plan so you can hit your goals.. many programs give a goal of 800 cals/70+g protein/and low carb- usually at or under 40 grams.
Good luck! My friend went through a similar ordeal- her ulcers ended up landing her in the hospital for a blood transfusion. They did heal eventually- but it took months and was not pleasant! Her doc also alerted her that if they could not control them, a re-operation would be needed.. though I don't think they suggested a revision, just a re-do of the stomas. Her**** at 8mo out. Unfortunately the ulcer risk is lifelong and not uncommon, so she is very aware if she gets that feeling, to get it checked asap. Please take care and hopefully this will heal with time!
If you search on OH for pyloric valve, you will get pages upon pages of what it is, what it does.. why it's important to consider it.. It is responsible for keeping the contents inside the stomach and releasing controlled amounts of chyme into the small intestine after the stomach has started digestion..
You may need to travel outside your area for a true reversal/revision. Completely taking down a RNY is a very involved surgery and not all surgeons do it. You may want to X post this in the revisions forum for better answers from others that had to revise from RNY to something else.
A typical diet is protein forward meals 3-5 a day depending on your plan so you can hit your goals.. many programs give a goal of 800 cals/70+g protein/and low carb- usually at or under 40 grams.
Good luck! My friend went through a similar ordeal- her ulcers ended up landing her in the hospital for a blood transfusion. They did heal eventually- but it took months and was not pleasant! Her doc also alerted her that if they could not control them, a re-operation would be needed.. though I don't think they suggested a revision, just a re-do of the stomas. Her**** at 8mo out. Unfortunately the ulcer risk is lifelong and not uncommon, so she is very aware if she gets that feeling, to get it checked asap. Please take care and hopefully this will heal with time!
I don't know if you can revise from RNY to sleeve......
I have heard of RNY to DS...
In both case it would take one hell of a surgeon that specializes in those things....
frisco
SW 338lbs. GW 175lbs. Goal in 11 months. CW 148lbs. WL 190lbs.
" To eat is a necessity, but to eat intelligently is an art "
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Dr. Paul Cirangle
In simple terms, the segment of intestine that they connect to the pouch isn't designed/evolved to be exposed to the stomach acid like the duodenum is in the normal anatomy; that connection is continually being irritated by exposure to the acid and the NSAIDS only compound the problem. This connection is also subject to minor chronic bleeding which can compound the iron problems brought on by the mineral malabsorption inherent in bypassing the duodenum.
The pyloric valve meters the partially digested food from the stomach into the duodenum and small intestine, allowing the stomach to do its part of the digestion process.
As far as diet goes, we go through a similar post op/weight loss regimen as the other weight loss surgeries, working to maximise loss during the 12-18 month prime weight loss period after surgery. In maintenance mode there is little in the way of functional dietary restriction, but as with the other restrictive procedures like the RNY and bands, weight regain is a distinct possibility if we don't continue to maintain a healthy moderate calorie diet. The duodenal switch, with its long term malabsorption component, is the only mainstream procedure that gives one a leg up on the long term weight maintenance front at the expense of a more intensive supplement regimen than is required for the VSG or bands, but is similar to RNY practice.
As Frisco suggests, revisions are more complicated and challenging procedures and you certainly want one of the top notch surgeons on your side for it. I would suggest seeking out of the the better, more experienced DS surgeons, even for a revision to a VSG, as they are already experienced in doing the more complex procedures and the VSG is fundamentally the top end of a DS. I know my doc has done many revisions along with his normal portfolio of DSs and VSGs as well as other more delicate procedures outside the bariatric field (which is why I travelled to SF to have a straightforward VSG.)
Good luck in resolving your challenges.
The pyloric valve meters the partially digested food from the stomach into the duodenum and small intestine, allowing the stomach to do its part of the digestion process.
As far as diet goes, we go through a similar post op/weight loss regimen as the other weight loss surgeries, working to maximise loss during the 12-18 month prime weight loss period after surgery. In maintenance mode there is little in the way of functional dietary restriction, but as with the other restrictive procedures like the RNY and bands, weight regain is a distinct possibility if we don't continue to maintain a healthy moderate calorie diet. The duodenal switch, with its long term malabsorption component, is the only mainstream procedure that gives one a leg up on the long term weight maintenance front at the expense of a more intensive supplement regimen than is required for the VSG or bands, but is similar to RNY practice.
As Frisco suggests, revisions are more complicated and challenging procedures and you certainly want one of the top notch surgeons on your side for it. I would suggest seeking out of the the better, more experienced DS surgeons, even for a revision to a VSG, as they are already experienced in doing the more complex procedures and the VSG is fundamentally the top end of a DS. I know my doc has done many revisions along with his normal portfolio of DSs and VSGs as well as other more delicate procedures outside the bariatric field (which is why I travelled to SF to have a straightforward VSG.)
Good luck in resolving your challenges.
1st support group/seminar - 8/03 (has it been that long?)
Wife's DS - 5/05 w Dr. Robert Rabkin VSG on 5/9/11 by Dr. John Rabkin
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