WLS'rs- Why do you do this to yourselves?

This is has all been very interesting reading.  I am always intrigued by the human desire to make "thier point" and to be right.  This thread was not nearly as mean as some of the threads I have read in the past.  I appreciate the information from all sides, the bickering well that is just silly.

I had RYN almost 5 years ago and have gained a very sudden 20lbs.  At the time I choose to have surgery I had a nagging feeling that the DS may be the route for me but  my bmi was 41 and my surgeon only did RYN. I had been informed that the DS was to drastic for me, I have no idea if that information was correct or not.  It was never an option for me to seek a surgeon outside my hometown, I had alot of anxiety about traveling for a surgey.  Also I was a self pay and had a hard time coming up with the money for the surgery locally.

With all this said I have developed three gastro gastric fistulas although I was completed transceted, I have  moved to a knew State and the surgeon I found here who is willing to take me on as a patient has advised that she can fix the fistulas and that I am almost completely reconnected.  She states that she can go in and re-construct my pouch and will do her best to ensure that she keeps the two stomachs so far apart that they do not develop fistulas again. 

I would like to loose 25 - 30 lbs and I am wondering if I could opt to have the DS with only that amout of weight to loose or would have I have to get back up to 100lbs over weight?  Also my insurance does not cover any weight loss surgery, we are working on getting the repair of the fistuals covered by insurance but still do not have a response.  I already paid cash for my RYN and for subsequent plastics, so I am pretty much outta money.  I will be the first to say I still have restriction but I get hungry very quickly and often make poor choices. 

Can anyone shed any light on my questions about having a DS with a bmi of 28?  Also what does a self pay DS cost? 

Thanks!
Melissa

Hi, Melissa.

I’m pleased you found my long rant interesting. Heartfelt, and a bit of a kick to write, but I wouldn’t want to be the rest of you having to suffer reading all they way through it. **Smirk**

Your case interests me on a umber of levels, non of which I have the slightest expertise in. I have always found gastro-gastric fistulas kind of fascinating and you’ve managed to present with 3, no less. I’m sorry you’re facing this and I can certainly understand this all may be a bit overwhelming for you. These are relatively rare, and I hope you managed to find a surgeon you have every confidence in, preferably with lots of experience resolving this type of complication. These certainly should be fixable with the right, skilled intervention. Don’t know how relevant or helpful these might be for you, but I took a quick look at some more recent abstracts that you can look through and maybe discuss with your treating if you feel the need.

http://www.springerlink.com/content/4638j840671140m1/

http://www.springerlink.com/content/c1uml45643140w28/

http://www.springerlink.com/content/56538463667814mj/

I can certainly understand your alarm at the weight regain and your wanting to aggressively deal with same before it becomes less manageable. You’re to be applauded for that. I think it safe to say with 3 gastro-gastric fistulas this is entirely consistent with some regain and feeling hungry all the time. Successful resolution of those, and you should do just fine shedding those few extra pounds and getting back to your more normal post-op lifestyle and obvious success. Has your surgeon explained this and tried to reassure you in this regard?

Unfortunately, back when you were mistakenly told the DS would have been too aggressive for you, this was the widely promulgated attitude put forth by even some of the well intentioned practitioners. It’s since been learned with certitude that virtually all good candidates who qualify for WLS will do as well or more often better with the DS, assuming they follow the very basic rules needed postoperatively.

No ethical DS revision surgeon would do an RNY to DS conversion on you with your need to lose 25 to 30 lbs. And that’s appropriate, Melissa. It’s by far the most complex revision to perform and carries significant added risks. Yes, revisions like this are done all the time by the very few surgeons possessing the skills to do so and with wonderful successes, but I’m afraid you’re just NOT a candidate. The good news is I think you should have every expectation with the successful resolving of your fistulas, you’re going to do just great. And please keep in mind, but for these complications and the relatively minor weight regain, you already appear to be a success story.

Please keep us posted, and I’d love to hear more about you progress though this.

Rockne   

Thanks Rockne,

I have found a wonderful surgeon in Lenexa KS, I live in KC, MO now and I have done many telephone interviews with the offices of many bariatric centers in and around the surrounding areas, I did not do in person interviews as most would not see me, no one seemed to want to take on another Dr.'s patient, even though I now live over 1200 miles away from my original surgeon.  When I went to the see the surgeon who will take care of me I was very impressed with her, and her staff.  The follow up care offerred by her program is fabulous. 

Based on the EGD done she said that the conclusion she could come up with is that the original surgeon left the two stomachs to close to each other and that some how they came into contact. Or perhaps she said that with time things shifted inside of me....who knows but she agreed with you that one gastro gastric fistula is a rare occurance when completed transceted........and three practically unheard of, go figure!  She plans on cutting away a portion of my old stomach so that the stomachs will be no where in proximity to each other and she will have to make my pouch a  little smaller.  This is the site for the Dr. who will be repairing my fistulas...http://www.iabsobesitysurgery.com/ I am hoping my insurance will cooperate.

Thanks for the info!! 

 

 

 

How kind of you to reply so promptly, Melissa. Took a look at your chosen provider's site and it sounds like you're in good hands, especially, if your surgeon might happen to be the director. Again, I can't bring any expertise to your issue, but from what you've been told to date, I think it sounds pefectly reasonable, given what you've you shared about your presentation. I'm still a bit blown away you're demonstrating three GGF's with a FULL transection. Even with the best diagnostics, only so much can be known until one can see first hand at what's operationally going on under the knife.  I'm still a bit blown away you're presenting with three GGF's with a full transection. No joy on your part, to be sure, but literally and figuratively a wet dream on the part of interested researchers, surgeons and idiot medical geek types like yours truly.  

By the way, I feel the need to add a caveat to my last. Obviously, I don't know your FULL medical/surgical Hx: (history) Even if I had the benefit of holding a Doctorate in Medicine, i or anyone much more qualified would be IMPRUDENT to so quickly dismiss your question about your wondering if the DS might be a option you should seriously consider. Given what you shared, I still feel as I do, but there may be things about your history, I would have no way of knowing which may be relevant factors as of yet that, I, or my professional betters would need to consider.

In short, I owe you an enormous apology for being overly presumptuous and dismissive at your considering a DS revision. Still, i dont want to lend myself to give you false hope. Given what you have shared, and my (limited reasoning stands, but should be given no more import that any other lay person posting here). Please do orgive me.

Thank you again-

Rockne

Hi Rockne,

No need for an apology I think you are probably right, I would not qualify for a DS.  My surgeon said I would be having a revision in as much as the pouch will be re constructed but there will be nothing done to the anatomosis or the bowels, unless of course under the knife they find something very wrong that needs correcting. 

I am lucky the surgeon is the director of the facility I have chosen, and she is such a laid back honest Dr. and does all surgeries.  I truely appreciate any input from any posters on these sites, I am easy going and take what I find useful and chalk the rest up to it may not apply to my cir****tances, I like most know my body and my demons best, lol.  I really could relate with your statement in the original post about the on going diet battle, in retro spect had I been better informed and more secure within myself  I would have ventured out of my comfort zone and looked for a Dr. who would have performed the DS.  But I am greatful for what I have now and look forward to getting this damned fistuals repaired.  

Wish me luck! 

Wish you luck? Why Certainly!

By the way, I'd be surprised if your new insurance didn't cover your documented complications. 

God speed,

Rock

While I know that the original requirements are the same for any of the surgeries, I'm afraid I don't know about revisions. I'm sure someone will see this that does.

As far as having revisions to your RNY or to a DS, revisions are tricky and carry more risk, so you should look for a surgeon that specializes in revisions. There is a good list of surgeons and the revision surgeons (most do all surgeries, not just DS).

Since your bmi is still only 30, it may be an issue for you to get any kind of revision, but the DS mal-absorption can vary depending on how long the common channel is, so you may be able to find a surgeon that is willing to revise if the common channel is made longer for very little mal-absorption. I wish you luck getting help with your RNY.