Revision Questions!!

Hi guys!  Okay, I have a couple of quetions about revisions that I am really hoping that you can help me with!  I have my first revision appt scheduled for 2/7, I know my insurance will cover revisions if certain criteria are met, but I was wondering how the Dr determines if you are somebody that he would do a revision on?  How does he decide what type of revision he will perform for you?  (I haven't updated my profile, so a little background info is that I am almost 6 years post lap transected proximal rny, I got down to 162 and now I am back up to 236 - My high BP and high cholesterol are back).  I can eat a lot, but I don't know if it is because I did something wrong, or if my pouch or stoma are just larger than normal.  What kinds of questions do you go thru at your first revision appt?  The place I am going has the nutritionist, psych, exercise phys, & surgeon all in the same place and you meet with them the same day.  Are all revisions performed open, or can they be done lap?  Does grazing specifically cause the pouch to stretch?  I plan to ask the Dr all of this stuff when I see him on 2/7, but my mind has been racing thru questions for the past week and I still have another week before my appt, so I was hoping to post this and possibly get some answers!  :-)  I appreciate any answers and insight!  Thanks a bunch!!!         

Hi Elizabeth, I think the type of revision recommendation anyone might receive would depend on the type of Bariatric surgeon they ask!  A Lapband surgeon would generally tell every patient to revise to a lapband over their Rny or over their sleeve or to begin with a lapband in the first place.  A DS surgeon might think that's the answer to every issue. After doing almost 3 years of research as to which revision would be right for me personally, I ran into much of the above.  I finally went to a doc who does ALL types of revisions for ALL types of WL surgeries (as well as the first surgeries).  His answer for me personally made more sense and I ended up having my Rny proximal revised to a Distal.  I had considered the DS but because of other medical issues, tons of scarring from past surgeries, etc. the DS was just way too risky for essentially the same type of results offered by a Distal. In general, the research I have found is: Lapband Revision?  Depending on your BMI you may want an RNY Distal if you  have scarring or esophogous damage.  Otherwise you may want the sleeve or the DS which is basically the 2nd step more agggressive from a sleeve. Rny Proximal Revision?  50 pounds from goal weight or less....You may want to consider the stomaphyx or Restore or a lapband over your Rny to provide more restriction but be resigned to have to mess with fills and strict meal planning if you choose lapband. 40 pounds plus and have some other medical issues that would improve from losing all the weight?  Revise from an Rny proximal to Distal which is the least amount of reconstruction for an invasive choice but still provides the maximum malabsorption.  Or, revise from Rny proximal to Deudenol Switch (DS) which is a complete reconstruction but leaves you with better absorption of vitamins.  Sugar and alcohol absorption is still working at about 100% on either of those malabsorptive procedures though so if you're a sweets eater; you'd have to be very disciplined with your choices. My bottom line opinion after research.... 50 pounds or less?  Stomaphyx or lapband 40 pounds plus?  Distal or DS .....other opinions will certainly vary.....but hope that helps a bit! 

I have to agree with Joyce. Dependent on the choice of Physician is the answer you will get...If you chose a Surgeon who focuses on one type of procedure vs. another they often times will try to sale you on the version they are comfortable with.  As Joyce said, there are many Bariatric Surgeons who specialize in many forms of Revision that I believe is the safest way to go. Check this site under the Physicians and you will see they have listed the types of surgery they do most, how many, success rates, revisions kinds and how many, all the info that you should consider before settling on an option or most important a Surgeon. This could be your last chance at reaching goal, I wouldn't trust it with someone who isn't well versed on everything! When you go to a store it's always nice to shop in one that has everything, if you know what I mean? I was considering the Stomphyx, but due to the fact I have more than 50 lbs to lose I've decided to aim towards Distal RNY. And this will be my Third WLS. Yikes!!! Just my 2 Cents worth. Janie

I considered a lap band and at first that is what I was going to do, but after I thought about it some more, I decided to go with Stomaphyx simply because it is the least invasive...no time out of work etc etc.  I actually would like to lose 100lbs, and that is why I'm working hard with my head.  I know when I had my gastric bypass the surgeon actually was surprised at how much I lost...but I remember going swimming every day and that probably helped a lot.  Remember this was in 1982 and even if I didn't keep it off I'm much more motivated now than before.  I have all those years of life experience behind me and I will be working extra hard to prevent the same thing from happening again.  I did the stomaphyx anyway even if people say it's good for 50 lbs or less...with a positive attitude and daily exercise, I truly believe I can reach my goal.  The battle is truly in the head  andI look at Stomaphyx as an aid, not the end all solution.

Smart Choice...Everyone has to do what is good for them. Hope it works for you, It has for others.  Good Luck on your goal!!! We will be thinking and rooting for you. J Rolfson