Revision to a BPD
Lemme see if I can sort this out.
When they did my distals, we were the first step from the original BPD (scopinaro). VBG or distal, that was the choice.
As ppl saw distals maintaining their wt loss, they started asking for them. So, docs who do not believe in malabsorption offered a "distal", which is in the mouth of the speaker, at that point. They meant a Long Limb Proximal. Proximals are measrued from the stmach9 ooooooooo (UGH! i'm not erasing any more priscilla words. read around her, ok?). Proxies are measured from the stomach out, so one would say they are bypassed XXX cm. Usually their op report will give the BP limb and the alimentary (roux) limb. No common channel is given. But it's long.
A regular proximal is the same as the above, but the 2 limbs are a bit shorter, common channel is longer.
The sales pitch is in the tiny details. So, regular proximal, no bowel issues, hardly any vites needed (and they never are if they never run the labs!) OR the LLP, might have stinkies, might needs vites (but not if they never run the labs). Those are proximals.
TRUE distals are measured from the colon back, like BPD or DS. My op report is in inches, so it reads that my CC is 40" (100cm) and my alimentary is 60" (appx 120), so in other words, nearly identical to today's average DS. What is NOT in my op report is the original length, nor the length of my BP limb. Just wasn't done yet. I amuse myself trying to guess.
As far as I know, only the one doc refers to his as ERNY. In that case, he measures from the colon back, but it might be as little as 50, or as much as 150cm, and I think he also does a std 120 or 150 alimentary. No BP limb measured THAT I KNOW OF. But it's still got a pouch, like mine. So, in essence, if done by that doc, I'd ******NY without changing a thing.
If I had a sleeve vs a pouch, I'd be a DS, theoretically.
The malabsorption is all the same, no matter which of these. The same elements are malabsorbed, the same TYPE of supplements are needed. The difference is the DOSING.
Some say revisions lose better than originals, some say revisions lose more slowly. I'd say it could go either way.
Only my staple line was changed when I was revised. My surgery type was not changed at all, was working just fine.
If they are calling it an ERNY, it's like mine or more drastic.
If they call it a distal, well, it might still be a long limb proximal.
And now you know why I never hung my vites plans on my site. *I* need to know just exactly what a person has. Heck, 10% have no clue AT ALL, what they had!
OK, sorry, didn't mean to give you nightmares.
When they did my distals, we were the first step from the original BPD (scopinaro). VBG or distal, that was the choice.
As ppl saw distals maintaining their wt loss, they started asking for them. So, docs who do not believe in malabsorption offered a "distal", which is in the mouth of the speaker, at that point. They meant a Long Limb Proximal. Proximals are measrued from the stmach9 ooooooooo (UGH! i'm not erasing any more priscilla words. read around her, ok?). Proxies are measured from the stomach out, so one would say they are bypassed XXX cm. Usually their op report will give the BP limb and the alimentary (roux) limb. No common channel is given. But it's long.
A regular proximal is the same as the above, but the 2 limbs are a bit shorter, common channel is longer.
The sales pitch is in the tiny details. So, regular proximal, no bowel issues, hardly any vites needed (and they never are if they never run the labs!) OR the LLP, might have stinkies, might needs vites (but not if they never run the labs). Those are proximals.
TRUE distals are measured from the colon back, like BPD or DS. My op report is in inches, so it reads that my CC is 40" (100cm) and my alimentary is 60" (appx 120), so in other words, nearly identical to today's average DS. What is NOT in my op report is the original length, nor the length of my BP limb. Just wasn't done yet. I amuse myself trying to guess.
As far as I know, only the one doc refers to his as ERNY. In that case, he measures from the colon back, but it might be as little as 50, or as much as 150cm, and I think he also does a std 120 or 150 alimentary. No BP limb measured THAT I KNOW OF. But it's still got a pouch, like mine. So, in essence, if done by that doc, I'd ******NY without changing a thing.
If I had a sleeve vs a pouch, I'd be a DS, theoretically.
The malabsorption is all the same, no matter which of these. The same elements are malabsorbed, the same TYPE of supplements are needed. The difference is the DOSING.
Some say revisions lose better than originals, some say revisions lose more slowly. I'd say it could go either way.
Only my staple line was changed when I was revised. My surgery type was not changed at all, was working just fine.
If they are calling it an ERNY, it's like mine or more drastic.
If they call it a distal, well, it might still be a long limb proximal.
And now you know why I never hung my vites plans on my site. *I* need to know just exactly what a person has. Heck, 10% have no clue AT ALL, what they had!
OK, sorry, didn't mean to give you nightmares.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
StacysMom
on 11/2/09 11:51 am
on 11/2/09 11:51 am
"Heck, 10% have no clue AT ALL, what they had!"
10%???? From what I've read here and other boards, I'd say it's more like 90% of post-op patients don't know!
Thanks for the anatomy lesson. Most of those who call themselves ERNY's who have posted here have a 75 cm CC. Then there are the folks who have had a "revision" but don't know specifically had done and aren't losing any "real" weight. Then there are the ones who found out what the doctor did AFTER they came out of surgery, were displeased, but never bothered to get the details up front.
So, your intestines were never revised, the malabsorption was original to your surgery and you didn't have your stomach cut away - you had stapling. An unusual combo, if ever I've heard one!
Your info is mah-velous! And, congratulations on your success!
10%???? From what I've read here and other boards, I'd say it's more like 90% of post-op patients don't know!
Thanks for the anatomy lesson. Most of those who call themselves ERNY's who have posted here have a 75 cm CC. Then there are the folks who have had a "revision" but don't know specifically had done and aren't losing any "real" weight. Then there are the ones who found out what the doctor did AFTER they came out of surgery, were displeased, but never bothered to get the details up front.
So, your intestines were never revised, the malabsorption was original to your surgery and you didn't have your stomach cut away - you had stapling. An unusual combo, if ever I've heard one!
Your info is mah-velous! And, congratulations on your success!
well, 1994, the first transected ones were being done. The lap stapler is sorta like a very big pen? The open stapler is huge, two handed. Think vego-matic. LOL
I have a lap stapler, but couldn't get the salesman to leggo the antique used on me. Dang.
So, our doc did not transected til 1/1/96. And he didn't transected the original SLD's until 95, but restapled them. Today that would be considered unethical.
Yes, mine was RNY, but stapled, not transected, intestines were ERNY/distal/DS right from day 1. Revision merely "cut" along the then defunct staple line and gave me a separate pouch and woulda left a sealed remnant, as done today, BUT I had 30 yrs history of ulcer (thanks to NSAIDS), and so I asked them to remove my remnant. It was a disaster waiting to happen as far as I can see.
So, it makes me even odder, in the scheme of things. The rem is not usually removed in RNY.
What kills me is revision of a bad rny to a bad rny. Which is a waste of anesthesia, IMHO
I have a lap stapler, but couldn't get the salesman to leggo the antique used on me. Dang.
So, our doc did not transected til 1/1/96. And he didn't transected the original SLD's until 95, but restapled them. Today that would be considered unethical.
Yes, mine was RNY, but stapled, not transected, intestines were ERNY/distal/DS right from day 1. Revision merely "cut" along the then defunct staple line and gave me a separate pouch and woulda left a sealed remnant, as done today, BUT I had 30 yrs history of ulcer (thanks to NSAIDS), and so I asked them to remove my remnant. It was a disaster waiting to happen as far as I can see.
So, it makes me even odder, in the scheme of things. The rem is not usually removed in RNY.
What kills me is revision of a bad rny to a bad rny. Which is a waste of anesthesia, IMHO
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
(deactivated member)
on 11/2/09 10:27 pm
on 11/2/09 10:27 pm
Cherie,
What Vitalady said.
I wanted to clear something up here.
IF you have had an RNY AND the remnant stomach has shriveled up from non-use and the pyloric valve is atrophied (which is what happens in RNY's that are far out from their surgery, like you) there is no way to redo the stomach to a true DS. I don't care how experienced a surgeon is, he cannot fix a totally atrophied pyloric valve or make a stomach that has shriveled up to the size of my little finger come to life.
All that being said, I would only contact EXPERIENCED DS surgeons and I would probably get more than one opinion.
The conversions that are being done successfully are generally RNY patients that are not as far out as you and still have some functioning.
I am waiting for an email or letter from Dr. Rabkin explaining this in detail.
HTH,
Michele
What Vitalady said.
I wanted to clear something up here.
IF you have had an RNY AND the remnant stomach has shriveled up from non-use and the pyloric valve is atrophied (which is what happens in RNY's that are far out from their surgery, like you) there is no way to redo the stomach to a true DS. I don't care how experienced a surgeon is, he cannot fix a totally atrophied pyloric valve or make a stomach that has shriveled up to the size of my little finger come to life.
All that being said, I would only contact EXPERIENCED DS surgeons and I would probably get more than one opinion.
The conversions that are being done successfully are generally RNY patients that are not as far out as you and still have some functioning.
I am waiting for an email or letter from Dr. Rabkin explaining this in detail.
HTH,
Michele
Hi Cherie:
I did want to ask you if you are able to travel for surgery? If so there are Dr.'s on the West Coast who are highly versed in the RNY to DS Revision. Although, Dr. Husted has (3) different methods which he personally developed for changing an RNY pouch to a sleeve...Although if the Pyloric Valve is destroyed I'm not sure how he handles that...But when I was researching we spoke at great length and he amazed me with his knowledge and how he made you feel so at ease with the Revision...He doesn't seem scared or leary of doing this procedure whatsoever, he almost seems like he prefers it over anything...Not so with other DS Revision Surgeons most don't like to mess with it...
There is Dr. Rabkin, Dr. Keshishian both are extremely talented and well versed in the procedure as well and both reside in California...
Janie
I did want to ask you if you are able to travel for surgery? If so there are Dr.'s on the West Coast who are highly versed in the RNY to DS Revision. Although, Dr. Husted has (3) different methods which he personally developed for changing an RNY pouch to a sleeve...Although if the Pyloric Valve is destroyed I'm not sure how he handles that...But when I was researching we spoke at great length and he amazed me with his knowledge and how he made you feel so at ease with the Revision...He doesn't seem scared or leary of doing this procedure whatsoever, he almost seems like he prefers it over anything...Not so with other DS Revision Surgeons most don't like to mess with it...
There is Dr. Rabkin, Dr. Keshishian both are extremely talented and well versed in the procedure as well and both reside in California...
Janie
Hi Janie,
To answer your question, I'm not really able to travel to the west for surgery. I live in northern AL and can travel in the southern area mostly. Although at the time Dr. Husted was in CA, I was willing to do whatever I had to in order to get there.
I actually wanted to have the DS with Dr. Husted 8 years ago when he was in Nashville. I had an appointment to go to a seminar then I found out that insurance didn't pay as well for out-of-state doctors, so I went with one in AL - my biggest mistake. I had a good surgeon, but he wasn't a bariatric surgeon and not one to help you decide what was best for you. So, that mistake is costing me today. When I went back to see him in 2006 he put in my records that I was non-compliant. I was starting to look into revision surgery at that time. I researched and found Dr. Husted in CA and started the ball rolling with him. I have spoken with him at great length also and he is amazing with his confidence and knowledge. I felt very relieved and grateful that I had found him again. I knew this was what I needed to have done in the first place.
Then started the insurance battle. His office tried to help me get it, but no luck. I hired a specialist - no luck there either. So that brings me to today. I decided to get a third opinion and all the documentation I could find supporting my claim that I was not non-compliant. (Dr. Husted had written a letter for me saying that it was the surgery, not non-compliance, but it doesn't seem to be enough). Thats when I went to Nashville and saw Dr. Olsen just recently. I was impressed with his bariatric center, staff and hospital and I believe he is a good doctor. I also believe he may can help me to get insurance approval. I'm just so undecided about having the BPD he proposes instead of the DS with Dr. Husted. The hospital where Dr. Husted does surgery is such a small place and I do have concerns that it might not be as well equipped to meet the needs of a large person as compared to the one in Nashville. Also, I have to consider what if there are complications and if that might be a problem for me in KY.
I also tend to have problems getting in touch with Dr. Husted and/or his staff at times, even when emailing him personally. This is a common problem with his patients from what I have read. However, I still can't help but feel that he is the answer. I just have to be able to get insurance approved.
Sorry, this turned out to be so long, but it pretty much sums up my weight loss journey. I appreciate your listening and all your helpful comments and advice. Thanks so much.
To answer your question, I'm not really able to travel to the west for surgery. I live in northern AL and can travel in the southern area mostly. Although at the time Dr. Husted was in CA, I was willing to do whatever I had to in order to get there.
I actually wanted to have the DS with Dr. Husted 8 years ago when he was in Nashville. I had an appointment to go to a seminar then I found out that insurance didn't pay as well for out-of-state doctors, so I went with one in AL - my biggest mistake. I had a good surgeon, but he wasn't a bariatric surgeon and not one to help you decide what was best for you. So, that mistake is costing me today. When I went back to see him in 2006 he put in my records that I was non-compliant. I was starting to look into revision surgery at that time. I researched and found Dr. Husted in CA and started the ball rolling with him. I have spoken with him at great length also and he is amazing with his confidence and knowledge. I felt very relieved and grateful that I had found him again. I knew this was what I needed to have done in the first place.
Then started the insurance battle. His office tried to help me get it, but no luck. I hired a specialist - no luck there either. So that brings me to today. I decided to get a third opinion and all the documentation I could find supporting my claim that I was not non-compliant. (Dr. Husted had written a letter for me saying that it was the surgery, not non-compliance, but it doesn't seem to be enough). Thats when I went to Nashville and saw Dr. Olsen just recently. I was impressed with his bariatric center, staff and hospital and I believe he is a good doctor. I also believe he may can help me to get insurance approval. I'm just so undecided about having the BPD he proposes instead of the DS with Dr. Husted. The hospital where Dr. Husted does surgery is such a small place and I do have concerns that it might not be as well equipped to meet the needs of a large person as compared to the one in Nashville. Also, I have to consider what if there are complications and if that might be a problem for me in KY.
I also tend to have problems getting in touch with Dr. Husted and/or his staff at times, even when emailing him personally. This is a common problem with his patients from what I have read. However, I still can't help but feel that he is the answer. I just have to be able to get insurance approved.
Sorry, this turned out to be so long, but it pretty much sums up my weight loss journey. I appreciate your listening and all your helpful comments and advice. Thanks so much.
Cherie
Hello Cherie:
Don't apologize for a long letter...You need to find out all that you can...and we all who have been there certainly understand...I would love to talk to you in private, please PM me so we can discuss Dr. Husted further...
Thank you and I look forward to talking with you more about your journey...
Janie
Don't apologize for a long letter...You need to find out all that you can...and we all who have been there certainly understand...I would love to talk to you in private, please PM me so we can discuss Dr. Husted further...
Thank you and I look forward to talking with you more about your journey...
Janie
Amy Farrah Fowler
on 11/4/09 10:16 am
on 11/4/09 10:16 am
The BPD is an outdated dinosaur of a procedure, and for darn good reason. I'd run from any surgeon that feels that is in your best interest.
Please find a surgeon that actually knows how to do the main surgeries, and can give you unbiased advice on what is in YOUR best interest, not what is easiest for his unskilled self. Sorry, but it makes me angry to hear an actual surgeon telling someone who needs help, that that ancient, problematic procedure would be in their best interest.
Please find a surgeon that actually knows how to do the main surgeries, and can give you unbiased advice on what is in YOUR best interest, not what is easiest for his unskilled self. Sorry, but it makes me angry to hear an actual surgeon telling someone who needs help, that that ancient, problematic procedure would be in their best interest.
Appledoozie - I just did a ton of research on this exact topic. I was considering going out of the country for revision surgery and found that Marchesini, Baltasar and Ungson all recommend this modified BPD procedure. The DS is definitely the Cadillac of procedures in comparison, but important you understand why - not just think it's no good because someone says so.. I'd be happy to talk to you about it at length, feel free to PM me.
Thanks,
Debbie
Thanks,
Debbie
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