I really need you guys

I had open RNY surgery 10 years ago and only lost 80 pounds. My highest weight was 365, my current weight is 304. I still need to lose 125 pounds aprox. I went to see my surgeon and he suggested the endoscopic suturing procedure but I have read so many bad reviews. My pouch has enlarged (I had an Upper GI done). I really want to lose all this weight. I've been reading your comments about the duodenal switch and now I am starting to consider this surgery. I have Federal BCBS and they do cover it. Was your BMI around 42 when you have yours done? A little motivation is needed here. :-)

Gavin, you were smart to do your own research. I have yet to see a positive outcome from any of the endoscopic pouch/stoma tightening procedures. People lose a bit at first because they are on a liquid diet. After that, nothing. And it isn't covered by any insurance that I've ever seen because it's considered experimental (not to mention ineffective!).

For someone with a failed gastric bypass - and note that it's the operation that failed, not you - the only operation with a good chance of significantly better results is the DS. However, revising from gastric bypass to DS is a very challenging and complex operation, as the surgeon has the completely take apart your gastric bypass, restore the original anatomy, and THEN do the whole DS. That's a lot of surgery, and the risks are much higher than for a virgin DS. There are only a few surgeons who do this revision, so you may need to travel, but the effort is worth it to get the right operation with the right surgeon. I don't know where you are so I don't know what surgeon would be closest to you, but some of the best options are Dr. John Rabkin of Pacific Laparoscopy in San Francisco, Dr. Ara Keshishian in Glendale (a suburb of Los Angeles), Dr. Ayoola in Denton, TX, and I think Dr. Simper in Utah does them as well. More info headed your way in a pm.

Larra

Another surgeon who has done many success RNY to DS revision is Hazem Elariny in Fairfax, VA.

I'm right there with Larra on this. My surgery BMI was in the 60's (66 I think) and the DS gave me a new life. I think he traditional DS is still the best way to achieve your goals as it was mine. You can do this you just need the right tools and while there are other tools the DS is the best one available in my book.

Pete

Thanks Pete. You look great. I am so confused because I read that my surgeon do not do the traditional DS, he does a modified version of it.

Run away. Go see one of the docs Larra recommended. RNY to DS is a big OP. You need a heavy hitter not an also ran.

I was afraid of that. Makes you wonder, also, if he has ever done a RNY to DS revision at all - most of the surgeons doing the "version" of the DS don't do these challenging revisions. There is no telling what you will end up with.

I understand the realities of finances, of traveling to have major surgery, etc, but the risks of RNY to DS revision are substantial and you are literally putting your life on the line (albeit with good reason). Put your life in the right surgeon's hands or don't do it at all.

Larra

Make sure you know exactly what your surgeon is going to do. This is especially important for a revision from a gastric bypass. Sometimes surgeons will lump a traditional DS and what is called a SADI DS under the same heading. They are different surgeries. I think the key surgeon lingo to look for is if they describe it as a single anastomosis then it is a SADI.

The traditional DS is still your best bet but I know there are a lot of things that go into that decision. The SADI is what people came up with that they consider to not have as much malabsorption that the traditional DS. so on a range it would be between a gastric bypass and a traditional DS. I think they are just getting to the point whre they might be getting some data for long term weight loss. It's a tool, in my opinion, better than just a VSG or bypass but not as good as a traditional DS. Some surgeons like it because it is not as complex a surgery as the traditional DS so more of them feel comfortable doing it.

That would be an issue for me. Also, verify that they are really going to change your pouch back to a functioning stomach. I've seen some people say that their Docs left the pouch and that is yet another type of surgery that seems to be an issue for some people.