ABC's of Revision II Rny weight regain

    Welcome back to the ABC's of Revision!     Weight regain after a "classic" Rny is NOT unusual. In fact it occurs so frequently that your bariatric surgeon should have discussed this with you at your initial consultation.     Often the first question I am asked by a patient interested in a revision is; "What did I do? How did I break my "tool"?" While these are not unreasonable questions; they are not the correct ones. It is EXTREMELY difficult to "break your tool." Sadly, many surgeons "feel better" if they can blame their patients.I recently saw a young lady who had her Rny performed by another surgeon. She had regained nearly all of the weight she had lost. Her after care left much to be desired. In spite of this, she scheduled an appointment with her bariatric surgeon to learn what could be done. The surgeon entered the exam room. Before this lovely young lady could say a word, her surgeon began scolding her. He rudely declared, "You...Look what you've done to my surgery!" In all my years of practice, I have never heard such a terrible story or a more inappropriate, incorrect  response.     Unless this woman had been flagrantly disregarding her nutritional program (she wasn't), her weight regain was NOT her fault. None of us is perfect. Everyone "cheats" from time to time. I tell all of my patients that they are entitled to a treat. Allow yourself a treat from time to time and when you do treat yourself, make it special. While these treats may lessen your weight loss, if they are limited to special occassions, they will not result in significant weight regain.     OK, then why do Rny patients experience weight regain? There are three factors that contribute to this weight regain.      First, the pouch has a tendency to "stretch" over time. Different pouches stretch differently. Pouches based off of the right side of the stomach (lesser curve) stretch less than pouches based off of the left side of the stomach (gretaer curve).      Second, the stoma (connection between the pouch and small intestine) also has a tendency to enlarge over time.      Third, the body is a miraculous thing. It is constantly adapting and changing. Over time your small intestine adapts to its reduced length by becoming better at absorbing the nutrients that are presented to it. It becomes more efficient.     In summary, through no fault of your own (unless you have been flagrantly abusing yourself and your operation), both the restrictive and malabsorptive components of your by-pass will diminish. That is why a degree of weight regain is the norm; not the exception.      So, what can we do about it? That is the topic for a future posting.                Remember; There are NO failures, only those who have yet to succeed! Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Thank you for posting!  Now, to find a surgeon who will be able to assist us!

Amen girl! Before RNY, never once did I say well what if this malfunctions especially when I have a surgeon that others call "God" which probably should have been the warning sign in and of itself. However, I was nieve and my largest concern was getting the pounds off that I struggled with for 2 decades and controlling my Type II diabetes. I was assured that if I did my part that the "tool" would do it's part and from the beginning it was VERY SLOW to do it's part and with the 60 pounds that I've lost in 3 years I've gained 30-35 back. My eating habits aren't horrible but due to major car accidents in Aug/Sept 07 I can no longer work out in a gym as I did before faithfully 4-5 times a week. I thought that once I got my weight down even 63 pounds that the need to work out 5 times a day wouldn't be as deal breaking as long as I controlled my food which I did then and am now for the most part (im in bed most the day due to my back/neck injury, ephidurals etc)!  RNY failed me the first time so why would I want it revised. I'm only interested in the DS alternative and I'll do whatever I can to make it a realization.

My gastric bypass surgeon moved to another state, so I don't have any back-up. So please post again and tell us who have gained weight and struggle to keep from gaining any more weight what to do.

Please be my doctor!  I am in desperate need of a Revison! Lorna

Lorna, If you would like, feel free to call my office at  480-419-2280. We can discuss your case in the privacy you deserve. Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Dr. Schlesinger, I also had RNY 4 years ago and I am 30 lbs up. I do not get full and can eat anything I want. I really need help. I'm having trouble with my knees again and its getting worse. I feel there is no end. Please can you help me. I live in Sacramento, CA. Do you accept patients that are so far from you or should I find another Dr. The Dr that is close to me has not preformed the surgery yet and I dont  feel safe with being the first or one of the first. How much do you charge for the stomophax if you self pay? Hope to here from you soon.. Martha Castro

Martha, I accept patients from everywhere. We provide follow-up care for all of our patients, whether they live next door, across the country or around the world. If you would like; call my office 480-419-2280. My staff and I would be happy to answer all of your questions in the privacy you deserve. It would be my pleasure to help you. Anyone who would like to ask questions of a personal, private nature is invited to call me at my office. 480-419-2280. Eric Schlesinger, MD, FACS AZ Weight Loss Solutions

Thanks for this post. This is almost verbatim what happened to me. If it weren't for OH I would have never even known revision was possible. Thank you for caring enough to reach out to those of us who have yet to succeed...but are eager to do so!